Pre S2: a marker for chronicity and/or liver damage in hepatitis B infection? Pre S2 marcador de cronicidad y/o de daño hepatico de la infeccion con el virus de la hepatitis B?

Pre S2 was investigated using a monoclonal ELISA in 100 samples from 52 patients with different forms of infection with Hepatitis B virus. Pre S2 was present in 18 of 19 patients with acute hepatitis. Its persistence for more than 150 days after beginning of symptoms was associated to a chronic hepatitis state. It was also present in 11 patients with chronic hepatitis or cirrhosis, 15 asymptomatic Hepatitis B carriers and 3 of 4 patients with hepatic carcinoma. Pre S2 became negative in only 1 of 3 patients treated with interferon who had a positive response according to HBe and HBs antigens. Thus, Pre S2 is present in patients with evidence of viral replication. It is more a marker of persistent Hepatitis B infection than of chronic liver damage

Paracetamol overdose: a new form of suicide in Chile and the value of N-acetylcysteine administration

Overdose of paracetamol is associated to varying degrees of hepatic necrosis and may lead to severe hepatic failure. In this paper, we report 2 patients with paracetamol overdose for suicidal purposes who were successfully treated using the antidote N-acetyl-cysteine orally. A brief analysis of the literature follows

Primary biliary cirrhosis. The experience in 33 consecutive cases Cirrosis biliar primaria. Experiencia en 33 casos consecutivos.

Primary biliary cirrhosis is a chronic, progressive and often fatal cholestatic liver disease. We report clinical characteristics and follow up in 33 consecutive patients studied at a single university hospital during the last 10 years. 31 were female (94%) and the mean age was 51 +/- 2 years. At diagnosis, itching was present in 26 cases (78%). Association with autoimmune mediated diseases was frequent. Liver function tests showed marked cholestasis (alkaline phosphatase levels of 439 +/- 58 IU/l, range 90-1335). High antimitochondrial antibody titers and elevation of IgM levels were shown in all cases. According to liver biopsy findings, the diagnosis of primary biliary cirrhosis was an early one during the prospective phase of the study and was made in 8 +/- 1.4% of liver biopsies performed during this period. After a follow up of 27 +/- 5 months, 10 patients have died (30%). Our experience suggests that primary biliary cirrhosis is not an uncommon cause of chronic liver diseases i

Hepatitis B virus vaccine: early and late response in Chileans with high risk of infection Vacuna contra el virus de la hepatitis B: respuesta precoz y tardía en Chilenos con alto riesgo de infección.

BACKGROUND: Hepatitis B vaccine has demonstrated to be very effective and safe preventing hepatitis B virus infection. Long term protection induced by hepatitis B vaccination depends on the initial immune response and the declining rate of anti-HBs titers. AIM. To investigate early and late response to hepatitis B vaccine in a sample of high risk Chilean population. MATERIAL AND METHODS: Thirty one subjects (20 relatives of hepatitis B chronic carriers, 10 health service workers and one HIV seropositive) were vaccinated with a plasma derivated hepatitis B vaccine. Early and late response were estimated by anti-HBs titers. RESULTS: Twenty eight subjects (90%) produced protective titers of anti-HBs after 2 months from the third dose of vaccine (early response), and they remained at these levels in 75% of vaccinated individuals after three years (late response). All the subjects without protective titers after the three year follow up had produced anti-HBs levels lower than 300 UI at th

Quimioembolización selectiva con adriamicina-Urografin-Lipiodol, en el tratamiento del hepatocarcinoma

Various methods of regional chemotherapy have been used in patients with non resectable heptic carcinoma. We report our preliminary experience with embolization using adriamycin-urographin-lipiodol in 2 patients with this cancer in whom a considerable reduction of tumoral mass was observed. The pertinent literature is briefly commented

Interferones lambdas (ifnsλ) en infección con virus hepatitis C

The current standard therapy for patients chronically infected with hepatitis C virus (HCV) is the administration of pegylated interferon-α (PEG-IFN) plus ribavirin (RBV), eliminating the virus in only about half of patients infected with the genotype most common in Chile and the world (genotype 1), being higher for genotypes 2 and 3. Genotyping of the HCV is a strong predictor of treatment response, and it defines the treatment duration (48 weeks for genotype 1 and 24 weeks for genotypes 2 and 3). Genome studies revealed the association of polymorphisms (SNPs) close to IL28B gene with increased spontaneous and treatment-inducing clearance for HCV, which are now evaluated as a strong predictor of treatment response. These SNPs are close to genes coding for type III IFNs family, known as IFNs lambda (IFNsλ), composed by IFNλ1 (IL29), IFNλ2 (IL28A) and IFNλ3 (IL28B). It has been shown that these cytokines are highly involved in antiviral immune responses, including HCV, playing IFNλ1 a central role. Today, there is an ongoing study where pegylated IFNα1 was administrated in chronic HCV patients as alternative to IFNλ therapy, seeking for a more specific response to infected hepatocytes and with fewer adverse effects

Variabilidad genética del virus hepatitis B y su significado clínico

The Hepatitis B virus (HBV) is the prototype member of the Hepadnaviridae family, which can cause acute or chronic hepatic illness. The virus has a partially double-stranded DNA genome of 3.2 kb. Molecular variations and change in the genome over time have resulted in the emergence of at least eight genotypes and multiple subgenotypes. The distribution of HBV genotypes varies widely across geographic regions, been the genotype F the most prevalent in Chile. In recent years, substantial progress has been made toward understanding the epidemiology and virologic significance of HBV variants. Actually, accumulating evidence suggests that hepatitis B genotypes and subgenotypes can influence the severity, course and likelihood of complications, and response to treatment of HBV infection and possibly vaccination against the viru

Osteopenia in primary biliary cirrhosis. Study in 20 patients Osteopenia en cirrosis biliar primaria. Estudio en 20 pacientes.

We studied 20 female patients, aged 51 +/- 13.6 years old, with the diagnosis of Primary Biliary Cirrhosis (PBC) to assess osteopenia, main involved sites and its relation to menopause, some parameters of mineral metabolism and the degree of histological liver involvement. The diagnosis of PBC was based in histological, clinical and laboratory features. Bone densitometry was measured with a dual-photon densitometer and compared with values of a normal female population from the laboratory. When compared to controls, studied patients had a significantly lower lumbar spine bone density and total bone mineral content and a non significantly lower density in femoral neck and total body. Serum calcium, phosphorus, magnesium, PTH and urinary calcium/creatinine ratio were within normal limits. Lumbar spine density was not significantly lower in patients with more severe liver histological involvement and in postmenopausal women. No correlation was found between the duration of postmenopausa

Pre S1 antigen in different forms of hepatitis B virus infection Antígeno Pre S1 en diferentes formas de infección con el virus de la hepatitis B.

Pre S1 antigen was measured using an ELISA technique in patients with different forms of hepatitis B virus infection. It was detected in 10 of 19 patients with acute hepatitis B (53%), 12 of 15 chronic hepatitis B virus carriers (80%), 9 of 11 patients with chronic hepatitis B (82%) and 3 of 4 patients with hepatoma and positive markers of hepatitis B virus infection. Pre S1 remained positive beyond 150 days in two patients with acute hepatitis that evolved to chronicity. Among subjects with chronic hepatitis B that received interferon, pre S1 antigen negativized only in the patient that had a complete response. Pre S1 detection is an index of hepatitis B virus replication and its persistence determines chronicity. Its negativization after antiviral therapy should have a predictive value