Search

The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline. Fil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Tanno, Mario. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Hospital Nacional del Centenario; Argentina Fil: Aballay Soteras, Gabriel. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina Fil: Tisi Baña, Matías. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Dirchwolf, Melisa. Hospital Privado de Rosario; Argentina Fil: Fassio, Eduardo. Hospital Nacional Profesor Alejandro Posadas.; Argentina Fil: Ruf, Andrés. Hospital Privado de Rosario; Argentina Fil: Mengarelli, Silvia Estela. Gobierno de la Provincia de Entre Rios. Hospital San Roque.; Argentina Fil: Borzi, Silvia. Hospital Privado de Cordoba; Argentina Fil: Fernández, Nora. Hospital Británico de Buenos Aires; Argentina Fil: Ridruejo, Ezequiel. Universidad Austral. Hospital Universitario Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Descalzi, Valeria. Fundación Favaloro; Argentina Fil: Anders, Margarita. Hospital Alemán; Argentina Fil: Mazzolini, Guillermo. Universidad Austral; Argentina Fil: Reggiardo, Virginia. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Doctor Cosme Argerich; Argentina Fil: Marciano, Sebastian. Hospital Italiano. Departamento de Medicina.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Perazzo, Florencia. Hospital Británico de Buenos Aires; Argentina Fil: Spina, Juan Carlos. Hospital Italiano; Argentina Fil: McCormack, Lucas. Hospital Alemán; Argentina Fil: Maraschio, Martín Alejandro. Hospital Privado de Cordoba; Argentina Fil: Lagues, Cecilia. Universidad Austral; Argentina Fil: Gadano, Adrián Carlos. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Villamil, Federico. Hospital Italiano. Departamento de Medicina.; Argentina. Hospital Británico de Buenos Aires; Argentina Fil: Silva, Marcelo. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Cairo, Fernando. Hospital Británico de Buenos Aires; Argentina Fil: Ameigeiras, Beatriz. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina

The development of new direct acting antiviral drugs for the treatment of Hepatitis C virus infection, has made it possible to obtain an excellent cure rate and extend the indications for eradication of Hepatitis C virus to previously very difficult populations to treat like cystic fibrosis, in whom treatment with classic regimens based on pegylated Interferon plus ribavirin could favor worsening lung function. We present a case of a 41-year-old man with cystic fibrosis, diagnosed with Hepatitis C virus infection, genotype 1a, non-cirrhotic, treated with direct acting antiviral drugs for twelve weeks, obtaining a sustained viral response, without adverse effects. One year later, being on the waiting list, underwent a bipulmonary transplant.

INTRODUCTION Although the effectiveness of direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C virus (HCV) has been reported in real-world settings, predictive factors of treatment failure are lacking. Therefore, we sought to explore the baseline predictors of treatment response to DAAs. METHODS This was a prospective multicenter cohort study from the Latin American Liver Research Educational and Awareness Network (LALREAN) including patients who received DAA treatment from May 2016 to April 2019. A multivariate logistic regression model was conducted to identify variables associated with unachieved sustained virological response (SVR), defined as treatment failure (odds ratios [OR] and 95% confidence intervals [CIs]). RESULTS From 2167 patients (55.2% with cirrhosis) who initiated DAA therapy, 89.4% completed a full-course treatment (n = 1938). Median treatment duration was 12 weeks, and 50% received ribavirin. Definitive suspension due to intolerance or other causes was observed in only 1.0% cases (n = 20). Overall non-SVR12 was 4.5% (95% CI, 3.5-5.7). There were no significant differences in treatment failure according to HCV genotypes and the degree of fibrosis. Independently associated variables with DAA failure were liver function impairment according to the Child-Pugh score B OR, 2.09 (P = .06), Child-Pugh C OR, 11.7 (P

