Óscar Santos

Differential characteristics in drug-induced autoimmune hepatitis: Drug-induced autoimmune hepatitis

Drug‐induced autoimmune hepatitis (DIAIH) is an adverse effect associated with several drugs that usually occurs acutely, with variable latency, and it may potentially be mortal. There are a few reports and studies about DIAIH.

Prevención de recurrencia de infección por hepatitis B en receptores de trasplante hepático utilizando dosis bajas de inmunoglobulina antihepatitis B y análogo de nucleósido

Introduccion: la hepatitis B es una causa importante de trasplante hepatico; produce 1 millon de muertesxa0anuales. El uso de inmunoglobulina antihepatitis B en dosis altas y analogos de nucleosidos redujeron en unxa090% la reinfeccion del injerto.Objetivo: evaluar la eficacia de dosis bajas de inmunoglobulina postrasplantexa0para prevenir la reinfeccion del injerto.Metodologia: serie de casos retrospectiva de pacientes trasplantadosen el Hospital “Pablo Tobon Uribe”, entre enero de 2004 y septiembre de 2014, que recibieron inmunoglobulinaxa0despues del trasplante. Se evaluaron la carga viral de hepatitis B, las transaminasas y los marcadoresxa0serologicos para documentar recaida, ademas de variables como mortalidad, complicaciones, disfuncion delxa0injerto, reacciones adversas y costos.Resultados: fueron 18 pacientes trasplantados con hepatitis B; 50%tenia hepatocarcinoma; 22%, cirrosis; y 22%, insuficiencia hepatica aguda. La mediana de seguimiento fuexa0de 43,27 meses (14,7-65,2). De los pacientes, 2 tuvieron antigeno de superficie positivo en el postrasplantexa0y en 1 hubo recaida con carga viral positiva a los 41 meses. La tasa de reinfeccion del injerto fue del 5,5%.xa0No hubo muertes. Se estimo que el costo de usar dosis bajas de inmunoglobulina fue menor comparado conxa0las dosis altas a 6 meses de terapia; sin embargo, no se hizo estudio de costo-efectividad. La disfuncion delxa0injerto fue del 10% a 33 meses.Conclusion: con dosis bajas de inmunoglobulina se previno la reinfeccionxa0del injerto, similar a lo reportado en otras series. Mientras los esquemas libres de inmunoglobulina logranxa0demostrar su utilidad a largo plazo, usar dosis bajas de inmunoglobulina sigue siendo util.

Trasplante hepático en mayores de 65 años de edad: experiencia en el Hospital Pablo Tobón Uribe, Medellín, Colombia 2004-2010

Liver transplantation protocols have been extended to people over 65 years of age who had previously beenxa0excluded from protocols due to the increased morbidity and mortality rates associated with age. This studyaims to identify survival rates and complications in patients over 65 years who have undergone liver transplantation.xa0Medical records of patients older than 65 who underwent liver transplantation in the period betweenSeptember 2004 and November 2010 at the Hospital Pablo Tobon Uribe in Medellin, Colombia were analyzed.xa0We studied 27 patients with an average age of 67 years. The 30 day post-transplant survival rate was 85.2%,xa0at one year the survival rate was 70.4%, and at five years it was 63%. An evaluation of post-transplant complicationsxa0found that the most frequent complications were massive bleeding and nosocomial infections. Thexa0main causes of death were cardiovascular events. Conclusion: Proper patient selection allows those overxa065 years of age to become candidates for liver transplantation with a good actuarial 5-year survival rate andxa0better quality of life.

Scalp Necrosis in Giant Cell Arteritis in an African-colombian Patient

Giant cell arteritis (GCA), the most common vasculitis in elderly individuals in Western countries, is a largeand medium-sized blood vessel systemic vasculitis characterized by the granulomatous involvement of the aorta with a predilection for the extracraneal branches of the carotid artery. GCA is usually seen in patients over 50 years of age primarily of white ethnicity and less frequently among African Americans, particularly men. Characteristic manifestations include headache, scalp tenderness, jaw claudication, ocular symptoms, polymyalgia rheumatica, and an elevated erythrocyte sedimentation rate (ESR). Scalp necrosis is an extremely rare manifestation which has been associated with severity and a bad prognosis. Herein, we present an unusual case of GCA in an African-Colombian who developed an extensive scalp necrosis.