La negatività delle IgM per HAV esclude la 5

Un caso interessante di qualcosa che in generale deve essere studiato. Dal modo in cui si presenta, è chiaramente un'epatite acuta, quindi la 1 è esclusa. La negatività delle IgM per HAV esclude la 5 e la negatività dell'HBs Ag esclude la 4 (per avere il virus delta è necessario l'antigene di superficie B). Quando si hanno IgM anti-HBc, si parla di epatite B acuta (3), poiché esiste un periodo finestra di negativizzazione dell'antigene.

Un caso interessante di qualcosa che in generale deve essere studiato. Dal modo in cui si presenta, è chiaramente un'epatite acuta, quindi la 1 è [HIDDEN]. La negatività delle IgM per HAV esclude la 5 e la negatività dell'HBs Ag esclude la 4 (per avere il virus delta è necessario l'antigene di superficie B). Quando si hanno IgM anti-HBc, si parla di epatite B acuta (3), poiché esiste un periodo finestra di negativizzazione dell'antigene.

Un uomo presenta improvvisamente astenia e ittero con transaminasi superiori a 2000 UI/L. I marcatori sierologici mostrano il seguente pattern: Anti HAV IgM negativo, HBsAg negativo AntiHBc IgM positivo, anti HCV negativo. Qual è la diagnosi?

[Elevata prevalenza ma bassa incidenza della infezione da HGV in pazienti con epatite cronica C]

Objectives To determine 1. The prevalence and incidence of HGV infection in patients with chronic hepatitis C and 2. Its influence on the clinical outcome of chronic hepatitis C. Patients and methods Sixty-five patients with non-parenteral chronic hepatitis C virus infection were investigated for HGV infection using the polymerase chain reaction for HGV-RNA and by detecting serum antibodies against the E2 protein of HGV (anti-E2 antibodies). Results HGV-RNA in serum was found in 12 patients (18.4%) and anti-E2 antibodies in 4 (6.1%). No difference in age, sex, liver histology, basal ALT or ?GT was found between HGV positive and negative cases. Thirty-four patients (6 with HGV-RNA) were followed-up for 4 years; 4 of the 6 lost HGV-RNA, one of whom seroconverted to anti-E2. None of the 28 HGV-RNA negative cases presented HGV infection during the follow-up period. The presence of HGV infection did not influence either basal HCV viremia or the response of HCV to IFN therapy. Conclusions The study demonstrated that HGV had an intense circulation through non-classic parenteral routes, but its impact on HCV replication and liver disease is negligible.

[Serum biological markers and screening of viral hepatitis].

The diagnosis of hepatitis A is based on IgM anti-HAV positivity. IgG anti-HAV indicates immunity from further infections of hepatitis A. In acute hepatitis B, HBs Ag is the first marker to appear in the serum, followed by HBe Ag and anti-HBc. After recovery, HBs Ag disappears, anti-HBs appears with anti-HBe and anti-HBc and persists for many years. Anti-HBs is indicative of recovery and immunity. Chronic hepatitis B infection is defined as the persistence of HBs Ag for more than 6 months. The presence of HBeAg and HBV DNA in the serum of HBsAg positive carriers has been considered as indication of active viral replication. After a variable period, often several years, viral replication disappears. The patient displays serum anti-HBe antibodies and HBV DNA is not detected in the serum. This state is the most frequently observed and has been classified as wild type. Mutations have been described. The delta virus is not able to replicate on its own, but is capable of infection when activated by the presence of hepatitis B virus. The appearance of serum IgG anti-delta is the simplest method of diagnosing delta infection. Serological tests for HCV detect antibodies to viral antigens (Elisa assay). Each positive anti-HCV assay must be followed by a complementary confirmation test. The most widely used method for supplementary testing is the recombinant immunoblot assay in which antibodies are sought for recombinant antigens of HCV coated on nitrocellulose strips.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis B

The surface antigen (HBsAg) is most frequently used to screen for the presence of this infection. It is the first detectable viral antigen to appear during infection. However, early in an infection, this antigen may not be present and it may be undetectable later in the infection as it is being cleared by the host. The infectious virion contains an inner "core particle" enclosing viral genome. The icosahedral core particle is made of 180 or 240 copies of the core protein, alternatively known as core antigen, or HBcAg. During this 'window' in which the host remains infected but is successfully clearing the virus, IgM antibodies specific to the core antigen (anti-HBc IgM) may be the only serological evidence of disease. Therefore, most diagnostic panels contain HBsAg and total anti-HBc (both IgM and IgG).

[Prevalenza di ipotiroidismo nei pazienti sottoposti a emodialisi presso un ospedale generale di Ahvaz.]

Riassunto. Obiettivo. Lo scopo di questo studio trasversale è determinare la prevalenza dell'ipotiroidismo tra i pazienti in emodialisi (ED) e i suoi potenziali fattori di rischio. Metodi. Sono stati raccolti dati demografici e di laboratorio [vale a dire, livelli sierici di tireotropina (TSH), anticorpi anti-perossidasi tiroidea (anti-TPO)] di 117 pazienti con MH. I dati sono stati analizzati da SPSS.V 26, quando necessario. Risultati. I pazienti avevano un'età media (DS) di 59,47±15,08 anni e il 66,7% (n=78) era di genere maschile. I livelli medi (DS) di TSH erano 2,56 (4,01) μIU/mL. L'ipotiroidismo subclinico (SCH) è stato definito come un livello di TSH >4,2 μIU/mL e FT4 normale. Quindici pazienti (12,80%) avevano SCH. Non c'era correlazione significativa tra ipotiroidismo ed età, genere e/o malattie sottostanti (p>0,05). Inoltre, tra i 15 pazienti con SCH, 1 paziente (6,7%) ha mostrato un risultato anti-TPO positivo mentre 14 pazienti (93,3%) hanno avuto un risultato anti-TPO negativo. Conclusione. Data la notevole prevalenza dell'ipotiroidismo nei pazienti con ED, lo screening di routine della funzione tiroidea in questa popolazione di pazienti può aiutare a ridurre i tassi di complicanze e mortalità attraverso una diagnosi precoce e un intervento tempestivo.

[Hepatitis B and hepatitis delta in young inmates].