The increase survival of adult patients with Cystic Fibrosis (CF) has generated a greater relevance of extra pulmonary disease. Objective. Determine digestive, nutritional commitment and its impact on the survival of adult patients with CF. Methods. Retrospective, descriptive and comparative study of 100 adult patients with CF, assisted between 2003 and 2017. It was evaluated: clinical parameters, genetic, body mass index (BMI), respiratory function tests, bacteriological sputum, pancreatic insufficiency (PI), CF-related diabetes (CFRD), acute pancreatitis (AP), liver cirrhosis and biliary lithiasis. Results. 100 patients were evaluated [median age: 26 years (range: 16-65)]. Median age at diagnosis: 2 years. Mean BMI 21.5 ± 2.6 SD kg/m2. PI 69/100 (69%), CFRD 29 patients (29%), AP 4 patients (4%). Liver cirrhosis 6 patients (6%) and biliary lithiasis 21 patients (21%).Median Forced Expiratory Volume in first second (FEV1) 50%. Most frequent mutation ΔF508 (54%). Fourteen patients (14%) malnourished. Pseudomonas aeruginosa was the most frequent colonizing microorganism (67%), with a median overall survival of 160 months (95% CI 131-160). We found lower survival in those patients who had PI [(mean 124.2 vs. 136 months (p = 0.4)], malnutrition [median 60 vs. 160 months (p = 0.001)] and cirrhosis [median 36 vs. 160 months (p = 0.003).] Conclusion. Digestive diseases and malnutrition influence negatively in the survival of adult patients with CF.

Resumen: Objetivos: Estimar la proporción de pacientes que acceden al tratamiento de la hepatitis C con antivirales de acción directa (AAD) en Argentina, y evaluar factores asociados a la falta de acceso. Métodos: Estudio de cohorte transversal que incluyó la totalidad de prescripciones consecutivas de AAD realizadas entre enero de 2016 y febrero de 2017 por centros de salud que participan en el proyecto de telemedicina ECHOTM dirigido por el Hospital Italiano de Buenos Aires. Resultados: Se incluyeron 143 prescripciones de tratamiento. El acceso global fue del 70% (IC 95%: 62-77%). Pertenecer al sistema de salud público fue el único factor independiente asociado con la falta de acceso al tratamiento [OR 4.98 (IC95% 2.05-12.09)]. Conclusión: Los pacientes con hepatitis C pertenecientes al sistema de salud público tienen 4 veces más chances de no acceder a tratamiento con AAD que los pacientes con dependencia de otros sistemas de salud (medicina privada u obras sociales). Abstract: Aims: To estimate the number of patients that have access to treatment of hepatitis C with direct-acting antivirals in Argentina and evaluate the factors associated with the lack of access. Materials and methods: A cross-sectional cohort study was conducted that included all the consecutive prescriptions of direct-acting antivirals issued at health centers that participated in the ECHOTM telemedicine project directed by the Hospital Italiano de Buenos Aires, within the time frame of January 2016 and February 2017. Results: A total of 143 treatment prescriptions were included and overall access was 70% (95% CI 62-77%). The only independent factor associated with a lack of treatment access was coverage by a public healthcare system (OR 4.98 [95% CI 2.05- 12.09]). Conclusion: Patients with hepatitis C that were covered by a public healthcare system had a 4 times higher chance of not having access to treatment with direct-acting antivirals than patients covered by other healthcare systems (private insurance or the social welfare system). Palabras clave: Antivirales de acción directa, Acceso, Hepatitis C, Sistemas de salud, Barreras, Keywords: Direct-acting antiviral agents, Access, Hepatitis C, Healthcare systems, Barriers

