Molecular analysis of hepatitis B virus "a" determinant in asymptomatic and symptomatic Mexican carriers

BACKGROUND: Hepatitis B virus (HBV) is a small DNA-containing virus with 4 genes, C, S, X and P. The S gene codes for the surface antigen (HBsAg), which contains the "a" determinant, the main region for induction of a protective humoral immune response. To compare the genotype and sequence of the "a" determinant between strains isolated from asymptomatic and symptomatic Mexican HBV carriers. RESULTS: 21 asymptomatic (blood donors) and 12 symptomatic (with clinical signs and with >1 year lamivudine treatment) HBV carriers were studied; all patients were positive for the HBsAg in serum. Viral load, genotypes, and subtypes were determined in plasma. A fragment of the S gene including the "a" determinant was PCR amplified and sequenced to determine genotype, subtype and to identify mutations. Mean viral load was 0.7965 × 10(4 )copies/ml in asymptomatic carriers and 2.73 × 10(6 )copies/ml in symptomatic patients. Genotypes H, C, and F were identified in asymptomatic individuals; whereas H was dominant in symptomatic patients. A fragment of 279 bp containing the "a" determinant was amplified from all 33 carriers and sequences aligned with S gene sequences in the GenBank. Mutations identified were Y100N, T126I, Q129H and N146K in the asymptomatic group, and F93I and A128V in the symptomatic group. CONCLUSION: Differences in genotype and in mutations in the "a" determinant were found between strains from asymptomatic and symptomatic HBV Mexican carriers

Consenso Mexicano para el Tratamiento de la Hepatitis C

El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario. Abstract The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary

Evaluación clínica y de la calidad de vida relacionada con la salud en pacientes con dolor torácico no cardiaco

Introducción: El dolor torácico no cardiaco (DTNC) se relaciona principalmente con enfermedades del esófago, y aunque se considera una condición común, en México la información aún es escasa. Objetivo: Evaluar las características clínicas y la calidad de vida relacionada con salud en pacientes con DTNC de presunto origen esofágico. Material y métodos: Se incluyeron en el estudio pacientes con DTNC de presunto origen esofágico, sin tratamiento previo. Se evaluaron los síntomas asociados, se realizó endoscopia alta y monitorización de pH esofágico de 24 h para establecer el diagnóstico de enfermedad por reflujo gastroesofágico, y para descartar trastornos en la motilidad esofágica se llevó a cabo manometría esofágica. Se aplicó el cuestionario de calidad de vida SF-36, y los resultados se compararon con un grupo control de sanos. Resultados: Se incluyeron 33 pacientes, el 61% mujeres, y la edad promedio fue 46.1 (± 11.6) años. Las causas de DTNC fueron: enfermedad por reflujo gastroesofágico 48%, acalasia 34% y dolor torácico funcional 18%. El tiempo promedio de progresión del dolor torácico fue 24 (2-240) meses, con ≤ 3 eventos/semana en el 52%. Los síntomas acompañantes más frecuentes fueron: regurgitaciones (81%), disfagia (72%) y pirosis (66%). Los pacientes con DTNC muestran deterioro en su calidad de vida comparado con el grupo control, independientemente de la etiología del dolor torácico. Los dominios más afectados son la percepción general de salud, problemas emocionales y la subescala de salud mental, sin diferencia estadística significativa (P > 0.05). Conclusiones: En nuestra población, los pacientes con DTNC muestran deterioro en su calidad de vida independientemente de la etiología, frecuencia y síntomas que acompañan al dolor torácico

Anatomical cardiac alterations in liver cirrhosis: An autopsy study

Background. It has been suggested that liver cirrhosis (LC), regardless of etiology, may be associated with anatomical cardiac alterations.Objective. To describe the frequency and type of macroscopical anatomic cardiac abnormalities present in alcoholic and non-alcoholic cirrhotic patients in an autopsy series.Material and methods. The autopsy records performed at our institution during a 12-year period (1990-2002) were reviewed. All cases with final diagnosis of LC were included, their demographic characteristics as well as cirrhosis etiology and macroscopic anatomical cardiac abnormalities (MACA) analyzed. Patients with any known history of heart disease prior to diagnosis of cirrhosis were excluded.Results. A total of 1,176 autopsies were performed, of which 135 cases (11.5%) were patients with LC. Two patients with cardiac cirrhosis were excluded. Chronic alcohol abuse (29%) and chronic hepatitis due to hepatitis C virus (HCV) infection (20%) were the most common causes of cirrhosis. The etiology was not identified in 35% of the cases, even after exhaustive clinical, serological and/or radiological assessment. In the postmortem analysis, 43% of the cases were informed to have MACA (47% in the group of patients with alcoholic cirrhosis and 41% in other types of cirrhosis); this rate increased to 62% in patients with ascites. The most frequent alterations were cardiomegaly and left ventricular hypertrophy (LVH).Conclusion. The results confirm the high frequency of cardiac abnormalities in patients with cirrhosis, regardless of cirrhosis etiology