The prevalence of infection by hepatitis B (HBV) and delta (HDV) viruses and presumably related variables were evaluated in a prison for young male convicts, aged 16-21 years (n = 686), 55.1% of convicts were positive for one or more VHB markers, and 7.1% were positive for HBsAg; 89.7% of these were negative for IgM anti-HBc (chronic carriers), while 36.6% were positive for HBeAg. Anti-delta antibodies were detected in 37.5% of chronic carriers. The seropositivity of HVB markers was much higher in parenteral drug abusers (PDA) as compared with non PDA (76.3% vs 26.7%, p less than 0.0000001, OR = 8.82). Among PDA, it was higher in regular users than in occasional ones (83.3% vs 62.9%, p = 0.0001, OR = 2.95) and in those who had acquired the habit at an early age (p = 0.035). The stratified analysis also showed an association of VHB infection with other variables, basically ethical and prison-related. The possibility to develop active immunization programs is evaluated.

[Sero-epidemiologic studies of acute hepatitis A in Umbria: behavior of IgM anti-HAV antibodies].

The diagnosis of acute Hepatitis A is made when antibodies anti-HAV, of the IgM class, are detected in the blood. The Authors have examined with RIA test (HAVAB-M, Abbott) 298 samples of serum from patients with acute non B hepatitis, non drug abusers, also they had not received blood transfusions; as control they examined 41 sera from patients with hepatitis B, 29 sera from patients with non B hepatitis and drug addiction, 25 sera from patients with transfusional non B hepatitis and 37 sera from healthy persons. From the first group (298 patients) 47% were positive for anti-HAV antibodies IgM class; the greatest incidence of positivity (80%) was detected in the class age 0-10 years. In the control groups only in one serum positivity was evidenced and the patient was 22 years old, drug addicted with non B acute hepatitis and with previous episodes of acute hepatitis.

[The OIBOH Registry (Optimal Intensification therapy in a Broad Observed High risk patient population with coronary disease): an Italian observational study of secondary prevention after a coronary event during the pandemic COVID-19 outbreak].

Razionale. In Italia la pandemia COVID-19 ha determinato importanti riorganizzazioni logistiche nell'erogazione delle cure ospedaliere e di specialistica ambulatoriale. Ciò ha spinto clinici e decisori pubblico-amministrativi della Sanità ad adottare nuovi modelli organizzativi in molteplici scenari clinici. Materiali e metodi. Il registro OIBOH (Optimal Intensification therapy in a Broad Observed High risk patient population with coronary disease) è uno studio osservazionale "cross-sectional" condotto in vari centri italiani di cardiologia ambulatoriale per valutare durante la pandemia COVID-19 la capacità di identificare in breve tempo i pazienti ad altissimo rischio cardiovascolare residuo dopo un evento coronarico recente (<12 mesi). Successivamente alla valutazione clinica iniziale, venivano arruolati i pazienti ritenuti ad altissimo rischio, registrando le caratteristiche cliniche e di trattamento in una scheda di raccolta dati elettronica.Risultati. Al registro hanno partecipato 134 centri di cardiologia ambulatoriale che hanno arruolato 1428 pazienti su 3227 esaminati fra quelli che avevano avuto accesso ad una visita cardiologica durante la pandemia nel periodo ottobre 2020-marzo 2021. Il criterio di arruolamento era costituito dall'aver avuto una diagnosi di coronaropatia confermata angiograficamente negli ultimi 12 mesi, per sindrome coronarica acuta (SCA) o cronica (SCC). La SCA come evento indice era presente nel 93% dei pazienti arruolati mentre la SCC nel 7%. L'età media era 67 ± 10 anni, il 25% era di sesso femminile. Il 96.1% dei pazienti con SCA e il 67.6% dei pazienti con SCC sono stati sottoposti a rivascolarizzazione coronarica. Il 46% e 47% dei pazienti con SCA e SCC, rispettivamente, era diabetico. Oltre il 65% dei pazienti presentava una malattia coronarica multivasale. È stata osservata una importante prevalenza di arteriopatia periferica (17.5% nei pazienti con SCA e 19.6% nei pazienti con SCC). I valori di pressione arteriosa e frequenza cardiaca risultavano ben controllati (128 ± 25.2 mmHg e 65 ± 12.3 b/min nei pazienti con SCA; 127 ± 23.4 mmHg e 67 ± 13.2 b/min nei pazienti con SCC). Viceversa, è stato riportato uno scarso controllo dei livelli di colesterolemia LDL, con un valore medio di 88.8 ± 38.6 mg/dl nei pazienti con SCA e 86 ± 36.6 mg/dl nei pazienti con SCC. Solo il 16.4% dei pazienti con SCA raggiungeva i livelli raccomandati dalle attuali linee guida europee. Nonostante l'estensivo uso di statine (>90%), si è rilevato un utilizzo limitato dell'associazione statina ad alta intensità + ezetimibe (solo il 22.4% dei pazienti). Estremamente basso è stato l'utilizzo di inibitori di PCSK9 (2.5%). La duplice terapia antiaggregante piastrinica (DAPT) è risultata complessivamente ben condotta fin dalla dimissione ospedaliera. Nei pazienti in DAPT, l'inibitore P2Y12 più utilizzato è risultato il ticagrelor alla dose di 90 mg, soprattutto dopo un evento coronarico acuto (in circa l'80% dei pazienti con SCA). Nella stragrande maggioranza dei casi (>90%) i cardiologi ambulatoriali hanno posto indicazione a prosecuzione della DAPT oltre i 12 mesi con aspirina e ticagrelor 60 mg bid. Conclusioni. La gestione del paziente con coronaropatia in fase cronica stabilizzata è molto complessa. Tale complessità logistico-gestionale si è accentuata durante la pandemia COVID-19. Il registro OIBOH ha evidenziato un'ottima capacità di identificare le problematiche clinico-prognostiche delle cardiologie ambulatoriali italiane, specie nei pazienti ad altissimo rischio residuo. Rimangono importanti aree di miglioramento come uno stretto controllo della colesterolemia LDL, mentre altre raccomandazioni delle linee guida, come la prosecuzione della DAPT con ticagrelor 60 mg oltre i 12 mesi, risultano ben applicate. L'implementazione dell'assistenza con la medicina digitale e l'intelligenza artificiale potrebbe migliorare di molto la performance dei clinici.

