RESUMEN
BACKGROUND: Since the beginning of the COVID-19 pandemic, the number of medical appointments and the offer and use of oral health services have decreased sharply with the lockdown period. Restriction to regular dental care can increase the risk of oral diseases, capable of affecting general health and oral health-related quality of life, particularly among medically compromised patients. This study aimed to assess health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) of patients with non-alcoholic liver disease (NAFLD) before and during the COVID-19 pandemic. MATERIAL AND METHODS: Prospective cohort of 58 patients with NAFLD followed up from March 2020 (before the pandemic) to December 2021 (during the pandemic). RAND 36-Item Health Survey and Oral Health Impact Profile 14 (OHIP-14) questionnaires were used to assess HRQoL and OHRQoL, respectively, in the two points of time. RESULTS: The scores of all scales HRQoL and of the question about health change in the last year decreased substantially with the advent of the pandemic. Large (>0.50) effect sizes were estimated for the scales Role functioning/physical, Pain, General health, and Energy/fatigue. Patients who had COVID-19 presented better HRQoL and OHIP-14 mean scores than those who did not have the disease. The OHIP-14 total score increased 3.6 points with the advent of the pandemic, representing a large effect size (0.62). Patients presented high probability (84.3%) of increasing OHIP14 score during the pandemic. CONCLUSIONS: The HRQoL and the OHRQoL scores of NAFLD patients decreased substantially with the advent of the pandemic. However, these decreases were not associated with the COVID-19 disease by itself, but probably to other factors related to the deep social changes brought by the social isolation measures to combat the pandemic.
Asunto(s)
COVID-19 , Enfermedad del Hígado Graso no Alcohólico , Humanos , Calidad de Vida , Salud Bucal , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Pandemias , Estudios Prospectivos , Control de Enfermedades Transmisibles , Encuestas y CuestionariosRESUMEN
Peginterferon alfa plus ribavirin is currently the treatment of choice for chronic hepatitis C. Peginterferon alfa-2a (40KD) plus ribavirin has given an overall sustained virological response of 18% in F3/F4 previous nonresponder US patients. We evaluated the effectiveness of peginterferon alfa-2a (40KD) plus ribavirin in Brazilian patients who were relapsers or nonresponders to previous interferon-based therapy. One-hundred-thirty-four patients with biopsy-proven chronic hepatitis C, HCV RNA positive, elevated ALT and who were either relapsers (n=37) or nonresponders (n=97) to at least 24 weeks of conventional interferon/ribavirin therapy were retreated with peginterferon alfa-2a (40KD) 180mg/qw and ribavirin 800 mg bid for 48 weeks. Efficacy was assessed as virological response (defined as undetectable HCV RNA) at the end of treatment (EoT) and at the end of follow-up (SVR - Sustained Virological Response). Safety assessments consisted of clinical and laboratory evaluations. In the patient sample, 72% were genotype 1 and 34% were cirrhotic. In an intention-to-treat analysis, relapser patients showed 78% EoT response and 51% SVR. Nonresponders showed 57% EoT response and 26% SVR. Positive predictive factors of SVR were non-1 genotype and relapser state. Six percent of the patients interrupted treatment because of adverse events and 45% had dose reduction (mainly associated with leucopenia and anemia). Brazilian patient relapsers and nonresponders to conventional interferon and ribavirin treatment can achieve a sustained virological response when retreated with peginterferon alfa-2a (40KD) and ribavirin. The safety profile is similar to that of naive patients.