Aims: To estimate the number of patients that have access to treatment of hepatitis C with direct-acting antivirals in Argentina and evaluate the factors associated with the lack of access. Materials and methods: A cross-sectional cohort study was conducted that included all the consecutive prescriptions of direct-acting antivirals issued at health centers that participated in the ECHOTM telemedicine project directed by the Hospital Italiano de Buenos Aires, within the time frame of January 2016 and February 2017. Results: A total of 143 treatment prescriptions were included and overall access was 70% (95% CI 62-77%). The only independent factor associated with a lack of treatment access was coverage by a public healthcare system (OR 4.98 [95% CI 2.05- 12.09]). Conclusions: Patients with hepatitis C that were covered by a public healthcare system had a 4 times higher chance of not having access to treatment with direct-acting antivirals than patients covered by other healthcare systems (private insurance or the social welfare system). Resumen: Objetivos: Estimar la proporción de pacientes que acceden al tratamiento de la hepatitis C con antivirales de acción directa (AAD) en Argentina, y evaluar factores asociados a la falta de acceso. Métodos: Estudio de cohorte transversal que incluyó la totalidad de prescripciones consecutivas de AAD realizadas entre enero de 2016 y febrero de 2017 por centros de salud que participan en el proyecto de telemedicina ECHOTM dirigido por el Hospital Italiano de Buenos Aires. Resultados: Se incluyeron 143 prescripciones de tratamiento. El acceso global fue del 70% (IC95%: 62-77%). Pertenecer al sistema de salud público fue el único factor independiente asociado con la falta de acceso al tratamiento [OR 4.98 (IC95% 2.05-12.09)]. Conclusión: Los pacientes con hepatitis C pertenecientes al sistema de salud público tienen 4 veces más chances de no acceder a tratamiento con AAD que los pacientes con dependencia de otros sistemas de salud (medicina privada u obras sociales). Keywords: Direct-acting antivirals, Access, Hepatitis C, Healthcare systems, Barriers, Palabras clave: Antivirales de acción directa, Acceso, Hepatitis C, Sistemas de salud, Barreras

We report the first real-world prospective multicenter cohort study that evaluated the effectiveness and safety of original or generic sofosbuvir-based regimens in patients with chronic hepatitis C in Latin America. The main endpoints were assessment of sustained virological response and serious adverse events rates. A total of 321 patients with chronic hepatitis C treated with the following regimens were included: sofosbuvir plus daclatasvir for 12 (n = 34) or 24 (n = 135) weeks, sofosbuvir plus daclatasvir plus ribavirin for 12 (n = 84) or 24 (n = 56) weeks, or sofosbuvir plus ribavirin for 12 (n = 8) or 24 (n = 2) weeks. Patients received either original sofosbuvir (Sovaldi® , Gilead Sciences, n = 135) or generic sofosbuvir (Probirase® , Laboratorios RICHMOND, n = 184) which were randomly assigned by the National Ministry of Health. Overall, 292 (91%) patients had cirrhosis, 136 (42%) were treatment experienced, and 240 (75%) genotype 1. The overall sustained virological response was 90% (95% CI 86-93%); 91% (95% CI 84-95%) in patients who received Sovaldi® , and 89% (95% CI 84-93%) in patients who received Probirase® . Anemia was the most common adverse event and was reported in 52 (17%) patients. Bacterial infection, gastrointestinal bleeding, worsening of ascites or encephalopathy occurred in less than 5% of the patients. During the study, seven (2%) patients died, four of whom died of cirrhosis-related complications. In summary, we observed similar sustained virological response rates than prior studies, both in patients who received Sovaldi® or Probirase® . Serious adverse events were infrequent, in line with prior studies that included patients with cirrhosis treated with protease-inhibitor-free regimes.

Background: Predicting short-term mortality in patients with cirrhosis and bacterial infections is challenging. Aims: To compare the performance of various scores in predicting in-hospital mortality in this population. Methods: We performed an analysis of the multicenter prospective cohort study of patients with cirrhosis with bacterial infections throughout Argentina and Uruguay (clinicatrials.gov.NCT03919032). Patients were classified according to the CLIF criteria as having ACLF or mere acute decompensation (AD). We evaluated the performance of scores of liver disease and infection severity in predicting in-hospital mortality. MELD, MELD-Na, and Quick SOFA (qSOFA) were computed in all patients. CLIF-AD was only computed in patients without ACLF, and CLIF-ACLF only in patients with ACLF. We plotted ROC curves and estimated their area under the curve (AUROC). Results: We included 472 patients: 66% male, mean age 57 ± 12 years. Most frequent infections: SBP (30%) and urinary tract infection (25%). Overall, 332 (70%) patients had acute decompensation, and 140 (30%) ACLF. In-hospital mortality rate was 19%: 41% in patients with ACLF vs 10% in patients with AD (p

