Efficacy and Safety of Therapy With Simeprevir and Sofosbuvir in Liver Transplant Recipients Infected by Hepatitis C Virus Genotype 4: Cohort Spanish Society of Liver Transplantation Cohort.

BACKGROUND: Patients with hepatitis C virus (HCV) genotype 4 infection are poorly represented in clinical trials of 2nd-generation direct-acting antivirals (DAAs), and more data are needed to help guide treatment decisions. We still have even fewer data concerning liver transplant patients. Simeprevir (SIM) and sofosbuvir (SOF) combination is useful to treat this genotype. The aim of this study was to know the efficacy and safety of the combination SIM + SOF ± ribavirin (RBV) in a group of liver transplant patients with HCV genotype 4 infection in Spain in real life. METHODS: This was a multicenter retrospective study, including 28 HCV genotype 4 patients from 11 liver transplant centers who were treated with SIM + SOF ± RBV. We included in the analysis demographic, clinical, and virologic data and details of serious adverse events (SAEs), including mortality rate 6 months after treatment. RESULTS: All patients were male, mean age 52 ± 9.43 years, and 50% were IL28B CT and 37.5% TT; 46.42% of them were pretreated and 76.9 were null responders. Fibrosis stage 4 was found in 38.7% of patients; in 67.8% of those cases the diagnosis of fibrosis was made with the use of Fibroscan, in 21.4% by liver biopsy. The average Fibroscan was 13.86 KPa. The average Model for End-Stage Liver Disease (MELD) score of cirrhotic patients was 10.9 and the Child-Pugh score was A in 70%, B in 20%, and C in 10%. We included RBV in 75% of patients, and treatment duration was 12 weeks in all patients. The sustained virologic response at week 12 (SVR12) was 95.23%. There were no discontinuations due to SAEs, but the mortality rate at 6 months after treatment was 7.14%. All deceased patients were cirrhotic, Child C, and with an average MELD score of 20. CONCLUSIONS: The combination SIM + SOF ± RBV to treat HCV genotype 4 in liver transplant patients is an option with high rates of SVR12 and very safe, similarly to genotype 1. There was no treatment-related mortality, but when it is administered in advanced stages of fibrosis it may not be enough to prevent mortality associated with cirrhotic hepatitis C recurrence after transplantation.

Cytologic brushing as a simple and rapid method in the diagnosis of Helicobacter pylori infection.

OBJECTIVE: To assess broad antral cytologic brushing as an alternative approach for the diagnosis of Helicobacter pylori gastric colonization as compared to histology. STUDY DESIGN: Multiple gastric biopsies were taken from the antrum of 117 patients with an endoscopic appearance compatible with antral gastritis. Broad antral brushing was also obtained, and smears were stained with Papanicolaou stain. RESULTS: Chronic gastritis was diagnosed histopathologically in 93 patients. H pylori was identified in 115 cytologic smears. Cytologic smears from 97 patients with H pylori on biopsy specimens contained the organisms. Only two poor-quality cytologic smears with no H pylori had the organisms on biopsy specimens. In 18 patients, H pylori was identified on the cytologic smears and not on the biopsy specimens. CONCLUSION: Broad antral cytologic brushing is a useful alternative approach to histology for the diagnosis of H pylori gastric infection.

[Giant gastric and duodenal trichobezoar. Presentation of a case and review of the literature]. / Tricobezoar gigante gástrico y duodenal. Presentación de un caso y revisión de la literatura.

The case of a giant trichobezoar of 2.500 g in weight observed in a 26-year old woman with paranoid disorder which led her to trichophagia is presented. A review of the literature was carried out with the different etiopathogenic theories and proposed treatments being discussed.

Retinopathy as a systemic complication of acute pancreatitis.

We describe three cases of sudden severe retinopathy in patients with acute pancreatitis. The relative times of the organ manifestations and comparisons with other published cases strongly suggest that pancreatitis was the cause of the retinal changes. This systemic complication is unknown to most physicians, but approximately 35 cases have been published. The pathogenesis is not well known. We briefly discuss the significance of this complication and several possible pathogenetic mechanisms.

[The brown bowel syndrome. A case report]. / Síndrome de intestino marrón. Descripción de un caso.

We present a patient with celiac sprue in whom intestinal lymphoma was suspected. At laparotomy, a brown discolouration of small bowel loops was observed, and a transmural biopsy confirmed a brown bowel syndrome, an entity that is found in long-standing malabsorption conditions. We believe that the intestinal disorder caused by deposition of lipofuscin in the bowel non-striated muscle may cause radiologic changes similar to those seen in intestinal lymphoma.