InternalMed_Harrison

Serologic Tests of Patient’s Serum Note: See text for abbreviations. the absence of HBsAg when IgM anti-HBc is detectable. A diagnosis of acute hepatitis A is based on the presence of IgM anti-HAV. If IgM anti-HAV coexists with HBsAg, a diagnosis of simultaneous HAV and HBV infections can be made; if IgM anti-HBc (with or without HBsAg) is detectable, the patient has simultaneous acute hepatitis A and B, and if IgM anti-HBc is undetectable, the patient has acute hepatitis A superimposed on chronic HBV infection. The presence of anti-HCV supports a diagnosis of acute hepatitis C. Occasionally, testing for HCV RNA or repeat anti-HCV testing later during the illness is necessary to establish the diagnosis. Absence of all serologic markers is consistent with a diagnosis of “non-A, non-B, non-C” hepatitis, if the epidemiologic setting is appropriate.

ABC Epatite Web App: raising health awareness in a mobile world.

This paper presents the case study of a health campaign for mobile devices launched in Italy in 2019 aimed at raising viral hepatitis awareness. The research project "<iABC epatite. Sviluppo di una app per la prevenzione delle epatiti virali e per la consapevolezza dei comportamenti a rischio</i", winner of the 2018 Digital Health Program of Gilead Italia, was carried out by the Italian National Research Council. The project entailed the development of a free Italian language Progressive Web App (PWA) providing current and scientifically validated information on viral hepatitis (A, B and C). A mobile first PWA health awareness app was implemented (https://epatite.web.app) together with an Android app version. Diversified landing pages cater to two target audiences: general public and schools. An initial campaign was directed toward engaging schools in nine Italian regions. Preliminary results based on the campaign directed toward Italian schools in just under half of its regions have shown promise on the feasibility of reaching large audiences and encouraging engagement on viral hepatitis prevention. A mobile first approach to health communication is a cost-effective way to help reaching the goal of eradicating viral hepatitis by reducing infections and deaths.

[Detection of virus A antibody through epidemiology and diagnosis of hepatitis A].

In the present work the Authors report the results of the research of HAAb in 383 subjects living in Rome with negative history for hepatitis (divided for age, sex and occupation) and in 64 acute non B hepatitis (HBsAg-). In the latter, the titer of HAAb was determined at the beginning and later during the course of the disease. A fractionation of 13 sera of these patients was done and the type of specific immunoglobulin was determined. Among the subject with negative history for hepatitis, 68.9% was positive during first 6 months of age 6.2% from 6 months to 5 y.o., 27.6% from 6 to 12 y.o., 45.4% from 12 to 17 y.o., 76.8% from 18 to 25 y.o., 82.2% from 26 to 45 y.o., 90.2% from 46 to 65 y.o.. There was no statistically significant difference either between males and females, or among various occupations. Among the 64 patients with non B hepatitis, 25 (39%) were hepatitis A (because they showed either a seroconversion for HAAb or a positive HAAb-IgM); 12 (18.7%) were non A-non B hepatitis because HAAb negative or HAAb positive but negative for HAAb-IgM; while 27 (42.2%) were impossible to classify because they showed a positivity for HAAb but not a seroconversion during the disease. The limit of the determination of HAAb and the utility of the research of IgM antibody for the diagnosis of hepatitis A are discussed.

Hepatitis B -- Evaluation -- Interpretation of Serologic Markers

Following serologic markers are often tested: Hepatitis B surface antigen (HBsAg), antibody to Hepatitis B surface antigen (anti-HBs), Hepatitis B core Ab (Anti-HBc) IgM, Hepatitis B core Ab (Anti-HBc) IgG, Hepatitis B e antigen (HBeAg), and Hepatitis B e antibody (anti-HBe). [10] HBsAg: Acute infection (less than 6 months) or chronic infection (more than 6 months). Anti-HBs: Recovery from acute infection or immunity from vaccination. HBeAg: Mostly associated with high viral load. Anti-HBe: Low replicative phase. Anti-HBc IgM: Acute infection, an only marker present in the window period, can be present during exacerbation of chronic infection. Anti-HBc IgG: Exposure to infection, chronic infection (if present along with HBsAg), recovery from acute infection (if present with anti-HBs), if isolated presence, may represent occult infection.

Evaluación del desempeño diagnóstico del Índice de Riesgo de Malignidad II en mujeres con diagnóstico de masa anexial en un hospital de tercer nivel.

Evaluar la exactitud diagnóstica del Índice de Riesgo de Malignidad II (IRM II) en 100 pacientes con diagnóstico de masa anexial. En una muestra de 100 pacientes con diagnóstico de masa anexial se cuantificaron variables demográficas y se aplicó el IRM II. Mediante una tabla 2 × 2 se obtuvieron la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la exactitud diagnóstica, y se compararon con el resultado histopatológico. El IRM II con resultado positivo se presentó en el 73.1% (52 pacientes) de los casos con resultado histopatológico maligno y en el 26.9% de aquellos con resultado histopatológico benigno. Presenta una sensibilidad en la prueba del 73.1%, una especificidad del 70.8%, un valor predictivo positivo del 73.2% y un valor predictivo negativo del 70.8%. La exactitud diagnóstica es del 72%. El IRM II es una herramienta de cribaje con aceptable desempeño diagnóstico para normar la conducta, como referir a un centro especializado o solicitar estudios más específicos en pacientes con diagnóstico de masa anexial por sospecha de malignidad. Evaluate the usefulness of the Malignancy Risk Index II (MRI II) using diagnostic accuracy variables in 100 patients diagnosed with adnexal mass. In a sample of 100 patients with a diagnosis of adnexal mass, demographic variables were quantified and MRI II was applied. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were obtained using a 2 × 2 table and compared with the histopathological result. MRI II with positive result was presented in 73.1% (52 patients) with malignant histopathological result and in 26.9% of patients with benign histopathological result. It presents a sensitivity in the test of 73.1%, a specificity of 70.8%, positive and negative predictive value of 73.2 and 70.8%, respectively. Diagnostic accuracy of 72%. MRI II is a screening tool with acceptable diagnostic performance to regulate behavior, such as referring to a specialized center or requesting more specific studies in patients diagnosed with adnexal mass due to suspected malignancy.