Background: Antibiotic de-escalation is considered a safe strategy that reduces costs and the risk of multi-drug resistant infections. However, its prevalence and associated factors in real-life practice were not reported in patients with cirrhosis in Latin-America. Aims: To estimate the prevalence of antibiotic de-escalation in patients with cirrhosis in real life-practice, and to explore its associated factors. Methods: We performed an analysis of the multicenter prospective cohort study of cirrhotic patients with bacterial infections throughout Argentina and Uruguay (clinicatrials.gov NCT03919032). Patients who died in the first 72 hs from the diagnosis of the infection were excluded. In accordance with guidelines, de-escalation was defined as changing the initially antimicrobials to a narrower spectrum regimen, or suspending one or more of the empirical antibiotics, according to culture results or to other clinical reasons, either in patients with culture-positive or culture-negative bacterial infections. We used inverse probability weighting (IPW) of having a culture-positive infection to estimate its causal effect on de-escalation. Results: We included 450 patients. Most frequent infections were SBP (30.4%), and urinary tract infection (12.9%). Overall, 243 (54%) infections were culture-positive, and 207 (46%) culture-negative. De-escalation was reported in 85 patients (18.9%: 95% CI 15%-22%) at a mean of 3.3 ± 2.4 days from treatment initiation and was more frequent in culture-positive than culture-negative infections (28.4% vs 7.7%, p< 0.001). The table shows the crude analyses of variables associated with de-escalation. Culture-positive infection was strongly and independently associated with de-escalation (ORIPW 6.08; 95% CI: 2.90-12.70; p < 0.001). Conclusions: Antibiotic de-escalation was reported in one-fifth of in-patients with cirrhosis. Given that having a culture-positive infection had a strong effect on de-escalation, efforts should be made to increase the likelihood of obtaining adequate culture samples in a timely manner.

Background & Aims Little is known about how a sustained virologic response (SVR) to treatment of hepatitis C virus infection with direct-acting antivirals (DAAs) affects patient mortality and development of new liver-related events. We aimed to evaluate the incidence of disease progression in patients treated with DAAs. Methods We performed a prospective multicenter cohort study of 1760 patients who received DAA treatment at 23 hospitals in Latin America, from May 1, 2016, through November 21, 2019. We excluded patients with a history of liver decompensation, hepatocellular carcinoma (HCC), or solid-organ transplantation. Disease progression after initiation of DAA therapy included any of the following new events: liver decompensation, HCC, liver transplantation, or death. Evaluation of variables associated with the primary outcome was conducted using a time-dependent Cox proportional hazards models. Results During a median follow-up period of 26.2 months (interquartile range, 15.3–37.5 mo), the overall cumulative incidence of disease progression was 4.1% (95% CI, 3.2%–5.1%), and after SVR assessment was 3.6% (95% CI, 2.7%–4.7%). Baseline variables associated with disease progression were advanced liver fibrosis (hazard ratio [HR], 3.4; 95% CI, 1.2–9.6), clinically significant portal hypertension (HR, 2.1; 95% CI, 1.2–3.8), and level of albumin less than 3.5 mg/dL (HR, 4.1; 95% CI, 2.3–7.6), adjusted for SVR achievement as a time covariable. Attaining an SVR reduced the risk of liver decompensation (HR, 0.3; 95% CI, 0.1–0.8; P = .016) and de novo HCC (HR, 0.2; 95% CI, 0.1%–0.8%; P = .02) in the overall cohort. Conclusions Treatment of hepatitis C virus infection with DAAs significantly reduces the risk of new liver-related complications and should be offered to all patients, regardless of disease stage. Clinicaltrials.gov: NCT03775798 .