Asunto(s)
Antivirales/administración & dosificación , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/administración & dosificación , Polietilenglicoles/administración & dosificación , Ribavirina/administración & dosificación , Adulto , Anciano , Antivirales/efectos adversos , Quimioterapia Combinada , Femenino , Genotipo , Hepacivirus/efectos de los fármacos , Hepacivirus/genética , Humanos , Interferón alfa-2 , Interferón-alfa/efectos adversos , Masculino , Persona de Mediana Edad , Polietilenglicoles/efectos adversos , ARN Viral/análisis , Proteínas Recombinantes , Retratamiento , Ribavirina/efectos adversos , Resultado del Tratamiento , Carga ViralRESUMEN
Peginterferon alfa plus ribavirin is currently the treatment of choice for chronic hepatitis C. Peginterferon alfa-2a (40KD) plus ribavirin has given an overall sustained virological response of 18 percent in F3/F4 previous nonresponder US patients. We evaluated the effectiveness of peginterferon alfa-2a (40KD) plus ribavirin in Brazilian patients who were relapsers or nonresponders to previous interferon-based therapy. One-hundred-thirty-four patients with biopsy-proven chronic hepatitis C, HCV RNA positive, elevated ALT and who were either relapsers (n=37) or nonresponders (n=97) to at least 24 weeks of conventional interferon/ribavirin therapy were retreated with peginterferon alfa-2a (40KD) 180mg/qw and ribavirin 800mg bid for 48 weeks. Efficacy was assessed as virological response (defined as undetectable HCV RNA) at the end of treatment (EoT) and at the end of follow-up (SVR - Sustained Virological Response). Safety assessments consisted of clinical and laboratory evaluations. In the patient sample, 72 percent were genotype 1 and 34 percent were cirrhotic. In an intention-to-treat analysis, relapser patients showed 78 percent EoT response and 51 percent SVR. Nonresponders showed 57 percent EoT response and 26 percent SVR. Positive predictive factors of SVR were non-1 genotype and relapser state. Six percent of the patients interrupted treatment because of adverse events and 45 percent had dose reduction (mainly associated with leucopenia and anemia). Brazilian patient relapsers and nonresponders to conventional interferon and ribavirin treatment can achieve a sustained virological response when retreated with peginterferon alfa-2a (40KD) and ribavirin. The safety profile is similar to that of naive patients.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antivirales/administración & dosificación , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa , Polietilenglicoles/administración & dosificación , Ribavirina/administración & dosificación , Antivirales/efectos adversos , Quimioterapia Combinada , Genotipo , Hepacivirus/efectos de los fármacos , Hepacivirus/genética , Interferón-alfa , Polietilenglicoles/efectos adversos , Retratamiento , ARN Viral/análisis , Ribavirina/efectos adversos , Resultado del Tratamiento , Carga ViralRESUMEN
OBJECTIVE: To evaluate the association of anthropometric indexes (body mass index and waist circumference) in patients with non-alcoholic fatty liver disease (NAFLD), and its association with insulin resistance (IR), metabolic syndrome (MS) and histological findings. METHODS: From August 2003 to July 2004 a case series of 81 outpatients with clinic and/or histological diagnosis of NAFLD were selected at the Bahia University Gastro-Hepatology Clinic, Brazil. Liver function tests, lipid profile, glucose and insulin were performed in all patients. Body mass index (BMI) and waist circumference (WC) were determined according to WHO criteria. IR was measured by means of the homeostasis model assessment (HOMA) and IR was considered with HOMA > or =3. MS was defined according to the Adult Treatment Panel III (ATP III). Liver biopsy was performed in 37 cases. RESULTS: Body mass index > or = 30 kg m(-2) (obesity) was found in 39% of the cases and BMI > or = 25-29.9 kg m(-2) (overweight) in 53%. BMI was correlated with IR (r = 0.29; P = 0.02) and WC with ALT (r = 0.02; P = 0.03). Increased WC also was related to IR and to MS. The presence of steatohepatitis with fibrosis on liver biopsy was associated with overweight (68%) and increase of WC (41%). CONCLUSIONS: Body mass index and WC are frequent associated with MS, IR and histological findings (steatohepatitis and fibrosis) in patients with NAFLD.
