Transmission of HIV-1 from an obstetrician to a patient during a caesarean section.
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Cesarean Section↗
Biomedical subjects
Miguel Bruguera
Publications and source records attributed to Miguel Bruguera.
[Hepatitis C in Spain].
Spain has a medium endemicity of hepatitic C infection among central Europe countries and Italy. Prevalence of anti-HCV varies among regions and it ranges from 1.6 to 2.6%, which means that there may be between 480,000 and 760,000 people infected with hepatitis C virus in Spain. The prevalence is very low in people under 20 years of age and it increases from age 30 years. Prisoners and drug addicts have the highest infectious rates, between 40 and 98%. Some populations of immigrants also have a high prevalence of HCV infection, especially people from Asia and sub-Saharan countries, whereas people from Latin America have rates lower than those in the autochtones population. Spanish people with chronic hepatitis C were mainly infected via blood transfusions, IV drug use, or during some medical and surgical hospitalization. The reduction in the use of IV drugs and the programs of needle sharing, as well as the eradication of post-transfusional hepatitis, have led to a progressive reduction in the incidence of new infections (from 6.8 per 100,000 in-habitants in 1997 to 2.3 in 2003). Preliminary data suggest that an important rate of new hepatitis C cases owe to nosocomial transmission. Transmission is almost exclusively vertical in children. In spite of a two-third reduction of incident cases of hepatitis C in Spain in last few years, it is foreseeable that the number of patients with advanced HCV liver disease attended in the health-care system will increase in forthcoming years. This is due to the fact that many, still undiagnosed patients will be likely recognized for the first time as a result of some complication of the disease. All efforts to increase the screening of hidden cases of hepatitis C in primary health-care centers, allowing a prompt treatment before an advanced stage, will have a beneficial impact both in economic and social terms.
Hepatitis C↗
[Hepatitis B vaccine and multiple sclerosis: an unproved association].
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Epidemiologic Studies↗
[Prevention of viral hepatitis].
Prevention of viral hepatitis infection involves health measures designed to avert transmission of viral agents and promote the use of gammaglobulin and vaccines. The availability of safe drinking water and improvements in quality of life result in better individual hygiene; these factors have had the greatest impact on hepatitis A prevention. Serum gammaglobulin administration has been replaced by vaccinations for pre-exposure, and to a great extent for post-exposure prophylaxis because of the progressively lower anti-HAV content of gammaglobulin and the short duration of the protective effect. Universal vaccination in childhood is the recommended measure for controlling hepatitis A. Adults belonging to high-risk groups should also undergo vaccination. The incidence of hepatitis B has decreased worldwide because of universal vaccination programs, initiated in preadolescence and childhood. Prevention of hepatitis C requires control of situations in which there is a likelihood of parenteral infection with the virus. Post-transfusion hepatitis has been virtually eradicated, but considerable effort is still needed to prevent nosocomial hepatitis.
Adult↗
[Use of complementary and alternative medicine in patients with chronic hepatitis C].
BACKGROUND AND OBJECTIVE: Complementary and alternative medicines (CAM) have achieved a great development in western countries. However, their use among patients simultaneously treated by the mainstream medicine is largely unknown. Our goal was to assess how many patients with chronic hepatitis C treated in a tertiary hospital use or have used CAM. PATIENTS AND METHOD: Analysis of the answers of 319 patients to a self-administered questionnaire. RESULTS: 113 (37%) patients had used or were using CAM, 63 (20%) because of chronic hepatitis and 50 (17%) for other reasons. Women, those with higher education, divorced and widows were those who more frequently used CAM. More than half of patients felt some subjective improvement, yet none of them normalized their serum transaminase activities. CONCLUSIONS: CAM are used by a high proportion of patients who are simultaneously attended by 'official' physicians. The perceived efficacy of these practices is high but no changes in the hepatic disease could be seen in any of the patients who answered the questionnaire.
Complementary Therapies↗
[Liver and sports].
Physical exercise does not have harmful effects on liver, yet it can be an occasional cause of heat stroke in long-distance runners if they do not drink enough. Practicing sports does not have harmful liver effects as long as some risk behaviors are avoided such as consumption of anabolizers, sharing syringes or traveling to hepatitis endemic countries without being vaccinated. In patients with acute or chronic liver diseases, physical activity or practicing sports can be allowed as long as these do not lead to an excessive fatigue.
