Hepatitis: Pérez JL

Orta Mira N, Guna Serrano MR, Gimeno Cardona C, Pérez JL. · Programa de Control de Calidad Externo. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, Madrid, España. · Enferm Infecc Microbiol Clin. · Pubmed #19195441 links to  free full text

Abstract: The term quality assurance (QA) refers to the quality control activities related to analytical procedures performed in the clinical microbiology laboratory. QA should include both external and internal quality assessment. Application of quality control tools in molecular microbiology assays is crucial to ensure the accuracy of results and appropriate patient management. External quality control is used for laboratory intercomparisons, detection of random and systematic errors, evaluation of the suitability of some reagents or commercial diagnostic kits, and continuing education. The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology includes quality control procedures for molecular microbiology, as well as specific programs for quantitative determination of the viral load of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV), two highly important molecular markers in clinical settings due to their prognostic value and utility as a treatment guide. Internal quality control allows random and systematic errors to be detected through the inclusion of quality control samples in the assays performed in the laboratory, equipment monitoring, and audit. Evaluation of all molecular microbiology assays before their inclusion in the daily routine work of the laboratory is of utmost importance.

Casanovas-Taltavull T, Baliellas C, Benasco C, Serrano TT, Casanova A, Pérez JL, Guerrero L, González MT, Andres E, Gil-Vernet S, Casais LA. · Service of Hepatology and Gastroenterology, Hospital Principes de España, Ciudad Sanitaria y Universitaria de Bellvitge, Barcelona, Spain. · Am J Gastroenterol. · Pubmed #11316166 No free full text.

Abstract: OBJECTIVES: Interferon-alpha (IFN) may have undesirable effects on a functioning graft. The aim of this study was to evaluate IFN treatment in kidney transplant candidates during the hemodialysis period as well as the results after transplantation. METHODS: A total of 29 noncirrhotic hemodialysis patients with chronic hepatitis C virus (HCV) infection (based on long-term rise in ALT, HCV serology, HCV RNA by polymerase chain reaction methods, and histological evidence) were included. Tolerability to IFN treatment, pre- and posttransplantation therapeutic results, and long-term outcome were recorded. IFN regimen consisted of 3 million units (MU) times per week after hemodialysis sessions for 6 months, followed by 1.5 MU after each hemodialysis session for an additional 6 months. All patients gave informed consent for participation. RESULTS: IFN therapy was fairly well tolerated. Adverse effects due to IFN toxicity, renal disease, or causes related to the immunological properties of IFN were observed in 24% of patients. At the end of treatment, ALT had normalized in 23/28 patients (82.1%), and HCV RNA had cleared in 23/28 patients (82.1%). During follow-up, HCV RNA was persistently negative in 18 patients (64%, including transplant recipients). A total of 14 patients (nine HCV RNA-negative) received a kidney transplant. Mean follow-up after the procedure was 41 +/- 28 months. In all, 12 patients had a functioning graft, one had acute vascular rejection, and one died of carcinoma. All transplanted patients maintained normal ALT levels, and eight remained HCV RNA-negative. CONCLUSIONS: Treatment results in our study population were better than those observed in the general population. The long-term response achieved, which was maintained after transplantation, supports the use of IFN for HCV hepatitis in kidney transplant candidates under hemodialysis.

Anonymous00077, Orta Mira N, Guna Serrano Mdel R, Latorre Martínez JC, Ovies MR, Pérez JL, Gimeno Cardona C. · Programa Externo de Control de Calidad SEIMC, España. · Enferm Infecc Microbiol Clin. · Pubmed #19100161 links to  free full text

Abstract: BACKGROUND: Human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) viral load determinations are among the most important tasks performed in the molecular microbiology laboratory, due to their importance in patient follow-up. Quality control tools are crucial in these laboratories to ensure the accuracy of the results. This article presents the analysis of the results obtained in 2007 from the SEIMC External Quality Control Program for HIV-1 and HCV viral loads. METHODS AND RESULTS: In the HIV-1 program, a total of five standards were sent. One standard consisted of seronegative human plasma, while the remaining four contained plasma from three different viremic patients, in a range of 2-5 log(10) copies/mL; to analyze repeatability, two of these standards were identical. The specificity was good for all the methods used by the participants, and only two out of 75 results were considered to be false positive results. A substantial proportion of the laboratories (20% on average) obtained values outside the accepted range (mean +/-0.2 log(10) copies/mL), depending on the standard and on the method used for quantification. A few errors were due to the transcription of the analytical result. Repeatability was also acceptable but approximately 15% of laboratories failed this evaluation. The HCV program consisted of two standards with different viral load contents. Most of the participants (94.6%) obtained results within the accepted range (mean +/-1.96 SD log(10) UI/mL), and interlaboratory variability was <0.5 log units for both standards and all techniques. CONCLUSIONS: Data from this analysis reinforce the utility of proficiency programs to ensure the quality of the results obtained by a particular laboratory, as well as the importance of the post-analytical phase in overall quality. Due to wide interlaboratory variability, the use of the same method and the same laboratory for patient follow-up is advisable.

Catalina MV, Barrio J, García A, Alonso S, Rincón D, Pérez JL, Núñez O, Menchén P, Bañares R. · Servicio de Aparato Digestivo, Unidad de Hepatología y Hemodinámica Hepática, Hospital General Universitario Gregorio Maranon, Madrid, Spain. · Gastroenterol Hepatol. · Pubmed #12139837 No free full text.

Abstract: AIMS: Coinfection with human immunodeficiency virus (HIV) and hepatotropic viruses (hepatitis B and C) is frequent because the routes of infection are similar. Liver disease appears earlier in these patients and progression to cirrhosis and its complications is faster. The aim of this study was to determine the incidence and clinical characteristics of bleeding from esophageal-gastric varices in patients with HIV. METHODS: We retrospectively analyzed 258 consecutive episodes of bleeding from esophageal-gastric varices in cirrhotic patients between January 1996 and January 2001, of which 20 episodes occurred in patients with HIV (7.8%). RESULTS: The mean age was significantly lower in patients with HIV infection and all presented hepatitis C infection. The hepatic venous pressure gradient was higher in patients with HIV (22.8 3.4 mmHg vs 19.6 5,4 mmHg; p = 0.05). No differences in the severity of liver disease (Child-Pugh), transfusion requirements, treatment performed, initial hemostasis, early recurrence, or rescue treatment with dipeptidyl peptidase I (DPPI) were found. The development of complications (bacterial infections, hepatic encephalopathy and ascites), hospital stay and mortality were also similar. Mortality was not influenced by HIV stage. Bleeding from esophageal-gastric varices in patients with HIV infection has a similar form of presentation and clinical course with treatment to that in non-cirrhotic patients, despite a higher degree of portal hypertension. CONCLUSIONS: The presence of HIV infection should not modify diagnostic or therapeutic attitudes to bleeding from esophageal-gastric varices.