[Prevalence and incidence of hepatitis A in patients with hepatitis B and C].

Patients with chronic hepatitis are in risk to acquire a fulminant hepatitis associated with hepatitis A virus superinfection. Antibodies against hepatitis A were study in serum from 353 patients with chronic hepatitis B or C. The prevalence of IgG-HAV antibodies was 81% in chronic hepatitis C patients, and 77% in chronic hepatitis B patients. The presence of anti-HAV antibodies was related to the patients' age. None case of acute hepatitis A in chronic hepatitis patients was detected. The prevalence of anti-HAV antibodies is high in patients with chronic viral hepatitis but the incidence of the disease is low. Hepatitis A vaccination should do with previously screening.

Chronic evolution of acute hepatitis B: the significance of simultaneous infections with hepatitis C and D. Copenhagen Hepatitis Acuta Programme.

Seventy-six of 77 consecutive patients with hepatitis B surface antigen (HBsAg)-positive acute hepatitis were reevaluated using anti-hepatitis C virus (HCV), anti-hepatitis D virus (HDV), and IgM anti-hepatitis B core (HBc) testing. Anti-HCV and/or anti-HDV was found in 32 patients (42%). The presence of these markers was significantly associated with intravenous drug abuse (p less than 10(-6). Sixty-nine patients were IgM anti-HBc-positive, of whom two (3%) (95% confidence limits, 1-12%) became chronic HBsAg carriers with histologically verified chronic liver disease; both were anti-HCV and anti-HDV-negative. Among the remaining 67 IgM anti-HBc-positive patients 8 had HBV and HDV co-infection, 3 had HBV and HCV co-infection, and 1 had HBV, HCV, and HDV co-infection. Twenty-two had evidence of preceding or past HCV infection; two developed chronic active hepatitis in spite of HBsAg clearance. Seven patients with IgM anti-HBc negative. One was a chronic HBsAg carrier with HDV superinfection. One had subclinical acute HBV infection and became a chronic HBsAg carrier. In a further two patients reactivation of replication in a chronic HBV infection could not be disregarded. Three patients could not be classified; all had acute recent onset of symptoms, cleared HBsAg within 6 months, but lacked IgM anti-HBc. It is concluded that HCV and HDV superinfections in HBV carriers mimicking acute HBV infection with chronic evolution are rarely encountered in the present population in spite of high frequency of both HCV and HDV markers.

[Diagnosis of hepatitis B and C].

Diagnosis of hepatitis B and C is based on sensitive and specific serological assays. Molecular assays for the detection of HBV DNA or HCV RNA are in some instances needed to confirm the diagnosis. However, their principal role is in the therapeutic decision making and in the monitoring of antiviral therapy.

SEROPREVALENCE OF HAV, HBV, HCV, AND HEV AMONG ACUTE HEPATITIS PATIENTS AT KENYATTA NATIONAL HOSPITAL IN NAIROBI, KENYA.

Acute viral hepatitis is most frequently caused by the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV). To determine seroprevalence of HAV, HBV, HCV and HEV among patients with acute hepatitis in Nairobi, Kenya, elucidate various risk factors for hepatitis viral infection and determine the co-infection rates with these viruses in the acute hepatitis patients. Across sectional descriptive study. Kenyatta National Hospital, from November 2007 to April 2008. One hundred patients were recruited by purposive sampling method and comprised of 57 males and 43 females. Among the enrolled patients, twenty three tested positive for one or more markers of acute viral hepatitis, that is, HAV, HBV, HCV and HEV. No markers were detected in 77patients, 2% tested positive for IgM anti-HAV 11% for IgM anti-HBc; 3% for HBsAg; 5% for HCV RNA and 7% for IgM anti-HEV.Various risk factors associated with acute viral hepatitis were identified; poor sanitation, source of water, occupation, place of residence, level of education, household size, drug abuse and sexual behaviours. Co-infection rate with hepatitis Viruses was at 4%, IgM anti-HAV and IgM anti-HEV 1% (n=1); IgM anti-HBc and IgM anti-HEV 1% (n=1); IgM anti-HBc and anti-HCV 2% (n=2). Three patients were positive for HBsAg; among this two were negative for IgM anti-HBc and this accounted for HBV carriage (2%). Hepatitis viruses'infections are commoncause of hepatitis among patients with acute hepatitis at Kenyatta National Hospital. Co-infection with these viruses was also identified among these patients.

[Serum hepatitis B markers: atypical patterns detected at the Hospital Insular de Gran Canaria].

Two atypical serological markers of hepatitis B virus (HBV) infection were detected in 19 patients during a 18-month period study. Pattern 1 (10 patients) was consistent with HBV-2 infection. Reactivity of HbsAG was confirmed by neutralization tests; the absence of other markers was also verified, included anti-HBcIgM. Three of the patients were classified in high risk groups and seven in the low risk groups for hepatitis B; in none of them was co-infection with hepatitis A virus (HAV) detected. Pattern 2 (9 patients) was characterized by the detection of HBsAg and HBeAg and the absence of other hepatitis B markers. Six of these patients were HIV-positive patients and had increased and persistent levels (for longer than 12 weeks) of these markers. In the three remaining patients (with no underlying immunological disorders) there was a loss of these markers within a variable time (2 days to 16 weeks). Nevertheless, DNA-VHB was detected in one of these serum samples once all markers of virus B had disappeared.

[Injecting without getting infected: injectors' strategies to prevent HIV and HCV.]

