Viral hepatitis and Treponema pallidum prevalence in persons who underwent premarital blood tests in Argentina.

The objective of this study was to estimate the prevalence of different serological markers of hepatitis A, B and C viruses and Treponema pallidum among the adult population of Argentina. To achieve this, adults who attended health services for premarital exams (which are mandatory and includes screening for syphilis) were recruited. A cross-sectional study was designed with a cluster sampling strategy. Couples who attended selected health services for premarital screening between 2013 and 2014 in Buenos Aires, Cordoba, Mendoza and Santa Fe provinces were included. A total of 3833 individuals were recruited. Anti-HAV prevalence was 63.9%, anti-HCV 0.3%, anti-HBc (without HBsAg) 1.9%, HBsAg 0.3%, and T pallidum 0.8%. Anti-HAV was higher among older participants, foreigners and those from the lower strata. HBV increased with age and was higher among foreigners and those with lower formal educational level. Anti-HCV frequency increased with age. Premarital screening of viral hepatitis could constitute an instance of diagnosis, vaccination and inclusion in care of those in need. Results from this study will allow the national hepatitis programs to design public policies in order to diminish the impact of these infections on the population.

[Transient elastography: noninvasive assessment of liver fibrosis. Report of 1,000 cases in Argentina]. / Elastometría transicional: medición no invasiva de la fibrosis hepática. Reporte de 1.000 casos en Argentina.

BACKGROUND: Transient elastography (TE) is a noninvasive method for assessment of hepatic fibrosis. OBJECTIVE: To present the first case series evaluated in Latin America, in an University Hospital in Buenos Aires, during an 18-month period. METHODS: Data was collected between August 2009 and January 2011. A database was built considering clinical, biochemical and histology data. The exams were performed with a medium probe. An exam was considered valid when success rate was higher than 60% and interquartile range lower than 30%. RESULTS: 1,023 studies were performed. Patients were referred by in-hospital (53%) and out-hospital physicians (47%). Etiologies were: HCV 409 (40%), NAFLD 213 (20.8%), HBV 110 (10.7%), cholestasis 93 (9.1%), other 198 (19.4%). Significant fibrosis (F > 2) was detected in 32.4% HCV, 32.1% HBV 31.5% NASH, and 33.4% cholestasis. Exams were not technically achievable in 29 patients (2.8%), of whom 96.5% had body mass index (BMI) higher than 28 kg/m2. However 117 of 145 patients with BMI higher than 28 kg/m2 had a successful exam. In 332 patients simultaneously biopsies (less than 6 months) were obtained, with overall coincidence of 77%. In 21 HCV transplanted patients coincidence was 90.4%. CONCLUSION: Similar results to those in the literature were obtained, with excellent biopsy correlation in HCV transplanted patients. The increasing use of TE in the assessment and monitoring of chronic liver diseases has become evident by both increasing number of exams and decreasing number of diffuse liver biopsies.

Medición no invasiva de la fibrosis hepática: elastografía. Experiencia en 1200 estudios / Noninvasive measurement of hepatic fibrosis: elastography. Experience in 1200 tets

