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Introduction and Objectives: Infections in cirrhotic patients are frequent. Early diagnosis and treatment are essential to minimize the risk of serious complications. Currently, an epidemiological change in the causal bacterial agents is being evidenced. This study aimed to identify the involved bacterial infections in cirrhotic patients to determine the prevalence of multi and extremely-resistant and quinolone bacterial-resistant infections and to evaluate the mortality rate of these patients. Materials and Methods: Retrospective, descriptive and observational study including hospitalized patients older than 18 years with liver cirrhosis from September 2018 to October 2020. All of them were studied in a third-level of complexity hospital in Rosario, Argentina and admitted to suffering bacterial infections. Results: 70 patients were analyzed. The mean age was 47 years, male sex was 59%. The most frequent cause of cirrhosis was alcoholic (47%). Healthcare-associated infections predominated (44%). The most frequent infection was spontaneous bacterial peritonitis (21%). The most frequently isolated germs were Gram-negative (65%), with a predominance of E. Coli (45%). Gram-positive germs were recovered in 43%. Bacteria with high antibiotic resistance were isolated in 59.5% (E. coli, K. pneumoniae, enterococci) and 23% were associated with extremely resistant germs. No significant results were obtained when we compared the prophylactic use of quinolones, rifaximin, proton pump inhibitors, and previous use of antibiotics with the finding of resistant bacteria. The isolation of resistant germs was associated with a greater need for hemodialysis (p 0.034) and the presence of encephalopathy (p 0.044). Deaths (21%) were higher in those patients linked to systemic inflammatory response syndrome (SIRS) (p 0.036), in-hospital infections (p 0.017) and associated with resistant bacteria (p 0.02). Conclusions: A high percentage of both resistant and extremely resistant bacteria to treatment were found in our study. A high number of them were associated with gram-positive germs. These data indicate a change in the epidemiological behavior of cirrhotic infections.

Introduction and Objectives: Liver disease accounts for approximately 2 million deaths per year worldwide and is often not detected early in the general population. This study aimed to study the presence of liver disease in the general population of Rosario, Argentina (1.5 million inhabitants). Materials and Methods: 600 individuals over 18 years were studied who spontaneously attended our Hospital as part of a campaign called ''Take care of your liver,'' carried out from October 4 to 14, 2019. Anthropometric data, history of previous diseases and socioeconomic status were documented. Liver tests, serology for hepatitis A, B and C and abdominal ultrasound were also performed. IgG-HEV was analyzed in 400/600 (66%) of the cases. Hepatic elastography was performed in a subgroup of patients with steatosis. Results: 365/600 (61%) were women, a median age of 54 years (range 18-84). 222/600 (37%) had a BMI between 25-29.9 and >30 in 270/600 (45%). Alcohol intake between 30-60 gr/day was observed in 41/600 (7%) and >60 gr/day in 27/600 (4.5%). Anti-core IgG was positive in 33/600 (5.5%), while 3/600 (0.5%) were HBsAg positive. 8/600 (1.3%) presented HCV positive. ALT, AST, FAL and GGT levels were elevated at 6% (median 60 UI/L), 8,3% (median 64,5 UI/L), 17% (median 133 UI/L), 15% (median 109 UI/L), respectively. A diagnosis of steatosis was made in 235/600 (39%), of whom 17/600 (2.4%) had a BMI less than 25. Elastography in 65 pts with steatosis showed F4: 3, F3: 5, F2: 4, F0/F1: 53. As a finding, 40/600 (6.6%) presented liver cysts, 7/600 (1%) angiomas and 18/600 (3%) solid nodules. IgG-VHE was positive in 23/400 (5.75%). Conclusions: A high prevalence of fatty liver was observed in the general population of Rosario, where 2.4% corresponded to thin pts. Advanced hepatic fibrosis was found in 8 cases with steatosis. A strikingly elevated presence of IgG-HEV was documented.

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 <.0001); and liver transplant (LT) recipient OR, 3.75 (P =.01). Conclusion: In this real‐life setting, higher DAA treatment failure rates were observed in patients with decompensated cirrhosis and in LT recipients. These predictive baseline factors should be addressed to individualize the appropriate time‐point of DAA treatment (NCT03775798; www.clinicaltrials.gov). Highlights: SVR12 failure in clinical practice is low in Latin America (4.5%). End stage liver disease (Child B/C scores) and liver transplantation were independent predictors of DAA failure. Early DAA treatment to prevent disease progression is needed to avoid nonresponse to treatment. [ABSTRACT FROM AUTHOR]