OBJETIVO: Desde principios de los noventa, en la ciudad de Nueva York se han implementado con éxito programas para reducir la incidencia del virus de la inmunodeficiencia humana (VIH) y, en menor medida, del virus de la hepatitis C (VHC). A pesar de ello, aproximadamente el 70% de los usuario de drogas inyectables (UDI) están infectados por el VHC. Queremos investigar cómo el 30% restante se las ha arreglado para no infectarse. El Staying safe (nombre original del estudio) explora los comportamientos y mecanismos que ayudan a evitar la infección por el VHC y el VIH a largo plazo.  MATERIAL Y M#ENTITYSTARTX000E9;TODOS: Hemos utilizado el concepto de «desviación positiva» aplicado en otros campos de salud pública. Estudiamos las estrategias, prácticas y tácticas de prevención de aquellos UDI que, viviendo en contextos de alta prevalencia, se mantienen sin infectar por VIH y el VHC, a pesar de haberse inyectado heroína durante años. Los resultados preliminares presentados en este artículo incluyen el análisis de las entrevistas realizadas a 25 UDI (17 doble negativos, 3 doble positivos y 5 con infección por el VHC y sin infección por el VIH). Se usaron entrevistas semiestructuradas que exploraban con detalle la historia de vida de los sujetos, incluyendo su consumo de drogas, redes sociales, contacto con instituciones, relaciones sexuales y estrategias de protección y vigilancia.  RESULTADOS: La intencionalidad es importante para no infectarse, especialmente durante períodos de involución (períodos donde hay un deterioro económico y/o social que llevan al que se inyecta a situaciones de mayor riesgo). Presentamos tres dimensiones independientes de intencionalidad que conllevan comportamientos que pueden ayudar a prevenir la infección: a) evitar «el mono» (síntomas de abstención) asegurando el acceso a la droga; b) «llevarlo bien» para no convertirse en un junkie y así evitar la «muerte social» y la falta de acceso a los recursos, y c) seguir sin infectarse por el VIH (sólo un doble negativo tuvo un amplio conocimiento sobre la hepatitis C). Estas intencionalidades no son mutuamente excluyentes. La presencia de varias refuerza la puesta en práctica a diario de comportamientos que pueden ayudar al que se inyecta a mantenerse libre de infecciones durante años. Algunas prácticas que hemos identificado se implementan en grupo y se comunican de UDI a UDI, de esta manera se extienden entre algunas redes sociales de UDI.  CONCLUSIONES: Los UDI que permanecen sin infectarse planean e implementan estrategias de prevención en circunstancias donde otros UDI aplican prácticas de riesgo. El mantenimiento de la no infección no es, por lo tanto, un resultado del azar, sino más bien el resultado del esfuerzo (agencia) de los UDI. Investigar y extender estas estrategias y tácticas a través de programas de prevención podría contribuir a la prevención del VIH y el VHC.

[The prevalence of viral hepatitis markers in the general population].

The study objective was to measure the characteristic serological markers prevalence for viral hepatitis A, viral hepatitis B and viral hepatitis Delta in a representative group from apparent healthy general population. Viral hepatitis infections represent through their frequency and gravity a public health problem, in our country. A total of 860 subjects from 13 districts sided in the south part of the country were investigated. The sample were distributed by 9 age group. By using a certain work algorithm we examined the following serological markers: HBs Ag, anti HBs, AgHBe/antiHBe, AgHD/antiHD. For the serologic investigation we used ELISA test with Wellcozyme and Sanofi Diagnostics Pasteur Kits. The results of our study confirm high prevalence values for HAV and HBV (65.8% respectively 44.9%). We could estimate that 73.5% from the population has passed through either HAV infection or HBV infection and 29.1% to 37.7% has passed through both infections. The study also proved a very high HBs Ag carriage (10.5% to 30.9%). The HBe Ag were detected only in HBs Ag carrier children (4.5% to 13%). The presence of anti HBe was 31.4%. From the investigated persons 10% had hepatitis Delta virus infection.

Hepatitis

Viral hepatitis Viral hepatitis is primarily diagnosed through blood tests for levels of viral antigens (such as the hepatitis B surface or core antigen), anti-viral antibodies (such as the anti-hepatitis B surface antibody or anti-hepatitis A antibody), or viral DNA/RNA. In early infection (i.e. within 1 week), IgM antibodies are found in the blood. In late infection and after recovery, IgG antibodies are present and remain in the body for up to years. Therefore, when a patient is positive for IgG antibody but negative for IgM antibody, he is considered immune from the virus via either prior infection and recovery or prior vaccination. In the case of hepatitis B, blood tests exist for multiple virus antigens (which are different components of the virion particle) and antibodies. The combination of antigen and antibody positivity can provide information about the stage of infection (acute or chronic), the degree of viral replication, and the infectivity of the virus.

Spectrum of viral hepatitis in thalassemic children receiving multiple blood transfusions.

To investigate the prevalence of infection with hepatitis viruses in children with thalassemia receiving multiple blood transfusions. Sera from 50 children with thalassemia aged 5-15 years (30 boys), who had each received over 80 units of blood, were evaluated for the presence of markers for hepatitis A virus (HAV; IgG and IgM anti-HAV), hepatitis B virus (HBV; HBsAg, and IgG and IgM anti-HBc), hepatitis C virus (HCV; IgG and IgM anti-HCV, and HCV RNA) and hepatitis E virus (HEV; IgG and IgM anti-HEV). IgM anti-hepatitis D virus (HDV) was looked for only in HBsAg or IgM anti-HBc positive sera. No child had evidence of recent HAV or HDV infection. IgG anti-HAV was positive in 12 children. One patient had acute HBV infection. Nine patients were HBsAg-positive. HCV infection was present in 15 cases; six of them were HCV RNA positive, and three had superinfection with hepatitis B. Recent HEV infection was present in 5 cases. Thalassemic patients receiving multiple blood transfusions often acquire hepatitis B (20%) and C (30%) infections. Recent hepatitis E infection was documented in 10% in this one-point study.

[Epidemiology and prognosis of non-A, non-B hepatitis (author's transl)].

The frequency of non-A, non-B hepatitis (n = 325) was determined among all cases (n = 1368) of acute viral hepatitis observed in the Hannover are abetwen 1975 and 1978. Hepatitis A was excluded by demonstration of anti-HAV-IgM, hepatitis B by demonstration of HBs antigen or an isolated occurrence of anti-HBc at the beginning of the disease. Non-A, non-B hepatitis occurred predominantly in adults and showed no seasonal variability. As a consequence of results of followup investigations in 174 hepatitis patients 2 years after the onset of the disease it can be assumed that non-A, non-B hepatitis tends to lead to chronic courses more frequently than hepatitis B.

Prevalence of hepatitis A, B, C and E virus in adolescents with type-1 diabetes mellitus.