Asunto(s)
Índice de Masa Corporal , Hígado Graso/fisiopatología , Síndrome Metabólico/etiología , Obesidad/fisiopatología , Relación Cintura-Cadera , Adulto , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Hígado Graso/sangre , Femenino , Humanos , Resistencia a la Insulina/fisiología , Hígado/enzimología , Hígado/patología , Masculino , Síndrome Metabólico/sangre , Persona de Mediana Edad , Obesidad/sangre , gamma-Glutamiltransferasa/sangreRESUMEN
BACKGROUND: Hepatitis C infection in hemodialysis units has been evaluated in different geographic regions. AIMS: The prevalence of anti-HCV in patients undergoing hemodialysis program in the city of Salvador, State of Bahia, Brazil, was studied and its association with transfusions, duration of hemodialysis and ALT elevation. METHOD: During a period of 17 months, all patients undergoing dialytic treatment, were evaluated. The total number of patients was 395, all of whom completed a questionnaire and provided serum samples for laboratory analysis. Serological levels were measured for ALT and the samples were tested for anti-HCV using ELISA II with a further confirmation using RIBA III. RESULTS: Anti-HCV was positive in 23.8% (94/395). The presence of transfusions was associated with anti-HCV and as the number of transfusions used increased, so did the frequency of anti-HCV. Of the patients who never received transfusions, 12.5% (6/48) were anti-HCV positive. The duration of dialytic treatment lasted from 53.44 +/- 36.45 months in the anti-HCV positive group and 22.10 +/- 22.75 months for the group testing negative. ALT elevation was more frequent in the anti-HCV positive group. Positivity for the RIBA III fractions was 79.8%, 100%, 80.9% and 52.1%, for c100-3, c33, c22 and NS5, respectively. The anti-NS5 was even less frequent in the group with elevated ALT. CONCLUSIONS: The prevalence of anti-HCV in patients undergoing chronic hemodialysis in Salvador, Bahia, is elevated and it is associated with transfusions, a longer duration of dialytic treatment and ALT elevation.
Asunto(s)
Alanina Transaminasa/sangre , Hepacivirus/inmunología , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C/inmunología , Diálisis Renal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Donantes de Sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Immunoblotting , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Factores de Tiempo , Reacción a la TransfusiónRESUMEN
We used a reverse transcription-polymerase chain reaction (RT-PCR) to obtain the genotypes of circulating hepatitis C virus (HCV) in patients from a Gastro-Hepatology Unit in the city of Salvador (Bahia State) in northeastern Brazil. Viral RNA was detected in 83 (65.4%) of 127 anti-HCV seropositive serum samples. Positivity was significantly associated with alterations in levels of aspartate aminotransferase and alanine aminotransferase (P < 0.05). Genotyping of HCV was performed by RT-PCR using genotype-specific primers from the core region: 24.1% were infected with subtype 1a, 38.6% with 1b, 3.6% with 2, 21.7% with 3a, and 12.0% with a mixed genotype. There was no difference in genotype distribution when compared with results from other Brazilian locations. Surprisingly, the high frequency of genotype 3 in Brazilian samples continues to be different from that reported around the world and warrants further investigation.
Asunto(s)
Hepacivirus/genética , Hepatitis C/virología , Adolescente , Adulto , Anciano , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Southern Blotting , Brasil/epidemiología , Cartilla de ADN/química , ADN Viral/química , Femenino , Genotipo , Hepacivirus/química , Hepacivirus/clasificación , Hepatitis C/sangre , Hepatitis C/epidemiología , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , ARN Viral/química , ARN Viral/aislamiento & purificación , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estudios SeroepidemiológicosRESUMEN
Ribavirin is a nucleoside analogue, recently introduced in hepatitis C virus (HCV) therapy, that has postulated immunomodulatory and immunosuppressive action. Strongyloidiasis is an helmintic infection caused by Strongyloides stercoralis, endemic in tropical countries. Severe strongyloidiasis has been demonstrated after immunosuppression by corticosteroids evolving some fatal cases. Here, we describe two cases of severe strongyloidiasis coincident with ribavirin plus interferon therapy for treating HCV infection. The review of our monotherapy protocol with interferon did not disclose any case of symptomatic strongyloidiasis pointing to a possible role of ribavirin in modifying immune response to S. stercoralis. We propose a careful screening for S. stercoralis before initiating ribavirin therapy or even empiric antihelmintic treatment.
