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Resumen Introduccion y objetivo La inclusion en practica real de los antivirales de accion directa en pacientes con hepatitis cronica por VHC ha supuesto un hito historico en Medicina. Pacientes y metodos Estudio analitico, prospectivo que incluyo 126 pacientes con hepatitis cronica por VHC tratados con antivirales de accion directa. Evaluamos la eficacia y seguridad del tratamiento y factores asociados a fracaso terapeutico. Resultados Edad 54 ± 10 anos. Varon (70%). Cirrosis (60%). Distribucion segun genotipos: G1a (31%), G1b (42%); G3 (14%); G4 (13%). Child-Pugh B y C (n = 15). Naive (56%). Tasa RVS fue (87,3%): Child-A (91%), Child-B (75%) y Child-C (60%). Las mejores tasas de curacion se alcanzaron con las combinaciones Combo 3D/2D ± ribavirina (RVS = 97,4%; n = 39) y sofosbuvir/ledipasvir ± ribavirina (RVS = 93,1%; n = 29). Tasas Discusion La presencia de genotipo 3, ascitis o dosis de ribavirina

Introduction and objective Inclusion of direct-acting antivirals into clinical practice in patients with chronic HCV (CHC) has been a milestone in medicine. Patients and methods Analytical, prospective study, involving 126 patients with chronic HCV treated with direct-acting antivirals. Efficacy and safety of treatment and factors associated with failure treatment were evaluated. Results Age 54 ± 10. Male (70%). Cirrhosis (60%). Distribution according to genotypes: G1a (31%), G1b (42%); G3 (14%); G4 (13%). Child–Pugh B and C (n = 15). Naive (56%). SVR rate was (87.3%): Child-A (91%), Child-B (75%) and Child-C (60%). The best cure rates were achieved with a 3D/2D ± ribavirin (SVR = 97.4%; n = 39) and sofosbuvir/ledipasvir ± ribavirin (RVS = 93.1%; n = 29) combination. An SVR rate of Discussion The presence of genotype 3, ascites or dosage of ribavirin 600 mg/day in cirrhotic G1 or G3, who will be treated with sofosbuvir + simeprevir or daclatasvir is recommended where no baseline resistance test is available.

Resumen Fundamento y objetivo Valorar el metabolismo basal y cinetico de las lipoproteinas durante el primer mes de biterapia en pacientes con hepatitis cronica C genotipo 1 (HCC-1). Pacientes y metodos Estudio longitudinal, prospectivo, que incluyo 99 pacientes HCC-1 naive , biopsiados y tratados con biterapia. Clasificamos a nuestros pacientes en 5 niveles de exigencia lipidica, segun el grado de fibrosis hepatica, carga viral basal y ratio de infectividad (cociente entre concentraciones medias de trigliceridos y colesterol unido a lipoproteinas de alta densidad durante el primer mes), estableciendo para cada uno de ellos, durante este periodo, una concentracion media minima necesaria de colesterol unido a lipoproteinas de baja densidad (colesterol LDL) para que el paciente alcanzara un «metabolismo lipidico favorable» (MLF), y valoramos su relacion con las tasas de curacion. Resultados Alcanzaron mayores tasas de curacion aquellos pacientes con fibrosis F3-F4 que presentaron mayores concentraciones basales de colesterol LDL, asi como aquellos que consiguieron mantener durante el primer mes de biterapia una ratio de infectividad menor de 3,2 y mayores concentraciones medias de colesterol LDL: media (DE) de 100 (23) mg/dl en «curados» frente a 89 (28) mg/dl en «no curados», odds ratio 1,1, intervalo de confianza del 95% (1,0-1,2) (p Conclusiones No todos los pacientes con HCC-1 van a presentar durante el primer mes de tratamiento una cinetica lipidica favorable, siendo necesario para curarse y/o alcanzar un MLF mantener durante este periodo unas concentraciones plasmaticas medias de colesterol LDL mayores. Aquellos con ausencia de un MLF podrian beneficiarse del uso de estatinas.

Background and objective We analysed baseline and kinetic characteristics of lipid metabolism during the first month of bitherapy in patients with chronic hepatitis C genotype 1 (CHC-1). Patients and methods A longitudinal, prospective study including 99 naive CHC-1 patients with liver biopsy who were treated with bitherapy. Our patients were assigned to one of the 5 different “degrees of lipid requirement” that we established depending on the degree of liver fibrosis, baseline viral load and infectivity ratio (ratio between the median level of triglycerides and high density lipoproteins-cholesterol during the first month). The goal was to achieve “a favourable lipid metabolism” (FLM) by establishing a necessary minimum level of low density lipoproteins (LDL)-cholesterol during this period for each one of them. We also analysed the relationship with the rate of sustained virological response. Results Patients with liver fibrosis F3-F4 who had higher baseline levels of LDL-cholesterol achieved higher rates of sustained virological response. Those patients who had a lower value of infectivity ratio and median levels of LDL-cholesterol during the first month of bitherapy also achieved higher rates of sustained virological response: SVR group 100 (23) mg/dl against non-SVR group: 89 (28) mg/dl; odds ratio 1.1; 95% confidence interval (1.0–1.2); P P = 0.013). Patients with sustained virological response had higher rates of FLM. Conclusions Not every patient with CHC-1 has the same lipid kinetics during the first month of bitherapy, and it is necessary to achieve a sustained virological response and/or a FLM to keep higher plasma levels of LDL-cholesterol during this period. Those subjects without FLM could benefit from statins.