The hypothesis for this study was that hepatitis virus infection could be associated with diabetes, because of the high frequency of injections. In this study, we aimed to determine the prevalence of hepatitis A, B, C and E viruses in type-1 diabetes mellitus. Sixty-three patients with the diagnosis of insulin-dependent diabetes mellitus and 63 healthy controls were included in this study. Serological markers of four different types of hepatitis (Anti-HAV IgM, total, anti-HAV, HbsAg, anti-HBs, total anti-HBc, antiHBc IgM, anti-HCV and anti-HEV) were studied in all cases. None of the patients had a history of previous icterus or other signs of hepatitis, had received blood transfusions, or were on hemodialysis. There was no difference between the patients and controls with respect to hepatitis A, B, C and E virus serology. The rate of seropositivity of patients within a month of the diagnosis was smaller than those of the patients whose diagnosis were older than one month, but the difference was not found to be statistically significant (p > 0.05). Moreover, hepatitis virus infections did not seem to be related to duration of disease, nor age of onset, ketoacidosis, HbA1c, and insulin regimen. All of the sera were negative for anti-HCV in both patients and controls. Serological evidence of previous HAV, HBV, HCV and HEV infections was not significantly different between type-1 diabetes patients and healthy controls. Hepatitis virus infection was not associated with diabetes in spite of the high frequency of injections.

[The assessment of work ability in persons with hepatitis B and C].

A risk group for infection of virus hepatitis B (HBV) and C (HCV) makes health care professionals who contact with blood, and body fluid. The aim of this study was, on the base of markers of infection with hepatitis B and hepatitis C virus define criteria for evaluation work ability of the infected personnel. On the base of markers of HBV infection enabled identification of four groups infection persons with different work ability: 1) HBsAg-positive, anti-HBc-positive, HBcAg-positive, anti-HBc IgM-positive and HBV DNA-positive; 2) HBsAg-positive, anti-HBc-positive, HBcAg-negative, anti-HBc-positive, anti-HBc IgM-positive and HBV DNA-positive; 3) HBsAg-positive, anti-HBc-positive, HBcAg-negative, anti-HBe-positive, anti-HBc IgM-negative and HBV DNA-negative; 4) Anti-HBs-positive, anti-HBc-positive, anti-HBc IgM-negative and anti-HBc-positive. For HCV infection, two groups with different work ability were identified: 1) Anti-HCV-positive and HCV RNA-negative; 2) Anti-HCV-positive and HCV RNA positive.

Objetivo. Estudiar la asociación de la inseguridad alimentaria con los cambios percibidos en la alimentación durante el confinamiento por Covid-19 en México. Material y métodos. El nivel de inseguridad alimentaria se obtuvo utilizando la Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) en 9 933 hogares de la Encuesta Nacional de Salud y Nutrición Continua 2020 Covid-19 (Ensanut -Continua- 2020 Covid-19). Los cambios en el consumo de grupos de alimentos durante el confinamiento se clasificaron en negativos, positivos o sin cambios durante el confinamiento. La asociación entre cambios en la alimentación e inseguridad alimentaria se analizó con modelos multinomiales ajustados por características sociodemográficas del hogar. Resulta-dos. Los hogares con reducción en el gasto en alimentos e inseguridad alimentaria severa mostraron mayor probabilidad de tener cambios negativos en su alimentación (0.43, IC95%: 0.40-0.46). Conclusiones. La inseguridad alimentaria severa se asocia con cambios negativos en la alimentación durante el confinamiento por Covid-19, en hogares con reducción del gasto en alimentos.

[Diagnostic significance of the detection of hepatitis B virus DNA in acute and chronic hepatitis].

1065 sera from patients with acute and chronic hepatitis-B-virus-(HBV-) infections, double infections (HBV, HAV, nonA-nonB, delta-Ag) as well as patients with HBs-Ag-negative hepatitis (HAV, nonA-nonB) and healthy subjects were investigated for the presence of hepatitis-B-virus-DNA using molecular hybridisation. The sensitivity of the method was 0.1 pg HBV-DNA/100 microliters. HBV-DNA could be detected in 62% of cases of HBs-Ag-positive sera with HBe-Ag, in 8.9% with anti-HBe and in 11% of e-marker free sera. In acute hepatitis HBV-DNA was present in 44%, in chronic hepatitis in 71% of HBe-Ag-positive sera. In HBs-Ag-negative sera containing only anti-HBc, HBV-DNA, depending on the anti-HBc-titre, was present in 13-24% of cases. HBV-DNA could not be detected in patients with HBV infections (anti-HBc and anti-HBs positive) in the past or in HBV-marker-negative hepatitis. Follow-up investigations on acute and chronic HBV-infections showed that the disappearance of HBV-DNA generally preceded the disappearance of HBe-antigen by about 2-3 weeks. In chronic hepatitis the time interval can amount to several months or years. Double infections with other hepatotropic viruses (nonA-nonB and delta-virus) can lead to a temporary suppression of HBV-DNA replication.

Hepatitis D -- Evaluation

In response to the HDAg, antibodies of the IgM and IgG class (anti-HDV) are produced. The three infective patterns (acute HDV/HBV coinfection, acute HDV superinfection, and chronic HDV infection) vary with respect to appearance and levels of HDV RNA, HDAg, and anti-HDV as well as HBV markers (Table 1). As HDV is dependent on HBV, the presence of HBsAg is essential for diagnosis. Additionally, the presence of IgM antibody to hepatitis B core antigen (IgM anti-HBc) is essential to diagnose acute HBV/HDV coinfection. [18]

Performance of the dipstick screening test as a predictor of negative urine culture.