Asunto(s)
Antivirales/efectos adversos , Hepatitis C Crónica/tratamiento farmacológico , Terapia de Inmunosupresión/efectos adversos , Interferones/efectos adversos , Ribavirina/efectos adversos , Strongyloides stercoralis , Estrongiloidiasis/etiología , Adulto , Animales , Femenino , Humanos , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
The genomic diversity of HCV embraces 6 genotypes and at least 52 subtypes with clinical and epidemiological correlations. There is a paucity of studies assessing HCV genotypes and biomolecular epidemiology in Brazil. We studied genotype distribution and epidemiological aspects in 232 HCV carriers, 133 (57.9%) males and 99 (42.1%) females, followed in the liver disease referral unit in Salvador, BA, northeastern Brazil. All of them were anti-HCV positive by 3rd generation ELISA assay, and HCV-RNA positive by RT-PCR. Genotyping was performed by INNOLIPA. Assessment of risk factors for HCV infection showed that 93 (40%) had past blood transfusion, 14 (6%) intravenous drug use, 19 (8%) inhalation of cocaine, 28 (12%) tattooing, 15 (7%) were health care workers, 5 (2%) had reused disposable syringes, 5 (2%) had multiple risk factors and in 53 (23%) no risk factor was determined. Genotype 1a was observed in 75 (32%), 1b in 72 (31%), 3a in 61 (26%), 2ab in 14 (6%); 5 (2.5%) had mixed genotypes and 5 (2.5%) were undetermined. Patients with genotype 1 had a higher mean age (P < 0.05) and no particular risk factors were associated with a specific genotype. Genotype 1 largely predominates in northeast Brazil followed by genotype 3 which, in this population, does not seem to be related to intravenous drug abuse, in contrast to some European studies. Although 80% of the Salvador population comprises African-Brazilians, no African genotype was identified, which may mean that HCV was introduced into this region via European immigration. This study demonstrated some peculiarities of HCV epidemiology in Brazil and strongly suggests that HCV introduction to this region was probably related to European immigration.
Asunto(s)
Población Negra/genética , Hepacivirus/genética , Hepatitis C/epidemiología , Adulto , Brasil/epidemiología , Emigración e Inmigración , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
AIMS: Occupational/environmental exposure to hepatotoxins has recently been implicated in nonalcoholic steatohepatitis (NASH). The aims of this study were to determine the presence and frequency of NASH in a large group of workers chronically exposed to several volatile petrochemical products in an industrial area in north-east Brazil and to observe its course in workers removed from the work environment. METHODS: 1500 asymptomatic workers were screened with standard liver blood tests during 1994-5. Those with elevated transaminases (>3x normal) on 3 occasions were evaluated further both clinically and with serum HBsAg, anti-HCV, ferritin, lipids and autoantibody determination. Patients with either no etiological diagnosis, positive HBsAg/anti-HCV serology and/or excess alcohol intake underwent liver biopsy. Those with obesity, diabetes or an isolated abnormal GGT were excluded. Of workers diagnosed as having NASH (compatible histology and no excess alcohol intake), a proportion were removed from the work environment and evaluated monthly with liver blood tests and a repeat liver biopsy 8-14 months later. RESULTS: 112 workers had abnormal transaminases and 32 fulfilled the criteria for liver biopsy. 20 of these were classified as NASH, the remainder had viral hepatitis (n = 6), alcoholic liver disease (n = 5) or portal vein thrombosis (n = 1). In all of the 10/20 who were removed from the work environment, their aminotransferases and GGT gradually decreased and their histology improved. CONCLUSIONS: These results demonstrate that NASH can occur following chronic exposure to volatile petrochemical substances in the workplace. Exposed workers should be regularly screened for the presence of liver damage and ideally removed from the work environment where possible.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Hígado Graso/inducido químicamente , Hígado/efectos de los fármacos , Enfermedades Profesionales/inducido químicamente , Exposición Profesional/efectos adversos , Petróleo/efectos adversos , Adulto , Biopsia , Brasil , Enfermedad Hepática Inducida por Sustancias y Drogas/enzimología , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Diagnóstico Diferencial , Hígado Graso/enzimología , Hígado Graso/patología , Femenino , Estudios de Seguimiento , Humanos , Hígado/ultraestructura , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/enzimología , Enfermedades Profesionales/patología , Estudios Prospectivos , Transaminasas/sangreRESUMEN