Background & Aims: Data from Europe and North America have been published regarding the risk of developing hepatocellular carcinoma (HCC) after treatment with direct antiviral agents (DAA). We proposed to evaluate cumulative incidence and associated risk factors for de novo HCC. Methods: This was a prospective multicentre cohort study from Latin America including 1400 F1‐F4‐treated patients with DAAs (F3‐F4 n = 1017). Cox proportional regression models (hazard ratios, HR and 95% CI) were used to evaluate independent associated variables with HCC. Further adjustment with competing risk regression and propensity score matching was carried out. Results: During a median follow‐up of 16 months (IQR 8.9‐23.4 months) since DAAs initiation, overall cumulative incidence of HCC was 0.02 (CI 0.01; 0.03) at 12 months and 0.04 (CI 0.03; 0.06) at 24 months. Cumulative incidence of HCC in cirrhotic patients (n = 784) was 0.03 (CI 0.02‐0.05) at 12 months and 0.06 (CI 0.04‐0.08) at 24 months of follow‐up. Failure to achieve SVR was independently associated with de novo HCC with a HR of 4.9 (CI 1.44; 17.32), after adjusting for diabetes mellitus, previous interferon non‐responder, Child‐Pugh and clinically significant portal hypertension. SVR presented an overall relative risk reduction for de novo HCC of 73% (CI 15%‐91%), 17 patients were needed to be treated to prevent one case of de novo HCC in this cohort. Conclusions: Achieving SVR with DAA regimens was associated with a significant risk reduction in HCC. However, this risk remained high in patients with advanced fibrosis, thus demanding continuous surveillance strategies in this population. [ABSTRACT FROM AUTHOR]

Unlabelled: BACKGROUND & AIMS. Studies about the natural history of hepatitis C virus (HCV) infection report variable progression to cirrhosis depending on study design. Retrospective cross-sectional liver clinic studies overestimate the rate of fibrosis progression due to inclusion of patients with more severe disease leaving mild and asymptomatic patients underrepresented. We evaluated fibrosis progression in a group of "healthy" asymptomatic subjects, attending to a voluntary campaign for the detection of HCV infection., Material and Methods: A detection campaign was launched on subjects transfused before 1993. Of 1699 volunteers, 61(3.6%) had HCV infection. A liver biopsy was performed in 40 (65%). Assessed risk factors for liver fibrosis were: sex, body mass index, alcohol consumption (> 20 g/d - > 40g/d ), genotype, HLA-DRB1 alleles, present age, age at infection and duration of infection., Results: 25 (62.5%) were women with a median age of 52.5 years. The median duration of infection was 21.5 years with a median age at infection of 27 years. As regards fibrosis, 25 (62.5%) had a Low Stage (F0-F1), 8 patients, 20%, had severe fibrosis, one patient (2.5%) had cirrhosis. Alcohol consumption was the only risk factor associated with fibrosis progression., Conclusions: The low progression to cirrhosis may be explained by the clinical characteristics of our population: asymptomatic middle-aged "healthy" subjects infected at young age. The progression to severe fibrosis was noticeable; hence a longer follow-up might demonstrate changes in this outcome. Significant alcohol consumption clearly worsens the natural history of HCV infection; this is no so evident for occasional or mild alcohol consumers.

Objective: To obtain clinical and epidemiological information that could be relevant for the purpose of screening and diagnostic strategies in colorectal cancer (CRC)., Patients and Methods: A retrospective, descriptive, observational study was performed during a three year-period at the Hospital Provincial del Centenario in Rosario, Argentina. A population of symptomatic patients referred for colonoscopic examination was evaluated after the histopathologic diagnosis of colorectal adenocarcinoma was made. A total of 1.543 colonoscopies was evaluated. Relevant information was retrieved from clinical records, and endoscopic, pathologic and tomography examinations., Results: Eighty six cases of CRC were diagnosed, with an incidence rate of CRC in the study population of 5.6%. Eighty six percent of patients were older than 50 years. Seventy five percent of tumors were located in the sigmoid colon and rectum. Synchronic lesions were found in 5.8% of tumor cases. Type 2 stenotic lesions were preferentially found in the left colon, whereas the site of most type 1 lesions was within the right colon. Most tumors (89.70%) were moderately well-differentiated adenocarcinomas. The most frequent site of metastases was the liver (64%)., Conclusions: In this population of symptomatic patients, 75% of colorectal tumors were found in the sigmoid colon and rectum, with 5.8% of cases showing a second, synchronous tumor. More than 80% of neoplastic lesions occurred in patients aged 50 or older and almost 90% were moderately well-differentiated adenocarcinomas. These data suggest guidelines for a proper strategy to prevent CRC.