Anabolic Agents↗
Hepatitis C virus population analysis of a single-source nosocomial outbreak reveals an inverse correlation between viral load and quasispecies complexity.
The features of Hepatitis C virus (HCV) quasispecies within an envelope segment including the hypervariable region 1 were analysed at an early time point post-infection in seven patients that acquired HCV from a single common donor during a nosocomial outbreak. The grouping of patients according to viral load was reflected in the structure of the quasispecies. A higher viral load correlated with the presence of a predominant HCV genome and a corresponding lower quasispecies complexity. The quasispecies complexity itself was not correlated with HCV clearance or persistence. Thus, the relationship between an intrapatient HCV quasispecies and the clinical outcome of an HCV infection is more complex than previously anticipated.
Amino Acid Sequence↗
Evaluation of potential liver donors: limits imposed by donor variables in liver transplantation.
The aim of this study was to evaluate the predictive value of different donor and recipient parameters that have been recognised previously as proven and to suggest prognostic factors for immediate liver function and final outcome after liver transplantation. We evaluated a total of 228 liver grafts transplanted in the last 3 years in our institution. Parameters were recorded for the donor (age, polytransfusion, atherosclerosis, presence of infection, episodes of hypoxia or hypotension, use of vasoactive drugs, intensive care unit stay, steatosis, and ischemia time) and recipient (red blood cell requirements, immediate liver function [score], incidence of hepatic artery thrombosis, survival, and cause of death or retransplantation). Liver biopsy after reperfusion of the donor liver was performed before closure of the abdomen. Donor age over 65 years and presence of steatosis were associated significantly with initial poor function. The mortality rate at 6 months was related to donor age over 65 years. When donor age over 65 years was combined with transfusion requirement of > 10 U of red blood cells (RBC), the incidence of graft loss increased to 53%. The probability of graft survival at two years decreased when donor age was over 65 years. Moreover, when donor age over 65 years was combined with requirement of > 10 units RBC the probability of 2-year survival was significantly reduced. This study shows, for the first time, that the use of donor livers from older donors in liver transplant procedures, requiring more than 10 U of RBC, results in a significantly worse prognosis in terms of immediate liver function and long-term survival.
Aged↗
Outbreak of nosocomial hepatitis C virus infection resolved by genetic analysis of HCV RNA.
In July 2000, symptomatic acute hepatitis C was diagnosed in five patients who had attended the emergency room of a municipal hospital on the same day, about 6 weeks before. Investigation of the remaining 65 patients visited at the emergency room on that day disclosed that 8 patients had a positive anti-hepatitis C virus (anti-HCV) test and 4 of them had biochemical evidence of acute anicteric hepatitis. HCV RNA was detected in 12 of the 13 anti-HCV-positive patients. Phylogenetic analysis of the nonstructural 5A (NS5A) and E2 regions showed that 10 patients, including all 9 with acute hepatitis, were infected with a closely related HCV strain, while the remaining 2 patients harbored unrelated strains. Flushing of intravenous catheters with heparin retrieved from a multidose heparin solution in saline was carried out for all the patients involved in the hepatitis outbreak but in only 1 of 23 (4%) matched controls recruited among HCV-noninfected patients attending the emergency room on the same day, and this was the only significant difference concerning risk factors for HCV infection between patients and controls. Thus, accidental contamination of a multidose heparin solution with blood from an unrecognized HCV carrier was identified as the source of this nosocomial outbreak of hepatitis C.
Adult↗
[Cavernous hemangioma].
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Hemangioma, Cavernous↗
Management of chronic viral hepatitis in HIV-infected patients: Spanish Consensus Conference. October 2000.
Co-infection by human immunodeficiency virus and hepatitis B and C viruses is quite common because they share similar routes of transmission. The introduction of highly active antiretroviral therapy has significantly improved the life expectancy of HIV-infected patients in the last few years. However, chronic viral hepatitis represents an emerging cause of morbidity and mortality in this population, either as a result of end-stage liver disease or as a consequence of hepatotoxicity induced by antiretroviral drugs. The main goal of the Consensus Conference was to establish specific recommendations for the management of chronic viral hepatitis B and C in HIV-infected patients. The role of orthotopic liver transplantation for co-infected individuals with end-stage liver disease was also assessed.
AIDS-Related Opportunistic Infections↗