There is scarce data pertaining to acute hepatitis C (aHC) infection in South America. We aimed to describe clinical characteristics and evolution of aHC in a South American cohort. A retrospective survey was conducted at 13 hepatology units. All patients ≥16 years old with aHC diagnosis were included. Demographic, clinical and outcome information were registered in a standardized ad hoc questionnaire. Sixty-four patients were included. The majority were middle-aged (median age: 46 years) and female (65.6%); most of them were symptomatic at diagnosis (79.6%). HCV-1 was the most prevalent genotype (69.2%). Five patients had liver failure: three cases of severe acute hepatitis, one case of fulminant hepatitis and one case of acute-on-chronic liver failure. Nosocomial exposure was the most prevalent risk factor. Evolution was assessed in 46 patients. In the untreated cohort, spontaneous resolution occurred in 45.8% and was associated with higher values of AST/ALT and with the absence of intermittent HCV RNA viremia (P = 0.01, 0.05, and 0.01, respectively). In the treated cohort, sustained virological response was associated with nosocomial transmission and early treatment initiation (P = 0.04 each). The prevalence of nosocomial transmission in this South-American cohort of aHC stresses the importance of following universal precautions to prevent HCV infection. J. Med. Virol. 89:276-283, 2017. © 2016 Wiley Periodicals, Inc.

There is scarce data pertaining to acute hepatitis C (aHC) infection in South America. We aimed to describe clinical characteristics and evolution of aHC in a South American cohort. A retrospective survey was conducted at 13 hepatology units. All patients ≥16 years old with aHC diagnosis were included. Demographic, clinical and outcome information were registered in a standardized ad hoc questionnaire. Sixty-four patients were included. The majority were middle-aged (median age: 46 years) and female (65.6%); most of them were symptomatic at diagnosis (79.6%). HCV-1 was the most prevalent genotype (69.2%). Five patients had liver failure: three cases of severe acute hepatitis, one case of fulminant hepatitis and one case of acute-on-chronic liver failure. Nosocomial exposure was the most prevalent risk factor. Evolution was assessed in 46 patients. In the untreated cohort, spontaneous resolution occurred in 45.8% and was associated with higher values of AST/ALT and with the absence of intermittent HCV RNA viremia (P = 0.01, 0.05, and 0.01, respectively). In the treated cohort, sustained virological response was associated with nosocomial transmission and early treatment initiation (P = 0.04 each). The prevalence of nosocomial transmission in this South-American cohort of aHC stresses the importance of following universal precautions to prevent HCV infection. J. Med. Virol. 89:276-283, 2017. © 2016 Wiley Periodicals, Inc.

Resumen Fundamento y objetivos Investigar la presencia de hipertransaminasemia, como expresion bioquimica de dano hepatico, y correlacionarla con la exposicion a hidrocarburos (benceno, tolueno y xileno BTX) en trabajadores de una empresa petroquimica. Pacientes y metodo Se revisaron las historias clinicas de 167 empleados, 95 expuestos (GE) y 72 no expuestos (GNE), y se evaluaron los siguientes parametros: edad, sexo, antiguedad laboral, indice de masa corporal y pruebas bioquimicas. Se excluyo a los que presentaban hepatopatia previa, diabetes mellitus o ingesta de alcohol > 50 g/dia. En los que se hallo hipertransaminasemia se realizaron las siguientes pruebas: proteinograma, protrombina, anti-HBc, HBsAg, anti-VHC y ecografia hepatica. Tres operarios comprendidos en el GE fueron excluidos, 2 por presentar marcadores sericos de virus de hepatitis B y otro por haber decidido no participar en el estudio; en definitiva, el GE quedo constituido por 92 trabajadores. Se midieron los contaminantes ambientales. Resultados Veintisiete individuos del GE (29,4%) y uno del GNE (1,4%) presentaron hipertransaminasemia (p = 0,001). El resto de las pruebas bioquimicas, hemograma y de los otros parametros analizados no mostraron diferencias entre ambos grupos. Iguales parametros se evaluaron entre GE1 (ALAT normal) y GE2 (elevada) sin hallarse diferencias. En la ecografia se hallo compatibilidad con higado graso en 14 (51,9%) de los 27 pacientes del GE2. Un individuo (1,4%) del GNE presento alanino-aminotransferasa elevada y ecografia compatible con higado graso. Los valores de compuestos organicos volatiles ambientales resultaron inferiores a las 5 ppm exigidas durante los 9 meses que duro el estudio (benceno 1,5 ppm, tolueno 10 ppm, y xileno 18,5 ppm). La odds ratio para desarrollar hipertransaminasemia en el GE fue de 27,7 (p = 0,002). Conclusiones La exposicion laboral a hidrocarburos volatiles puede ocasionar dano hepatico. El higado, segun nuestros hallazgos, aparece como mas vulnerable a los hidrocarburos volatiles que la medula osea. Estas conclusiones deberian servir para modificar las normas de tolerabilidad ambiental vigentes en las refinerias de Argentina.