To investigate whether the urine dipstick screening test can be used to predict urine culture results. A retrospective study conducted between January and December 2014 based on data from 8,587 patients with a medical order for urine dipstick test, urine sediment analysis and urine culture. Sensitivity, specificity, positive and negative predictive values were determined and ROC curve analysis was performed. The percentage of positive cultures was 17.5%. Nitrite had 28% sensitivity and 99% specificity, with positive and negative predictive values of 89% and 87%, respectively. Leukocyte esterase had 79% sensitivity and 84% specificity, with positive and negative predictive values of 51% and 95%, respectively. The combination of positive nitrite or positive leukocyte esterase tests had 85% sensitivity and 84% specificity, with positive and negative predictive values of 53% and 96%, respectively. Positive urinary sediment (more than ten leukocytes per microliter) had 92% sensitivity and 71% specificity, with positive and negative predictive values of 40% and 98%, respectively. The combination of nitrite positive test and positive urinary sediment had 82% sensitivity and 99% specificity, with positive and negative predictive values of 91% and 98%, respectively. The combination of nitrite or leukocyte esterase positive tests and positive urinary sediment had the highest sensitivity (94%) and specificity (84%), with positive and negative predictive values of 58% and 99%, respectively. Based on ROC curve analysis, the best indicator of positive urine culture was the combination of positives leukocyte esterase or nitrite tests and positive urinary sediment, followed by positives leukocyte and nitrite tests, positive urinary sediment alone, positive leukocyte esterase test alone, positive nitrite test alone and finally association of positives nitrite and urinary sediment (AUC: 0.845, 0.844, 0.817, 0.814, 0.635 and 0.626, respectively). A negative urine culture can be predicted by negative dipstick test results. Therefore, this test may be a reliable predictor of negative urine culture. Verificar se a triagem de urina por fitas reativas é capaz de predizer a cultura de urina. Métodos Estudo retrospectivo realizado entre janeiro e dezembro de 2014 com 8.587 pacientes, com solicitação médica de triagem de urina (fita), sedimento urinário e cultura de urina. sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e curva ROC. Foram positivas 17,5% das culturas. O nitrito apresentou sensibilidade de 28% e especificidade de 99%. O valor preditivo positivo foi de 89% e o valor preditivo negativo de 87%. Esterase apresentou sensibilidade de 79% e especificidade de 84%. Valor preditivo positivo e valor preditivo negativo foram de 51% e 95%, respectivamente. A combinação de nitrito ou esterase positivos apresentou sensibilidade de 85% e especificidade de 84%. Valor preditivo positivo e valor preditivo negativo foram, respectivamente, 53% e 96%. O sedimento positivo (mais de dez leucócitos por microlitro) apresentou sensibilidade de 92% e especificidade de 71%. O valor preditivo positivo foi 40% e o negativo, 98%. A combinação de nitrito e sedimento urinário positivos apresentou sensibilidade de 82% e especificidade de 99%. Os valores preditivos positivo e negativo foram 91% e 98%, respectivamente. Para o nitrito ou esterase positivos mais os leucócitos positivos, a sensibilidade foi de 94% e a especificidade de 84%. O valor preditivo positivo foi de 58% e o negativo foi de 99%. Com base na curva ROC, o melhor indicador de urocultura positiva foi a associação entre a esterase ou nitrito positivos na fita mais os leucócitos positivos no sedimento, seguido por nitrito e esterase positivos, sedimento urinário positivo isolado, esterase positiva isolada, nitrito positivo isolado e, finalmente, pela associação entre nitrito e sedimento urinário positivos (AUC: 0,845, 0,844, 0,817, 0,814, 0,635 e 0,626, respectivamente). Uma urocultura negativa pode ser prevista com resultados negativos na fita. Portanto, este teste pode ser um preditor confiável de urocultura negativa.

[Viral markers of hepatitis A and B: main characteristics and clinical significance].

Etiologic diagnosis of hepatitis A virus infection, is discussed considering the antibody to hepatitis A virus (anti-HAV) type IgM and IgG. Clinical relevance of hepatitis B virus markers (HBsAg, HBeAg, anti-HBc IgM and IgG, anti-HBe and anti-HBs) is reviewed as they appear in the clinical course of the disease. The significance of chronic viremia and persistence of HBeAg is commented as well as the perspective prognostic factor of Delta antigen.

HIV-Infected Patients With Anal Cancer Precursors: Clinicopathological Characteristics and Human Papillomavirus Subtype Distribution.

People living with HIV have high rates of anal human papillomavirus infection and anal precancer/cancer. This study aims to: 1) determine human papillomavirus subtype distribution among people living with HIV with anal high-grade squamous intraepithelial lesions; 2) compare the clinicopathological characteristics of patients with anal high-grade squamous intraepithelial lesions by human papillomavirus 16 status; and 3) investigate high-risk human papillomavirus negative anal high-grade squamous intraepithelial lesion cases. In this retrospective study, 700 people living with HIV who have biopsy-proven anal high-grade squamous intraepithelial lesions were reviewed for demographics, cytological diagnoses, and human papillomavirus testing results for human papillomavirus 16, 18, and 12 other high-risk types. For human papillomavirus-negative subjects, corresponding biopsies were genotyped by using real-time polymerase chain reaction. This study was conducted in a large urban HIV clinic system and major referral center for anal cancer screening. Median age was 46 years (range, 20-76). Ninety-one percent of the patients were men who have sex with men. The primary outcome measure was the association between demographic variables and human papillomavirus 16 status. Anal cytology was unsatisfactory (5%), benign (13%), atypical squamous cells of undetermined significance (35%), low-grade squamous intraepithelial lesion (36%), and high-grade squamous intraepithelial lesions (11%). Human papillomavirus cotesting results were negative (n = 38, 5%), human papillomavirus 16 (n = 303, 43%), human papillomavirus 18 (n = 78, 11%), or exclusively non-16/18 types (n = 281, 40%). Human papillomavirus 16 positivity was associated with ≥3 high-grade lesions and ≥ low-grade squamous intraepithelial lesion cytology (p < 0.001). Age, race/ethnicity, sex, smoking, CD4+ T-cell count, and HIV viral load did not differ by status of human papillomavirus 16 (p > 0.05). For human papillomavirus-negative cases, human papillomavirus genotyping of biopsies was positive for high-risk (n = 14, 36%) or possibly carcinogenic types (n = 12, 32%), or negative (n = 12, 32%). This was a retrospective data analysis, and it pooled the results for 12 high-risk human papillomavirus types rather than individual types. Nearly all people living with HIV and anal high-grade squamous intraepithelial lesions test positive for high-risk human papillomavirus on anal swabs; negative results may be due to sampling error, L1-based polymerase chain reaction assay, or human papillomavirus types not captured by standard clinical assays. Patients who have human papillomavirus 16-positive anal high-grade squamous intraepithelial lesions are indistinguishable from others based on demographic and clinical characteristics, underscoring the potential role of human papillomavirus testing for anal cancer screening. See Video Abstract at http://links.lww.com/DCR/B208. PACIENTES PORTADORES DE VIH CON PRECURSORES DE CÁNCER DE ANO: CARACTERÍSTICAS CLINICOPATOLÓGICAS Y DISTRIBUCIÓN DEL SUBTIPO VPH: Los pacientes portadores de VIH tienen altas tasas de infección por VPH y alto riesgo de desarrolar lesiones precáncerosas / cáncerosas del ano.(1) Determinar la distribución del subtipo de VPH entre las personas portadoras de VIH con lesiones intraepiteliales escamosas anales de alto grado. (2) Comparar las características clinicopatológicas de pacientes con lesiones intraepiteliales escamosas anales de alto grado del subtipo VPH 16. (3) Investigar casos de lesiones intraepiteliales escamosas anales de alto grado negativas para el VPH de alto riesgo.Estudio retrospectivo sobre 700 personas portadoras de VIH con lesiones intraepiteliales escamosas anales de alto grado confirmadas por biopsia. Los datos fueron revisados para determinar información demográfica, diagnósticos citológicos y resultados de tipización en el VPH subtipos 16 y 18, y otros 12 tipos de alto riesgo. Para los individuos negativos al VPH, se analizó el genotipo en las biopsias correspondientes mediante test de PCR en tiempo real.Extenso sistema de clinicas urbanas tratando VIH y un importante centro de referencia para la detección del cáncer analla mediana de edad poblacional fue de 46 años (rango, 20-76). 91% eran hombres que tenían sexo con hombres.Asociación entre las variables demográficas y el estado del VPH subtipo16.la citología anal fue insatisfactoria (5%), benigna (13%), células escamosas atípicas de importancia indeterminada (35%), lesión intraepitelial escamosa de bajo grado (36%) y lesiones intraepiteliales escamosas de alto grado (11%). Los resultados de la prueba conjunta del VPH fueron negativos (n = 38, 5%), el virus del VPH subtipo 16 (n = 303, 43%), el VPH subtipo 18 (n = 78, 11%) o los subtipos exclusivamente no 16/18 (n = 281, 40%). La positividad del VPH subtipo 16 se encotraba asociado con ≥3 lesiones de alto grado y ≥ células escamosas atípicas en la prueba de citología de indeterminada importancia (p < 0.001). La edad, la raza / etnia, el sexo, el tabaquismo, el recuento de células T CD4 + y la carga viral del VIH no difirieron según el estado del VPH subtipo 16 (p > 0.05). Para los casos negativos al VPH, el genotipo del virus del papiloma humano de las biopsias fue positivo para los tipos de alto riesgo (n = 14, 36%) o posiblemente carcinogénicos (n = 12, 32%), o negativo (n = 12, 32%).Análisis de datos retrospectivos, con resultados agrupados para 12 tipos de VPH de alto riesgo en lugar de tipos individuales.Casi todas las personas portadoras de VIH con lesiones intraepiteliales escamosas anales de alto grado dan positivo para el VPH de alto riesgo al muestreo de hisopos anales; Los resultados negativos pueden deberse a un error en el muestreo y al análisis de PCR basado en L1 o subtipos de VPH no obtenidos en los ensayos clínicos estándar. Los pacientes con lesiones intraepiteliales escamosas anales de alto grado positivas para el VPH subtipo 16 no son identificables de los demás, en función de las características demográficas y clínicas, lo que minimiza el rol potencial de la prueba del VPH en la detección del cáncer anal. Consulte Video Resumen en http://links.lww.com/DCR/B208. (Traducción-Dr. Xavier Delgadillo).

[Hepatitis non-A, non-B: epidemiological significance in acute viral hepatitis and chronic active hepatitis of hepatological consultation].

157 acute viral hepatitis and 60 chronic active ones have been analyzed focusing on NANB etiology. HAV was implicated in 36.3% of the hole acute viral hepatitis sample, HBV in 29.3%, and HNANBV was presumed as etiology in 31.2%, 5 patients (3.2%) had acute infection by HAV, on previous one by HBV, except for Epstein-Barr virus, no other test for viruses were determined (CMV, HSV, etc.). Male/female ratio was 1.4:1, 1.9:1, and 1.4:1 for HAV, HBV and HNANBV acute hepatitis respectively; HAV was the main etiology in the 0-9 age group (72.2%) although it only represents 11.5% of the sample; small occurrence of HAV hepatitis were found in patients over 40 (8.8%); HBV was clearly prevalent in patients over 50 (65.2%); the highest concentration of NANB etiology was found between 20-39 years old, but it was represented in all age-groups. Out of 49 NANB acute hepatitis, 12.2% had related transfusional antecedents, 12.2% belonged to health care worker group, and 4.1% had a close family NANB hepatitis contact; 71.5% had no reported antecedent. Viral source was presumably implicated in 75.0% of chronic active hepatitis, 25.0% attributable to HNANBV. Results seem not feasible to transfer to general population due to the facts that most patients were of specialized consult, and pediatric assistance is unusual to the authors practice.

[Prevalence of hepatitis A, B, C and E virus markers among patients with elevated levels of Alanine aminotransferase and Aspartate aminotransferase in Phnom Penh (Cambodia) and Nha Trang (Central Vietnam)].

In order to describe the respective part of viral hepatitis in liver diseases observed in Cambodia and Vietnam, ninety consecutive patients with Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) > or = 100 Ul/l were tested for hepatitis A, B, C and E markers in Phnom Penh and Nha Trang. The markers were IgM antibodies to hepatitis A virus (anti-HAV IgM), hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (anti-HCVAb) and IgG antibodies to hepatitis E virus (anti-HEV IgG). Recruited patients were predominantly adults and male (sex ratio 76%). Among these patients, 81% were tested positive to at least one marker in Nha Trang and 79% in Phnom Penh. In Nha Trang, HBsAg was more frequent (73%) than anti-HCV Ab (9%) while in Phnom Penh both markers were closely similar (HBsAg: 41%, anti-HCV Ab: 39%). In both population samples, HBsAg was more prevalent among young people whereas anti-HCV Ab were only detected in adults. No case of acute HAV infection was diagnosed in Nha Trang while anti-HAV IgM were detected in 20% of Cambodian patients. Anti-HEV IgG were infrequent (2% in Nha Trang, 5.5% in Phnom Penh). Only one case was notified, a male Vietnamese patient probably suffering from acute hepatitis E. More studies would be useful to improve the control measures against viral hepatitis in the public health programs.