Objetivo. Presentar nuestra experiencia sobre 1200 elastografías transicionales hepáticas y correlacionar los resultados con las distintas etiologías y la biopsia hepática. Materiales y Métodos. Se realizó un estudio retrospectivo con los pacientes que se efectuaron elastografía transicional (ET) en el período 08/2009 - 04/2011, registrándose las variables clínicas e histológicas. Se calculó el índice de masa corporal (IMC) en todos los casos. Consideramos válidos los estudios con una tasa de éxito (SR) > 60% y una variación intercuartil (IQR) < 30%. Se evaluó el grado de acuerdo entre la ET y la histología, y se comparó el número y muestreo de las biopsias con un período previo. Resultados. Se evaluaron 1200 estudios. Etiologías: infección por virus de hepatitis C (HCV) 40%, enfermedad hepática por grasa no asociada a alcohol (NAFLD) 20,8%, infección por virus de hepatitis B (HBV) 10,7%, colestasis 9,1% y otras 19,4%. Se detectó fibrosis significativa (F > 2) en el 32,3% de HCV, 32,1% de HBV, 31,5% de NAFLD y 33,4% de colestasis. En 154 de los 1200 pacientes se constató un IMC > 28 kg/m2, sin embargo en 121 de ellos el estudio fue exitoso. En 34 pacientes no obtuvimos resultados válidos: en 33 por un IMC > 28 kg/m2 más cinturón graso tóracoabdominal > 2,5 cm. Tuvieron biopsia simultánea (diferencia < 6 meses) 388 pacientes con un acuerdo del 77%. Constatamos un descenso del 30% en la realización de biopsias hepáticas difusas en pacientes con HCV, comparando el período 01/2008 - 8/2009 con el comprendido entre 09/2009 - 04/2011. En 21 pacientes trasplantados con HCV el grado de acuerdo fue del 90,4%, y del 100% con medición del gradiente y ET. Conclusión. Obtuvimos resultados similares a la literatura mundial. Observamos excelente correlación con la biopsia en pacientes con HCV trasplantados. La principal limitación fue el cinturón graso tóraco-abdominal > 2,5 cm. El número creciente de estudios y descenso de las biopsias hepáticas difusas reflejan su...

Medición no invasiva de la fibrosis hepática: elastografía. Experiencia en 1200 estudios / Noninvasive measurement of hepatic fibrosis: elastography. Experience in 1200 tests

Objetivo. Presentar nuestra experiencia sobre 1200 elastografías transicionales hepáticas y correlacionar los resultados con las distintas etiologías y la biopsia hepática. Materiales y Métodos. Se realizó un estudio retrospectivo con los pacientes que se efectuaron elastografía transicional (ET) en el período 08/2009 - 04/2011, registrándose las variables clínicas e histológicas. Se calculó el índice de masa corporal (IMC) en todos los casos. Consideramos válidos los estudios con una tasa de éxito (SR) > 60% y una variación intercuartil (IQR) 2) en el 32,3% de HCV, 32,1% de HBV, 31,5% de NAFLD y 33,4% de colestasis. En 154 de los 1200 pacientes se constató un IMC > 28 kg/m², sin embargo en 121 de ellos el estudio fue exitoso. En 34 pacientes no obtuvimos resultados válidos: en 33 por un IMC > 28 kg/m² más cinturón graso tóracoabdominal > 2,5 cm. Tuvieron biopsia simultánea (diferencia 2,5 cm. El número creciente de estudios y descenso de las biopsias hepáticas difusas reflejan su progresiva incorporación en el algoritmo diagnóstico de hepatopatías crónicas.(AU)

Purpose. To report our experience from 1200 transient elastographies and correlate results with different etiologies and liver biopsy. Materials and Methods. We performed a retrospective study of patients undergoing transient elastography (TE) between 08/2009 and 04/2011. A database was completed considering clinical and histological data. Body mass index (BMI) was calculated in all cases. Tests were considered valid if the success rate was > 60% and the interquartile range (IQR) was 2) was detected in 32.3% of HCV, 32.1% of HBV, 31.5% of NAFLD and 33.4% of cholestasis. In 154 of 1200 patients we found BMI > 28 kg/m², however, the test was valid in 121 patients. In 34 patients, no valid results could be achieved because of BMI > 28 kg/m² and fatty thoracic belt > 2.5 cm in 33 of them. Simultaneous biopsy (within 6 months) was performed in 388 patients, with an overall agreement of 77%. We found a 30% decrease in diffuse liver biopsies in HCV patients when comparing the period 01/2008 - 08/2009 with 09/2009 - 04/2011. In HCV patients who underwent liver transplantation (n=21) agreement was 90.4%; 100% with gradient measurement and TE. Conclusion. We obtained similar results to those reported in the literature. We found an excellent correlation with biopsy in HCV transplanted patients. The main limitation was the fatty thoracic belt > 2.5 cm. The growing number of TE studies and decreased diffuse liver biopsies reflect the progressive incorporation of elastography into the diagnostic algorithm of chronic liver diseases.(AU)