El compromiso hepático en receptores de trasplante alogénico de células progenitoras hematopoyéticas (TCPH) es una complicación muy frecuente y es responsable de la morbimortalidad precoz. La toxicidad por fármacos, la enfermedad injerto versus huésped (EICH), la enfermedad venooclusiva (EVO) y las infecciones fúngicas, bacterianas y virales constituyen las principales etiologías. El objetivo de este estudio retrospectivo fue establecer la prevalencia y etiología de la afectación hepática, evaluar el impacto en la mortalidad y analizar el valor predictivo de las transaminasas pre TCPH en la ocurrencia de EICH agudo, crónico y mortalidad. De un total de 236 pacientes trasplantados, se evaluaron 82 sometidos a TCPH alogénico. El 88% de los pacientes tuvo afectación hepática: EICH agudo 40.2%, EICH crónico 15.9%, de causa indeterminada 9.8%, sepsis 7.3%, toxicidad por fármacos 6.1%, EVO 3.7%, hepatitis aguda y recidiva de enfermedad 2.4%. La mortalidad evaluada al año fue 36.6%. La insuficiencia hepática aguda (IHA) representó el 10% de las muertes. Las causas de IHA fueron: progresión de EICH agudo, recidiva de la enfermedad hematológica en el hígado, hepatitis herpética y EVO. El valor predictivo positivo de las transaminasas pre TCPH para EICH agudo, crónico y mortalidad fue 0.27, 0.14 y 0.43 respectivamente. No se hallaron diferencias significativas entre pacientes con pruebas bioquímicas hepaticas pre TCPH alteradas o normales en la ocurrencia de EICH agudo, crónico o mortalidad.Liver disease is a well-known cause of early morbidity and mortality affecting 80% of patients receiving allogeneic bone-marrow transplantation (BMT). Drug toxicity, veno-occlusive disease (VOD), acute graft-versus-host disease (GVHD), and fungal, bacterial, and viral infections are the most frequent hepatic complications during this period. The aim of this retrospective study was to determine the prevalence and etiology of liver disease and its impact on mortality as well as to assess the predictive value of pre BMT hepatic biochemical tests on the subsequent occurrence of acute and/or chronic GVHD and patient mortality. Of a total of 236 patients who underwent allogeneic BMT, 82 were analysed. Liver dysfunction was found in 88%. The causes of liver disease were: acute GVHD, 40.2%; chronic GVHD, 15.9%; unknown, 9.8%; sepsis, 7.3%; hepatotoxicity, 6.1%; VOD, 3.7%; acute hepatitis and disease recurrence, 2.4%.The mortality rate was 37%. We found acute liver failure (ALF) in 10% of the deaths (8 patients). The causes of ALF in these cases were acute GVHD progression in 5, herpetic hepatitis in 1, disease recurrence in 1, and VOD in 1. The correlation coefficients indicating positive predictive values of pre BMT hepatic biochemical tests for the subsequent occurrence of acute GVHD, chronic GVHD, and mortality were 0.27, 0.14, and 0.43, respectively. There was no significant difference between patients with abnormal or normal pre BMT liver function tests in the frequency of acute and chronic GVHD or mortality.