In a 4-year follow-up study, patients with acute sporadic non-A, non-B (NANB) hepatitis were evaluated to determine the etiology and natural history of the disease. Acute hepatitis C virus (HCV) was detected in 13 of 43 (30%) of patients, anti-hepatitis E virus (HEV) IgG in 5 (12%), and 25 (58%) were considered non-A-E. The HCV RNA was detected in all HCV patients but none of the non-A-E cases. The initial clinical and biochemical presentation of the HCV and non-A-E cases was quite similar, although 2 of the non-A-E patients had severe disease. The 5 patients who were found to be anti-HEV IgG-reactive recovered within 6 months of follow-up. Of the 13 HCV cases, alanine transaminase (ALT) levels returned to normal in 7 (53. 8%), while 6 (46.2%) continued to show abnormal ALT after 6 months of follow-up. However, 9 (69.2%) of them remained HCV-RNA-positive, denoting virological/biochemical dissociation. Long-term follow-up showed a reappearance of HCV RNA in 2 of the 4 patients who were in virological remission performing 84% of chronicity rate. Acute non-A-E hepatitis patients were less likely to evolve toward chronicity, as compared with acute HCV cases (16% vs. 84%; P =.0001). Only 4 (16%) of the non-A-E patients were hepatitis G virus (HGV)-RNA-positive. Concerning risk factors for acquiring parenterally transmitted viruses, tattooing was the only one that could be associated with HCV transmission (P =.002). No risk factors could be identified for putative non-A-E virus transmission. Liver biopsies performed for chronic HCV patients showed a variable degree of inflammation, while the non-A-E patients presented less severe histological disease.
Asunto(s)
Hepatitis C/fisiopatología , Hepatitis C/transmisión , Hepatitis E/fisiopatología , Hepatitis E/transmisión , Hepatitis Viral Humana/fisiopatología , Hepatitis Viral Humana/transmisión , Enfermedad Aguda , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Brasil , Femenino , Flaviviridae/aislamiento & purificación , Estudios de Seguimiento , Hepacivirus/aislamiento & purificación , Hepatitis C/patología , Hepatitis E/patología , Virus de la Hepatitis E/aislamiento & purificación , Hepatitis Viral Humana/patología , Humanos , Inmunoglobulina G/sangre , Inflamación , Hígado/patología , Masculino , ARN Viral/sangre , Valores de Referencia , Factores de RiesgoRESUMEN
Hepatitis E virus (HEV) is prevalent in Asia and Africa. Recently, it was also described in Mexico, but epidemiologic data from other Latin American countries are scarce. The seroprevalence of anti-HEV in a referral hepatology unit in northern Brazil was determined by testing for anti-HEV IgG in 701 serum samples from our serum bank. Specimens analyzed were from 200 blood donors, 79 patients with acute viral hepatitis (AVH), 392 hemodialyzed patients, and 30 carriers of schistosomiasis. Duplicate test results for anti-HEV were positive in four (2%) of 200 of the blood donors, three (10%) of the 30 carriers of schistosomiasis, and in none of the 392 hemodialyzed patients. Fourteen (17.7%) of the AVH patients were positive, as were six (25%) of 24 with hepatitis A virus, three (11%) of 26 with hepatitis B virus, 0 (0%) of 12 with hepatitis C virus, and five (29%) of 17 with non-A, non-B, non-C hepatitis viruses. Among AVH cases, those with hepatitis A virus had a higher frequency of anti-HEV positivity compared with all other hepatotropic viruses (P < 0.0003). We conclude that HEV is prevalent in northern Brazil. The higher prevalence in patients compared with blood donors could be explained by the lower social condition of patients who sought public health service in this area, in contrast with the heterogeneous socioeconomic distribution of blood donors. Patients with AVH due to hepatitis A had a greater frequency of anti-HEV, probably because of similar routes of transmission for both hepatitis A and E viruses. Finally, the absence of anti-HEV in the hemodialyzed group could be explained by a lower immunologic response found in patients with chronic renal failure.
