Navegando por Palavras-chave "Esquistossomose Mansoni"
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- ItemAcesso aberto (Open Access)Avaliação da Fibrose Hepática por Elastografia nos pacientes portadores de Esquistossomose Mansônica(Universidade Federal de São Paulo (UNIFESP), 2019-06-11) Lima, Leila Maria Soares Tojal De Barros [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Lacet, Celina Maria Costa [UNIFESP]; http://lattes.cnpq.br/2511547113985954; http://lattes.cnpq.br/8624120197731317; Universidade Federal de São Paulo (UNIFESP)Introduction: Schistosomiasis persists as an important public health problem. Its main pathogenic event is hepatic fibrosis, associated with disease progression and its prognosis. The applicability of hepatic elastography in the evaluation of schistosomal fibrosis remains undefined. Objectives: To correlate the degree of fibrosis obtained by transient liver elastography (TE) with sonographic graduation and clinical forms of patients with schistosomiasis mansoni (SM). Methods: A cross sectional study with prospective inclusion of patients with SM, in all its forms, coming from the hepatology outpatient clinic of the University Hospital of the Federal University of Alagoas and from active search in Alagoas municipalities with high endemicity. Clinical and laboratory characteristics (clinical form, AST dosage, ALT, gammaGT, alkaline phosphatase and platelet count) were evaluated. The patients were classified according to the degree of hepatic fibrosis of the Niamey sonographic protocol, adopted by the World Health Organization, gold standard in this study. The TE, performed with FIBROSCAN ECHOSENS 502 device, was correlated with sonographic findings and its performance was calculated as area under the ROC curve (AUC). Results: A total of 117 patients with schistosomiasis mansoni, 55.6% female and 44.4% male, with mean age of 47 + 15 years were studied, 37 patients with intestinal forms, 12 with hepatointestinal form and 68 with compensated hepatosplenic form. Applying the Niamey sonographic protocol, the patients were regrouped for a better statistical analysis in absent fibrosis (A) 34.2%, mild to moderate fibrosis (MM) 27.4% and intense fibrosis (I) 38.5% of the sample. The median value of TE in the entire study population was 8.0 kPa; in the hepatointestinal form 4.4 kPa, in the hepatointestinal form 5.8 kPa and in the hepatosplenic form 10.6 kPa, with statistical differentiation between the clinical forms (p<0.01). In the correlation between TE and ultrasonography (US), patients in group A presented a median of 4.7 kPa; group MM 9.3 kPa and group I 10.3 kPa. There was a significant difference in TE values between groups A and MM and between groups A and I (p <0.05). TE was not able to differentiate patients from the MM and I groups. In the bivariate analysis between the markers of fibrosis and the clinical and laboratory characteristics, the TE and the sonographic classification of Niamey showed a strong and direct correlation with the clinical form (r>=0.77) and moderate and direct with the levels of AST and GGT (0.45<=r<=0.56). The cut-off point of TE to define the presence of fibrosis according to the sonographic classification that presented the best sensitivity and specificity ratio was 6.1 kPa (AUC 0.92) and for advanced fibrosis 8.9 kPa (AUC 0.791). Conclusions: The TE had a direct correlation with the sonographic classification of Niamey and was able to differentiate the clinical forms of SM. Based on the AUC value, TE has proven to be effective in detecting the presence of schistosomiasis fibrosis and may assist in the identification of advanced forms of liver disease caused by Schistosoma mansoni.
- ItemSomente MetadadadosAvaliação das alterações morfológicas das vias biliares em pacientes com esquistossomose mansoni pela Colangiorressonância Magnética: correlação intra e inter observador(Universidade Federal de São Paulo (UNIFESP), 2009-02-27) Sales, Danilo Moulin [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To describe the biliary changes by means of magnetic resonance (MR) cholangiography in a group of patients with schistosomiasis mansoni. To evaluate interobserver agreement in detecting biliary ducts changes in these patients. Materials and methods: A prospective and transversal study was carried out from February 2005 to February 2007 in our University Hospital. Twenty four patients with hepatosplenic schistosomiasis and six healthy patients without known liver disease, considered as a control group, were submitted to MR cholangiography exam. The following patterns of biliary duct changes were established: distortion, thinning, stenosis, dilation and irregularity. The assessment of interobserver agreement in characterizing biliary changes was calculated using the McNemar test and the weight kappa test. It was also calculated the relationship between the occurrence of changes in the biliary ducts and the serum level of gamaglutamiltransferase, using the Fisher’s exact test. Results: The interobserver agreement in detecting distortion and thinning of the biliary tree was almost perfect (k = 0,867; confidence interval [CI] 95% [0,512 – 1,0] e k = 0,865; CI 95% [0,51 – 1,0], respectively). There was a substantial agreement in viewing stenosis (k = 0,78; CI 95% [0,424 – 1,0]), moderate agreement for dilation (k = 0,595; CI 95% [0,247 – 0,942]) and mild agreement for thinning (k = 0,229; CI 95% [0,095 – 0,552]). A substantial agreement was also found when we considered any change in the biliary tree (k = 0,722; CI 95% [0,364 – 1,0]) Conclusions: The changes found in the biliary tree were, from the most to the lesser frequent: thinning, distortion, stenosis, dilation and irregularity. The interobserver agreement was almost perfect in viewing distortion and thinning of the biliary ducts and it was substantial in detecting stenosis.
- ItemSomente MetadadadosAvaliação ultrassonográfica do baço por elastografia em pacientes com Esquistossomose mansoni(Universidade Federal de São Paulo (UNIFESP), 2019-09-26) Czapkowski, Adriano [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Shigueoka, David Carlos [UNIFESP]; http://lattes.cnpq.br/1047430444405235; http://lattes.cnpq.br/4029665568653148; http://lattes.cnpq.br/3704426844004248; Universidade Federal de São Paulo (UNIFESP)Objectives: To compare spleen stiffness (SS) by Point Shear Wave Speed Measurement (pSWE) elastography (VTTQ) in patients with splenic hepatic Schistosomiasis Mansoni (SM) in relation to asymptomatic studies and correlated with splenic parenchymal stiffness with indicators of portal hypertension for conventional ultrasound (US) and Doppler velocimetry. Methods: From June 2016 to May 2018, we evaluated patients with hepatosplenic SM and asymptomatic volunteers (AV), correlating the SS of these two groups using the elastography technique that assesses tissue elasticity through point measurement of shear wave velocity (Point Shear Wave Speed Measurement (pSWE) with Acoustic Radiation Force Impulse (ARFI). We correlate the stiffness of the splenic tissue with the degree of hepatic fibrosis classified by Niamey's criteria and the main ultrasound indicators of portal hypertension, as portal and splenic vein diameter, portal vein flow velocity, as well as splenomegaly and siderotic nodules in the spleen. Results: This study included 68 patients. The mean of SS patients was 50.4 ± 10.9 years (age range 31-76 years) and the age of asymptomatic volunteers was 37.6 ± 12.5 years; (age range 24-68 years). Mean spleen stiffness measurements using ARFI elastography were 2.1 m/s in AV patients and 3.5 m/s in SM patients (p <0.0001). There was a correlation between SS and portal vein diameter (r = 0.661), SS and splenic vein diameter (r = 0.722) and SS and splenic index (r = 0.807). Conclusion: Spleen stiffness assessed with ARFI elastography was higher in SM patients compared with AV and can be used as a noninvasive indicator of hypertension portal.