We present a 26-year-old man who developed severe acute hepatitis after consumption of an Aloe vera tea. On admission, the patient showed characteristic biochemical and clinical features of acute hepatitis and liver failure. The patient reported that he had been drinking an Aloe vera tea 2-4 weeks before symptom onset. Other causes of acute hepatitis were excluded and the patient improved after withdrawal of the Aloe vera tea. Aloe vera should be considered as a possible cause in cases of acute hepatitis.

The Dubin-Johnson syndrome is a hereditary deficiency in the excretion ofconjugated bilirrubin by hepatocytes characterized by chronic hyperbilirubinemia, alteration in coproporphyrin metabolism, and intracellular deposition of a dark melanin-like pigment giving the liver a typical black cast. We report a 28-year-old male patient who presented conjunctival jaundice and conjugated-hyperbilirubinemia without no other alteration in hepatic biochemistry. The diagnosis of this syndrome was perfomed by using the low-risk methods of laparoscopy-facilitated hepatic biopsy and oral cholecystography In contrast, we avoided the classical Bromsulphalein test because of potential severe side effects. We stress here the current importance of these tests for confirming the diagnosis. By using this methodology, we were not able to quantify the isomeric profile of the urinary coproporphyrins nor 99mTc-HIDA cholescintigraphy. In conclusion, we confirm the utility of hepatic biopsy with the aid of laparoscopy and oral cholecystography for the diagnosis of the Dubin-Johnson syndrome on the basis of their effectiveness and relative lack of complications.

We present a 26-year-old man who developed severe acute hepatitis after consumption of an Aloe vera tea. On admission, the patient showed characteristic biochemical and clinical features of acute hepatitis and liver failure. The patient reported that he had been drinking an Aloe vera tea 2-4 weeks before symptom onset. Other causes of acute hepatitis were excluded and the patient improved after withdrawal of the Aloe vera tea. Aloe vera should be considered as a possible cause in cases of acute hepatitis.

The aim of this study was to investigate the occurrence of hypertransaminasemia (hTAMSemia) as an indicator of liver damage and to establish the association of this hepatotoxicity with exposure to aromatic hydrocarbons (benzene, toluene, and xylene [BTX]) among workers in a petrochemical company.The medical records of 167 industrial employees, 95 with hydrocarbon exposure (EHCs) and 72 without exposure (NEHCs) were reviewed. Age, sex, number of years employed, body mass index, and biochemical and hematological parameters were evaluated. Employees with previous liver disease, diabetes mellitus, or alcohol intake (50 g/day) were excluded. In employees with hTAMSemia, we performed a proteinogram and hepatic ultrasonography and tested blood samples for prothrombin and hepatitis B and C markers. Within this subgroup, 3 workers were excluded (due to serum markers of hepatitis B virus in 2 and refusal to participate in 1), leaving a total of 92 in the EHC group. Finally, the working environment was screened for volatile contaminants.Twenty-seven employees from the EHC group (29.4%) and 1 from the NEHC group (1.4%) had hTAMSemia (p = 0.001). The remaining biochemical tests and parameters measured showed no significant differences between the two groups. Comparison between the EHC subgroup of 27 workers showing hTAMSemia and the remainder of the EHC group with normal values (65 workers) revealed no differences in the other parameters measured. Of the 27 workers of the former subgroup, 14 (51.9%) showed ultrasonographic images compatible with a fatty liver. One worker (1.4%) in the NEHC group showed hTAMSemia and ultrasonography compatible with fatty liver. The environmental levels of BTX during the 9 months of the study remained below the maximum values permitted by law in Argentina (benzene, 1.5 ppm., toluene 10 ppm and xylene 18.5 ppm). The odds ratio of developing hTAMSemia in the EHC group was 27.7 (p = 0.002).Occupational exposure to aromatic hydrocarbons may cause liver damage. The liver is more vulnerable to these hydrocarbons than bone marrow. These conclusions would argue for a modification of the environmental regulations currently in force within the petroleum refineries in Argentina.