Elastografía transicional (fibroscan): nuevo método para la evaluación no invasiva de la fibrosis hepática / Transitional elastography (fibroscan): new method for noninvasive assessment of liver fibrosis

Los grandes avances realizados en la biomedicina y biotecnología durante la última década han puesto en escenamétodos rápidos e incruentos que desafían el ôgold standardõ de los procedimientos diagnósticos y terapéuticos invasivos. Algunos ejemplos de esto incluyen estudioscomo la angiografía coronaria mediante tomografía computada (TC), la resonancia magnética cardíaca (RMcardíaca) para la evaluación no invasiva de las miocardiopatías, y la colonoscopia virtual mediante TC.De esta forma, varios grupos de investigación han desarrolladométodos de imágenes para evaluar la elasticidad de los tejidos de manera no invasiva, teniendo en cuenta las propiedades mecánicas de estos. La elastografía transicional (TE) fue el primer método utilizado, hace unosocho años, en pacientes con enfermedad hepática crónica.Muchos estudios han evaluado la eficacia de este método para el diagnóstico de la fibrosis hepática y la cirrosis, y el Fibroscan es ahora una herramienta utilizada por hepatólogos de todo el mundo, teniendo en cuenta que el pronóstico y tratamiento de las enfermedades crónicas del hígado dependen en gran medida de la extensión y progresión de la fibrosis.

[Diagnosis, treatment and evolution of the Budd-Chiari syndrome: a single center experience]. / Diagnóstico, tratamiento y evolución del síndrome de Budd-Chiari: experiencia de un centro.

INTRODUCTION: The Budd-Chiari syndrome is a low-prevalence disease due to an hepatic outflow obstruction. It is associated with procoagulant status and liver transplantation is one of the therapeutic tools for the treatment. OBJECTIVE: To evaluate the etiology, presenting form, treatment and evolution of patients with Budd-Chiari syndrome. PATIENTS AND METHOD: Ten consecutive adult patients with Budd-Chiari syndrome evaluated from January 1998 to June 2009 were prospectively included. The median follow up was 32.4 months (4-108 months). RESULTS: The mean age of patients was 34 +/- 12 years old. Presentation was acute in 1 patient, chronic in 2 and subacute in 7. The mean time from consultation to diagnosis was 4 +/- 2 days. Clinical manifestations were splenomegaly in 8 patients, malnutrition in 7, ascites in 6 and encephalopathy in 4. Diagnosis was confirmed by angiography in all cases. Initial prothrombin concentration was < 30% in 3 patients, 31% to 50% in 5, and > 50% in 2; hematocrit was > 45% in 5 patients and platelet count was > 400.000/mm3 in 6. MELD distribution at diagnosis was < or = 13 points in 4 patients, between 14 and 16 points in 5 and > or = 17 points in 1. Policytemia vera was detected in 7 patients, essential thrombocythemia in 1 and positive lupus inhibitor in 4. Nine patients were anticoagulated after diagnosis. Angioplasthy was required in 1 patient and 6 were treated with a transjugular intrahepatic portosystemic shunt. Death occurred in 1 patient due to gastrointestinal bleeding. Two patients were transplanted. CONCLUSION: In our experience all patients with Budd-Chiari syndrome have a procoagulant status. The transjugular intrahepatic portosystemic shunt is effective in treating this syndrome and liver transplantation should be reserved for patients who are refractory to other therapeutics.

[Twenty-four weeks therapy with peginterferon alfa-2a could be similar to 48 weeks therapy in patients with HBeAg positive chronic hepatitis B and good predictors of response: results of a pilot study]. / El tratamiento de 24 semanas con PEG interferón alfa 2a podría ser similar al de 48 semanas en pacientes con hepatitis B crónica HBeAg positivo y buenos predictores de respuesta: resultados de un estudio piloto.

BACKGROUND: 48 week therapy with peginterferon alfa-2a has demonstrated to be effective in about one third of patients with HBeAg-positive chronic hepatitis B. Although the recommended treatment duration for these patients is 48 weeks, there are no enough data supporting 48 weeks of therapy over 24 weeks of therapy. Treatment might be shortened particularly in patients with good predictors of response. AIM: To compare the efficacy of 48 weeks vs 24 weeks of therapy with peginterferon alfa-2a, in patients with chronic hepatitis B who had good predictors of response. PATIENTS AND METHODS: Nineteen patients with high baseline ALT levels (> 3 ULN) and low viral load (HBV DNA < 10(9) copies/ml) were treated with peginterferon alfa-2a 180 mcg/week, during 48 weeks. Virological, biochemical and serological responses were compared with those obtained in 16 patients with similar baseline characteristics treated with peginterferon alfa-2a for 24 weeks. All patients had a followup period of 24 weeks after the end of therapy. RESULTS: At end of follow-up, HBeAg seroconversion was observed in 7/19 (36.8%) of patients treated for 48 weeks and in 6/16 (37.5%) of patients treated for 24 weeks (NS). Patients treated for 48 weeks evidenced a significantly higher decrease in HBV DNA at the end of therapy than patients treated for 24 weeks (-4.8 logs vs -3.6 logs respectively, p < 0.05). However, the percentage of patients with HBV DNA < 100.000 copies/ml was similar in both groups at the end of follow up (42.1% vs 43.7%, NS). No significant differences between both groups were observed regarding ALT normalization, HBsAg loss or seroconversion. The incidence of aderse events was similar in both groups. CONCLUSION: The results from this pilot study indicate that 24 weeks of therapy with peginterferon alfa-2a could be similar to 48 weeks therapy in patients with HBeAg positive chronic hepatitis B who have good predictors of response.

Hepatitis virales / Viral hepatitis

Los virus que con mayor frecuencia producen hepatitis son los hepatotropos: virus de la hepatitisA (VHA), B (VHB), C (VHC), D (VHD), E (VHE). Otros virus como el citomegalovirus,Epstein Barr, herpes virus y varicela-zóster también pueden comprometer al hígado en forma aguda acompañando a la enfermedad sistémica producida por los mismos Los hepatotropos tienen distintas formas de transmisión y evolución clínica. Los virus de la hepatitis A y de la hepatitis E se transmiten por vía fecal-oral mientras que los de las hepatitis B y C se transmiten principalmente por vía parenteral. El modo de transmisión sexual es el más frecuente para virus B en zonas de baja endemia como la Argentina, mientras que las prácticas o derivados parenterales son el modo de transmisión más frecuente para el virus de la hepatitis C. Por su parte, el virus de la hepatitis D es un virus defectivo, ya que para resultar infectivo la persona debe portar el virus de la hepatitis B. El pronóstico y la gravedad de la hepatitis viral dependen de muchos factores, incluyendo la edad de la persona, el tipo de virus, el tipo de respuesta inmunológica que genera el huésped para controlar el virus, y la existencia de otros trastornos de salud que puedan influir en la evolución de la enfermedad hepática o su tratamiento.En la Argentina, la hepatitis A ha ocasionado brotes epidémicos cada tres a cuatro años hasta el año 2005, momento en el que se incorporó la vacuna al año de edad en el Calendario Nacional de Vacunación (Resolución Ministerial Nº653/05). Hasta entonces la hepatitis A era la causa principal de fallo hepático fulminante en la Argentina en niños menores de 10 años, llegando en algunos casos a la necesidad del trasplante hepático, con mayor frecuencia en niños de 5 años de edad. El último transplante realizado en la Argentina por FHF por VHA fue en el año 2006.