Asunto(s)
Anticuerpos Antihepatitis/sangre , Virus de la Hepatitis E/inmunología , Hepatitis E/epidemiología , Inmunoglobulina G/sangre , Adulto , Donantes de Sangre , Brasil/epidemiología , Femenino , Hepatitis E/inmunología , Hepatitis Viral Humana/epidemiología , Hepatitis Viral Humana/inmunología , Humanos , Parasitosis Hepáticas/epidemiología , Parasitosis Hepáticas/inmunología , Masculino , Prevalencia , Diálisis Renal , Esquistosomiasis/epidemiología , Esquistosomiasis/inmunología , Estudios SeroepidemiológicosRESUMEN
Hepatitis C virus can be found in all continents. However, differences exist with respect to its prevalence. In Brazil, epidemiological data are scarce, and are based, in their majority, on information obtained from blood donors and not from the general population. Our objective is to show the prevalence of anti-HCV in two distinct populations: one rural and one urban: Salvador, a metropolis, and Castro Alves, a rural village with very little contact with other populations. Eight hundred individuals from Salvador and 800 from Castro Alves were randomly visited. After obtaining consent, we collected blood samples for serology tests and determination of ALT levels. The anti-HCV antibody was tested using ELISA II (ABBOTT Labs), and confirmed by RIBA III (Chiron). We studied the prevalence of anti-HCV in two populations and its distribution with respect to age group and sex and ALT level. chi 2 and Fisher exact were used for the statistical analysis. Of the 800 individuals from Salvador, 44% were women and 56% were men. The age group varied from 10 to 70 years, with an average age of 42. Ten (1.25%) individuals were anti-HCV positive in the urban population and none in the rural population (P < 0.001). No evident correlation was found regarding sex and ALT level, between anti-HCV positive and anti-HCV negative individuals in the urban population. In conclusion, our results suggest a higher prevalence of HCV infection in the urban population probably due to a high level of exposure. The sero-epidemiological studies using blood donors do not reflect the epidemiological reality of HCV in Brazil due to selection bias which could overestimate its seroprevelence.
Asunto(s)
Anticuerpos contra la Hepatitis C/sangre , Hepatitis C/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Brasil/epidemiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prevalencia , Distribución Aleatoria , Estudios Retrospectivos , Población Rural , Factores Sexuales , Transaminasas/sangre , Población UrbanaRESUMEN
The treatment of ascites of large volume in chronic liver disease patients was evaluated in the present study. We compared diuretics with paracentesis and an infusion of Dextran-70. Therapeutic efficacy, complications and length of hospital stay were the variables studied. Of the 38 patients, 20 were selected randomly. They were evaluated using clinical, laboratory and/or histological criteria: 10 patients in the paracentesis group with Dextran-70 and 10 in the diuretic group. The groups were similar with respect to age, diagnosis and Child-Pugh classification. However, there was a greater number of males in the paracentesis group with Dextran-70. In each paracentesis, an average of 9.41 liters (4.5 to 14.1) of ascitic fluid was collected. The average hospitalization period in the paracentesis group with Dextran-70 was 10.5 days (8-14), significantly less when compared to the diuretic group: 24.4 days (14-48). In the diuretic group one patient presented complications such as hyperkalemia, increased urea and creatinine levels, while in the paracentesis group with Dextran-70 one patient presented a temperature above 38 degrees C during treatment. The results suggest that paracentesis associated with Dextran-70 could be a therapeutic alternative for chronic liver disease patients with ascites in our population. It was effective; it had no significant side effects; it reduced the length of hospital stay and therefore should decrease the cost and the risk of complications in patients requiring prolonged hospitalization periods.
Asunto(s)
Ascitis/terapia , Dextranos/uso terapéutico , Diuréticos/uso terapéutico , Punciones , Ascitis/tratamiento farmacológico , Ascitis/economía , Ascitis/etiología , Enfermedad Crónica , Femenino , Hepatitis B/complicaciones , Humanos , Tiempo de Internación , Hepatopatías Alcohólicas/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
Hepatitis B virus (HBV) serological markers were investigated in 40 incident cases of hepatocellular carcinoma (HCC) and in two age and sex matched control groups, comprising 40 patients with other cancers and 80 healthy individuals, resident in Bahia, Brazil. Serologic tests were done by radioimmunoassay. The study observed high proportion of seropositivity to HBsAg (42.5%) and of those presenting HBsAg or antiHBc (65.0%) among HCC cases, higher in men than women and in those aged 17 to 30 years old. HBsAg seropositivity among HCC patients was greater than in the control group with other cancers (7.5%) and in healthy controls (2.5%), corresponding to odds ratio estimates of 15.0 (95% CI 3.29, 68.30) and 33.0 (95% CI 9.13, 119.28), both statistically significant. HBeAg was not observed and antiHBe was present in 41.2% of cases, suggesting the absence of viral replication, possibly with viral DNA integration into the hepatocyte genome. The presence of cirrhosis was associated with HBsAg seropositivity among HCC cases. A history of chronic alcoholism is shown to be more frequently related to those cases with cirrhosis. This study highlights the relevant association between HCC and HBV in Northeast Brazil, particularly for young individuals, and the high risk of development of HCC for HBsAg carriers.
Asunto(s)
Carcinoma Hepatocelular/epidemiología , Hepatitis B/epidemiología , Neoplasias Hepáticas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Carcinoma Hepatocelular/sangre , Estudios de Casos y Controles , Comorbilidad , Femenino , Hepatitis B/sangre , Antígenos de la Hepatitis B/sangre , Humanos , Neoplasias Hepáticas/sangre , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Estudios SeroepidemiológicosRESUMEN
Recent studies have shown tropism of the hepatitis B virus (HBV) by peripheral blood mononuclear cells (PBMC). The consequences of this phenomenon and their clinical use are not yet clear, however. Seventy-nine patients were studied between March 1989 and October 1990. Sixty-nine patients had chronic liver disease with histological evaluations, and 10 were vaccinated for HBV. The following markers were determined: serum: HBsAg, HBeAg, anti-HBe, antitotal-HBc, anti-HBs, anti-HCV, HBV-DNA; lysated PMBC cells: HBsAg, HBeAg. Hepatic tissue: HBsAg, HBcAg. Four groups were formed according to serology. Group I--positive HBsAg patients (n = 25) HBsAg was observed in the lysated of PBMC in 19 (76%) of the patients. HBeAg in PBMC was detected in 8 (32%), all of them showed evidence of viral replication (presence of HBcAg and/or HBV-DNA in the serum HBcAg in the tissue). Group II--antitotal HBc/anti-HBs positive (n = 14), HBsAg in PBMC was found in 5 (36%) and HBeAg in 1 (7.0%). In this patient replication markers in the serum and in the tissue (HBV-DNA, HBcAg) was also present. Three patients out of 9 anti-HBs positive had HBsAg in PBMC. Group III--seronegative patients for HBV. HBsAg was present in PBMC in 2 (6.6%) of the patients, but was absent in all of them. There was concomitant presence of HBsAg in MN and the hepatic tissue in 1 patient. Replication markers were not observed in the group. Group IV--10 asymptomatic individuals vaccinated for HBV. Except anti-HBs in serum, no other HBV marker could be identified in serum or in PBMC.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Antígenos de Superficie de la Hepatitis B/análisis , Leucocitos Mononucleares/inmunología , Hepatopatías/inmunología , Adulto , Biomarcadores/análisis , Enfermedad Crónica , ADN Viral/aislamiento & purificación , Femenino , Virus de la Hepatitis B/genética , Humanos , MasculinoRESUMEN
This study was carried out to evaluate the relative importance of various patterns in liver in patients followed with chronic ethylism at the Hepatology Unit Care Service of the Hospital Prof. Edgard Santos--University Federal of Bahia, Brazil. Ninety six individuals were submitted to liver biopsy. Of those, 69 (71.9%) presented with alcoholic lesions and 27 (28.1%) had other histologic features of liver disease not commonly related to alcoholism. These data suggested that the presence of other types of liver diseases are prevalent in alcoholic patients in Bahia and showed that, in addition to clinic and laboratorial evaluation, it is essential to perform the histological study to complete the diagnostic of the patients, and detect other liver diseases not associated to alcohol.