Liver disease is a well-known cause of early morbidity and mortality affecting 80% of patients receiving allogeneic bone-marrow transplantation (BMT). Drug toxicity, veno-occlusive disease (VOD), acute graft-versus-host disease (GVHD), and fungal, bacterial, and viral infections are the most frequent hepatic complications during this period. The aim of this retrospective study was to determine the prevalence and etiology of liver disease and its impact on mortality as well as to assess the predictive value of pre BMT hepatic biochemical tests on the subsequent occurrence of acute and/or chronic GVHD and patient mortality. Of a total of 236 patients who underwent allogeneic BMT, 82 were analysed. Liver dysfunction was found in 88%. The causes of liver disease were: acute GVHD, 40.2%; chronic GVHD, 15.9%; unknown, 9.8%; sepsis, 7.3%; hepatotoxicity, 6.1%; VOD, 3.7%; acute hepatitis and disease recurrence, 2.4%. The mortality rate was 37%. We found acute liver failure (ALF) in 10% of the deaths (8 patients). The causes of ALF in these cases were acute GVHD progression in 5, herpetic hepatitis in 1, disease recurrence in 1, and VOD in 1. The correlation coefficients indicating positive predictive values of pre BMT hepatic biochemical tests for the subsequent occurrence of acute GVHD, chronic GVHD, and mortality were 0.27, 0.14, and 0.43, respectively. There was no significant difference between patients with abnormal or normal pre BMT liver function tests in the frequency of acute and chronic GVHD or mortality.

AIM: To evaluate pre-treatment factors associated with sustained virological response (SVR) in patients with hepatitis C virus (HCV) genotype 3 treated with peginterferon and ribavirin (RBV). METHODS: We retrospectively analyzed treatment naive, mono-infected HCV genotype 3 patients treated with peginterferon and RBV. Exclusion criteria included presence of other liver disease, alcohol consumption and African American or Asian ethnicity. The variables collected and compared between patients who achieved an SVR and patients who did not were as follows: gender, age, fibrosis stage, diabetes, body mass index, steatosis, INFL3 polymorphism, pre-treatment HCV-RNA, type of peginterferon, RBV dose and adherence. RESULTS: A total of 107 patients treated between June, 2004 and March, 2013 were included. Mean treatment duration was 25.1 (± 1.8) wk. Overall, 58% (62/107) of the patients achieved an SVR and 42% (45/107) did not. In the multivariate logistic regression analysis, pre-treatment HCV-RNA ≥ 600000 UI/mL (OR = 0.375, 95%CI: 0.153-0.919, P = 0.032) and advanced fibrosis (OR = 0.278, 95%CI: 0.113-0.684, P = 0.005) were significantly associated with low SVR rates. In patients with pre-treatment HCV-RNA ≥ 600000 UI/mL and advanced fibrosis, the probability of achieving an SVR was 29% (95%CI: 13.1-45.2). In patients with pre-treatment HCV-RNA < 600000 UI/mL and mild to moderate fibrosis, the probability of achieving an SVR was 81% (95%CI: 68.8-93.4). CONCLUSION: In patients with HCV genotype 3 infections the presence of advance fibrosis and high pre-treatment viral load might be associated with poor response to peginterferon plus RBV. These patients could benefit the most from new direct antiviral agents-based regimes. Fil: Marciano, Sebastián. Hospital Italiano; Argentina Fil: Borzi, Silvia Mabel. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina Fil: Dirchwolf, Melisa. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Ridruejo, Ezequiel. Universidad Austral. Hospital Universitario Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Bessone, Fernando. Sanatorio del Parque. Unidad de Hepatología; Argentina Fil: Sirotinsky, María Ester. Hepatosur group; Argentina Fil: Giunta, Diego Hernan. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; Argentina Fil: Trinks, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; Argentina Fil: Olivera Sendra, Pablo Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Galdame, Omar Andres. Hospital Italiano; Argentina Fil: Silva, Marcelo Oscar. Universidad Austral. Hospital Universitario Austral; Argentina. Hospital Italiano; Argentina Fil: Fainboim, Hugo. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina Fil: Gadano, Adrián Carlos. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina