Hepatitis D virus (HDV) infection occurs as a coinfection with hepatitis B and increases the risk of hepatocellular carcinoma, decompensated cirrhosis, and mortality compared to hepatitis B virus ...(HBV) monoinfection. Reliable estimates of the prevalence of HDV infection and disease burden are essential to formulate strategies to find coinfected individuals more effectively and efficiently. The global prevalence of HBV infections was estimated to be 262,240,000 in 2021. Only 1,994,000 of the HBV infections were newly diagnosed in 2021, with more than half of the new diagnoses made in China. Our initial estimates indicated a much lower prevalence of HDV antibody (anti-HDV) and HDV RNA positivity than previously reported in published studies. Accurate estimates of HDV prevalence are needed. The most effective method to generate estimates of the prevalence of anti-HDV and HDV RNA positivity and to find undiagnosed individuals at the national level is to implement double reflex testing. This requires anti-HDV testing of all hepatitis B surface antigen-positive individuals and HDV RNA testing of all anti-HDV-positive individuals. This strategy is manageable for healthcare systems since the number of newly diagnosed HBV cases is low. At the global level, a comprehensive HDV screening strategy would require only 1,994,000 HDV antibody tests and less than 89,000 HDV PCR tests. Double reflex testing is the preferred strategy in countries with a low prevalence of HBV and those with a high prevalence of both HBV and HDV. For example, in the European Union and North America only 35,000 and 22,000 cases, respectively, will require anti-HDV testing annually.
Previous survey-based research suggested that hepatitis C patients receive suboptimal care in primary care settings. The aim of our study was to define the actual level of care hepatitis C patients ...receive in primary care clinics.
Medical records of 229 hepatitis C antibody-positive (group 1), 229 hepatitis C antibody-negative (group 2), and 229 patients not tested for hepatitis C antibody (group 3) were reviewed to assess the indications for hepatitis C testing and the subsequent management and referral of hepatitis C antibody-positive patients diagnosed in primary care clinics. In addition, the compliance of primary care physicians with hepatitis C screening and testing guidelines was assessed.
Only 16% of group 1 and 10% of group 2 patients were tested for hepatitis C based on physician-identified risk factors. Only 1% of group 3 patients had documented discussion of hepatitis C risk factors during their initial visit with a primary care physician. The majority of hepatitis C antibody-positive patients was appropriately evaluated in primary care clinics, and most (77%) hepatitis C RNA-positive patients with elevated liver enzymes were referred for subspecialty care. Of the 59 patients who underwent liver biopsy, 40% had bridging fibrosis or cirrhosis.
Hepatitis C testing is rarely initiated in primary care clinics based on physician-identified risk factors. Interventions should be developed to optimize early diagnosis of hepatitis C as significant liver disease may be present despite the absence of symptoms.
El neumomediastino espontáneo o enfisema mediastinal es una condición rara en niños, generalmente benigna y autolimitada, causada por la ruptura alveolar y disección de aire al espacio mediastinal. ...Es más común en niños asmáticos, pero puede ocurrir en cualquier paciente que induzca una maniobra de Valsalva. Los signos clínicos son disnea, dolor torácico y enfisema subcutáneo. Su diagnóstico se realiza por sospecha clínica y se confirma con los rayos X de tórax. El tratamiento es sintomático y conservador. Este artículo le permitirá al clínico familiarizarse con los síntomas clínicos específicos y los signos radiológicos asociados. Se presenta el caso de una paciente de 12 años de edad que consulta al servicio de urgencias por dolor torácico y disnea luego de haber realizado un esfuerzo excesivo. Al examen físico se encontró enfisema subcutáneo y se diagnostica neumomediastino espontáneo con la ayuda de los rayos X de tórax. Se hace manejo de soporte y resuelve a los 15 días.
B‐cell non‐Hodgkin's lymphoma (B‐NHL) is a well‐documented complication of hepatitis C virus (HCV) infection. Marginal zone (mucosa‐associated lymphoid tissue; MALT) lymphomas constitute a less ...common type of B‐NHL. In this article, we report a case of liver MALT in a cirrhotic patient, incidentally discovered after liver transplantation (LT). We discuss pertinent diagnostic and management strategies in this clinical setting. (Liver Transpl 2005;11:796–799.)
El presente estudio está dirigido a cuantificar en términos monetarios la magnitud del impacto causado por la contaminación de la cuenca del rio San Juan, sobre la salud humana. En el trabajo se ...presentan las características generales de la cuenca ubicada en el suroeste antioqueño; se desarrolla una metodología para valorar en términos monetarios la pérdida de bienestar que experimentan los pobladores de la zona, al incurrir en costos asociados a los tratamientos médicos, incapacidades laborales y pérdidas de escolaridad. Al efectuar la valoración económica se encontró que los municipios más afectados al asumir los costos incurridos por enfermedades de origen hídrico son: Andes y Ciudad Bolívar, con un gasto aproximado de 224 y 96 millones de pesos durante el período 2000-2001.
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