Common variable immunodeficiency (CVID) is the most frequent primary antibody deficiency. It is characterized by recurrent bacterial infections, and occurrence of autoimmune and neoplastic diseases is also frequent; there is also a high prevalence of gastrointestinal diseases. There are reports of inflammatory bowel disease in this entity, but incidence is low (2-4 %). We present the case of a patient with common variable immunodeficiency suffering a chronic diar-rhoea episode and who was diagnosed with ileocaecal Crohn's-like disease after performing intestinal transit, CT abdomen and colonoscopy with biopsy. It was first treated with prednisone but on -showing cortisone dependency, treatment with azathioprine and adalimumab was started, with good results.

Background: Fecal biomarkers, especially fecal calprotectin, are useful for predicting endoscopic activity in Crohn’s disease; however, the cut-off point remains unclear. The aim of this paper was to analyze whether faecal calprotectin and M2 pyruvate kinase are good tools for generating highly accurate scores for the prediction of the state of endoscopic activity and mucosal healing. Methods: The simple endoscopic score for Crohn’s disease and the Crohn’s disease activity index was calculated for 71 patients diagnosed with Crohn’s. Fecal calprotectin and M2-PK were measured by the enzyme-linked immunosorbent assay test. Results: A fecal calprotectin cut-off concentration of ≥ 170 μg/g (sensitivity 77.6%, specificity 95.5% and likelihood ratio +17.06) predicts a high probability of endoscopic activity, and a fecal calprotectin cut-off of ≤ 71 μg/g (sensitivity 95.9%, specificity 52.3% and likelihood ratio -0.08) predicts a high probability of mucosal healing. Three clinical groups were identified according to the data obtained: endoscopic activity (calprotectin ≥ 170), mucosal healing (calprotectin ≤ 71) and uncertainty (71 > calprotectin < 170), with significant differences in endoscopic values (F = 26.407, p < 0.01). Clinical activity or remission modified the probabilities of presenting endoscopic activity (100% vs 89%) or mucosal healing (75% vs 87%) in the diagnostic scores generated. M2-PK was insufficiently accurate to determine scores. Conclusions: The highly accurate scores for fecal calprotectin provide a useful tool for interpreting the probabilities of presenting endoscopic activity or mucosal healing, and are valuable in the specific clinical context.

Inclusion of direct-acting antivirals into clinical practice in patients with chronic HCV (CHC) has been a milestone in medicine.Analytical, prospective study, involving 126 patients with chronic HCV treated with direct-acting antivirals. Efficacy and safety of treatment and factors associated with failure treatment were evaluated.Age 54±10. Male (70%). Cirrhosis (60%). Distribution according to genotypes: G1a (31%), G1b (42%); G3 (14%); G4 (13%). Child-Pugh B and C (n=15). Naïve (56%). SVR rate was (87.3%): Child-A (91%), Child-B (75%) and Child-C (60%). The best cure rates were achieved with a 3D/2D±ribavirin (SVR=97.4%;n=39) and sofosbuvir/ledipasvir±ribavirin (RVS=93.1%; n=29) combination. An SVR rate of90% was achieved with sofosbuvir+simeprevir±ribavirin (SVR=88%, n=25), simeprevir+daclatasvir±ribavirin 73%, n=15). The association of ribavirin to these last three therapeutic options (n=19) improved cure rates (SVR=94.7%, 18/19) compared to its absence (n=39;SVR=77%). Improvement in MELD (40%). Output transplant list (20%). Substitutions associated with resistors NS3: G1a (positions 80K; n=5); G1b and G4 (position 168 and 36; n=4), while for NS5a: G1a (position 30; n=2) and G1b and G3 (position 93; n=3). Variables associated with failure in multivariate analysis (p0.05): presence of ascites, G3 and ribavirin dosage600mg/day.The presence of genotype 3, ascites or dosage of ribavirin600mg/day were associated with higher failure rates. The use of ribavirin600mg/day in cirrhotic G1 or G3, who will be treated with sofosbuvir+simeprevir or daclatasvir is recommended where no baseline resistance test is available.

We analyzed baseline and kinetic characteristics of lipid metabolism during the first month of bitherapy in patients with chronic hepatitis C genotype 1 (CHC-1).A longitudinal, prospective study including 99 naïve CHC-1 patients with liver biopsy who were treated with bitherapy. Our patients were assigned to one of 5 different "degrees of lipid requirement" that we established depending on the degree of liver fibrosis, baseline viral load and infectivity ratio (ratio between the median level of triglycerides and high densitity lipoproteins-cholesterol during the first month). The goal was to achieve "a favorable lipid metabolism" (FLM) by establishing a necessary minimum level of low density lipoproteins (LDL)-cholesterol during this period for each one of them. We also analyzed the relationship with the rate of sustained virological response.Patients with liver fibrosis F3-F4 who had higher baseline levels of LDL-cholesterol achieved higher rates of sustained virological response. Those patients who had a lower value of infectivity ratio and median levels of LDL-cholesterol during the first month of bitherapy also achieved higher rates of sustained virological response: SVR group 100 (23) mg/dl against non-SVR group: 89 (28) mg/dl; odds ratio 1.1; 95% confidence interval (1.0-1.2); P.05, these differences being more significant for genotype IL-28B-CC (P=.013). Patients with sustained virological response had higher rates of FLM.Not every patient with CHC-1 has the same lipid kinetics during the first month of bitherapy, and it is necessary to achieve a sustained virological response and/or a FLM to keep higher plasma levels of LDL-cholesterol during this period. Those subjects without FLM could benefit from statins.