[Virology, diagnostic tests, epidemiology and transmission mechanisms of hepatitis C virus infection]. / Virología, pruebas diagnósticas, epidemiología y mecanismos de transmisión del VHC.

The hepatitis C virus is a human virus, classified within a third type (Hepacivirus) of the Flaviviridae family. It is a spherical virus, of approximately 50 nm in diameter, with a glycoprotein covering that contains lipids, and its genome is a simple chain RNA molecule. It is characterised by a high degree of genomic heterogeneity, whose evolutionary consequence in the long term is the appearance of genetically different viral groups, genotypes and quasispecies. There are different diagnostic techniques for detecting hepatitis C virus infection. Serological assays: the detection of specific IgG against HCV by means of enzyme immunoassays is the most practical method for diagnosing infection by this virus. Supplementary immunblot tests are employed to confirm the specificity of the results of the EIA test. Molecular assays: qualitative and quantitative techniques have been developed for detecting RNA-HCV, based on the direct detection of the virions. The pathogeny of hepatitis C is not well understood. Its world prevalence is estimated at some 3%, which is why routine screening for its detection is not recommended. HCV transmission basically occurs through percutaneous exposure to infected blood, with higher rates observed in imprisoned persons, vagabonds, intravenous drug addicts, haemophiliacs and patients on haemodialysis. Although it can be transmitted sexually, it seems that this path is not very efficient, with a greater prevalence observed in persons with multiple sexual partners. Vertical transmission is estimated at some 2%, reaching 20% in cases of maternal coinfection with HIV.

Is carbohydrates-deficient transferrin the best test of the alcoholic etiology in acute pancreatitis?

AIM: To demonstrate if carbohydrates deficient transferrin (CDT) is the best marker to detect an excessive alcohol consumption as a cause of acute pancreatitis. MATERIAL AND METHODS: Prospective study of 60 patients consecutively admitted in our hospital. Acute pancreatitis were classified according to their different etiologies, alcoholic (11), probably alcoholic (4), biliary (25) and others (20). In all cases, we have compared CDT with classical quemical markers of alcohol abuse such as mean corpuscular volumen (MCV), gamma-glutamyltransferase (GGT) and aspartateaminotransferase (AST). Statistic correlations were done between the quantity of alcohol consumed and CDT, GGT, AST and MCV variables. RESULTS: Correlation between CDT and MCV with the excessive alcohol consumption was statistically significant. The acute pancreatitis caused by alcohol and the suspicious alcoholic group had a average CDT higher than the rest of the groups (p < 0.05). Taking a cut point with a CDT value of 20, the diagnosis capacity of the test to detect the alcoholic etiology was 82 and 92% of specificity. Taking a cut point with a MCV value higher than 95, sensibility was 67% and specificity was 82%. CONCLUSION: In our experience, the most efficient marker of the alcoholic etiology in acute pancreatitis was CDT.

¿La transferrina deficiente en carbohidratos es el mejor test de la etiología alcohólica en la pancreatitis aguda? / Is carbohydrates-deficient transferrin the best test of the alcoholic etiology in acute pancreatitis?

Objetivo: demostrar si el test de la transferrina deficiente en carbohidratos (CDT) es la mejor prueba para detectar la ingesta excesiva de alcohol como causa de la pancreatitis aguda. Material y métodos: estudio prospectivo de 60 pacientes con pancreatitis aguda ingresados consecutivamente en nuestro hospital. Las pancreatitis agudas se clasificaron según las diferentes etiologías en alcohólicas (11), probablemente alcohólicas (4), biliares (25), y otras (20). Comparamos en todos los casos la CDT con los marcadores bioquímicos clásicos de la toma excesiva de alcohol como son el volumen corpuscular medio (VCM), gammaglutamil-transpeptidasa (GGT) y aspartato-aminotransferasa (AST).Se realizaron las correlaciones estadísticas entre la cantidad de alcohol consumida y las variables CDT, GGT, AST y VCM.Resultados: la correlación entre la CDT y el VCM con la toma excesiva de alcohol fue estadísticamente significativa.Las pancreatitis agudas por el alcohol y el grupo de sospecha alcohólica tuvieron una CDT media mayor que los demás grupos (p<0,05). Tomando como punto de corte un valor de CDT de 20, la capacidad diagnóstica de la prueba para detectar la etiología alcohólica fue del 82 por ciento y 92 por ciento de especificidad. Tomando como punto de corte un VCM mayor de 95 la sensibilidad fue de un 67 por ciento y la especificidad de un 82 por ciento. Conclusión: en nuestra experiencia, el marcador más eficiente de la etiología alcohólica en las pancreatitis agudas fue la CDT (AU)