Navegando por Palavras-chave "Liver cirrhosis"

Agora exibindo 1 - 14 de 14
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Avaliação da força muscular, capacidade pulmonar e capacidade ao exercício dos candidatos ao transplante de fígado acompanhados no ambulatório de um hospital universitário.
    (Universidade Federal de São Paulo (UNIFESP), 2018-08-30) Almeida, Marley Cintra de [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; http://lattes.cnpq.br/6234829429056217; http://lattes.cnpq.br/4228343647352111; Universidade Federal de São Paulo (UNIFESP)
    Due to the changes caused by terminal liver disease, patients on the waiting list for liver transplantation may present decreased muscle strength, altered lung capacity, and poor exercise capacity. essential factors in order to design effective and satisfactory strategies in pre-transplant physiotherapeutic care. Objectives: To evaluate muscle strength, lung capacity and exercise capacity of patients candidates for liver transplantation and to correlate with their clinical variables. Methods: The patients enrolled in the single technical registry for liver transplants of the Federal University of São Paulo, from February 2015 to February 2016, of both sexes and aged 18 years or over, were evaluated. Muscle strength was assessed by measuring Manual Grip Strength, lung capacity through Slow Vital Capacity and Respiratory Pressures, and ability to exercise through the 6-minute walk test. Results: The sample consisted of 50 patients, 62% of whom were males, with a mean age of 52.2 ± 12.6 years. The mean Slow Capacity was 72.8 ± 22.7% of predicted value (p <0.001). In the 6 'walk test, the mean was 76.6 ± 15.4% of predicted (p <0.001). Maximum inspiratory pressure was 26.5 ± 9.9% predicted (p <0.001), Maximum Expiratory Pressure reached 32 ± 11.7% of predicted (p <0.001), and the Manual Holding Force reached totaled 119 ± 28.8% of predicted. Fatigue and absence of regular physical activity were factors that negatively influenced the Maximum Inspiratory Pressure values (p <0.001). Patients who had ascites, fatigue or did not practice regular physical activity obtained worse performance in the Manual Grip test (p <0.005). Conclusion: Respiratory muscle strength, slow vital capacity, and ability to exercise are significantly reduced in patients who are candidates for liver transplantation. Fatigue, ascites and lack of regular physical activity were factors that negatively influenced the results of Maximum Inspiratory Pressure and Manual Grip Strength.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Avaliação de Escores Clínicos para predição de fibrose hepática em obesos clinicamente complicados
    (Universidade Federal de São Paulo (UNIFESP), 2010-03-31) Ribeiro, Tarsila Campanha da Rocha [UNIFESP]; Kondo, Mario [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: The majority of patients with NAFLD are medically complicated obese. Non-invasive indices for estimating risk of advanced fibrosis have, to date, been developed in different patient cohorts with liver disease. Most patients at risk for NAFLD advanced fibrosis are seen in clinical settings and morbidly obese patients are considered prone to have it. Aims: To prospectively evaluate the performance of noninvasive scores with the best reported predictivity in an obese population that has not been referred to a Hepatology practice. Methods: Liver biopsies were obtained in 461 sequential patients with Class III-IV, medically complicated obesity undergoing bariatric surgery over a six year period. Histology was interpreted blinded to the studied scores. Advanced fibrosis was defined according to the modified Brunt criteria stage >/=3. Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet (AP index), AST-to-platelet ratio index (APRI), FIB-4, BARD, BAAT, “NAFLD FIBROSIS SCORE” were calculated. Results: 80% of patients were female, mean age was 48y (range: 20-77) and mean BMI was 48.8 kg/m2. Liver histology was entirely normal in 11,5% of patients. Nonalcoholic fatty liver disease (NAFLD) was observed in 85% and non-alcoholic steatohepatitis (NASH) in 50%. Some degree of fibrosis was found in 63% of patients and only 5% had advanced fibrosis. The areas under the receiveroperating characteristic curves of the AAR, AP index, APRI, FIB-4, BARD, BAAT and “NAFLD FIBROSIS SCORE” for predicting advanced fibrosis were respectively 0.564, 0.683, 0.780, 0.724, 0.621, 0.436, 0.633. The presence of advanced fibrosis could be correctly excluded by the majority of the scores (NPP: 68-97%), but the presence could not be confirmed (VPP:0-25%). The better specificity was with BARD >2 (100%) and the best sensitivity with “NAFLD FIBROSIS SCORE” > 0.676 (67%). Conclusion: In this large study of a high risk population (Class III-IV obesity), all the studied scores had good negative predictive value but they lacked positive predictive value. The low PPV of the scores could be explained by the low prevalence of advanced fibrosis in this subset of patients. More accurate noninvasive indices for determining advanced fibrosis NAFLD are still needed
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Avaliação dos potenciais evocados relacionados a eventos (ERP-P300) em pacientes com cirrose hepática sem encefalopatia
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2008-03-01) Teodoro, Vinicius Vasconcelos [UNIFESP]; Bragagnolo Junior, Maurício; Lucchesi, Ligia Mendonça [UNIFESP]; Kondo, Mario [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: In hepatic cirrhosis structural liver alterations occur leading to the loss of the organ functions with neuro-psychiatric consequence, as cognitive dysfunctions. One of the most effective ways of objectively evaluating cognition is to measure electrophysiological activity in the central nervous system trough event-related potentials (ERP-P300). AIM: To assess the value of the event-related potential (ERP) in order to determine cognitive disturbances in patients with liver cirrhosis and to assist in the diagnosis of minimal hepatic encephalopathy. METHODS: Fifty patients with liver cirrhosis were selected, without clinical symptoms of hepatic encephalopathy and 35 healthy volunteers, matched by sex and age. The patients were submitted to clinical-neurological and laboratorial examination. The ERP-P300 was performed by the two groups to determine cognitive disturbances. RESULTS: The study showed significant differences between the ERP-P300 latency averages of the two groups. CONCLUSION: The ERP-P300 is simple to use and depends on controllable variables. It is also easy to reproduce and, when properly used, can be useful both to determine cognitive disturbances in patients with hepatic cirrhosis and to assist in minimal hepatic encephalopathy diagnosis.
  • Nenhuma Miniatura disponível
    Item
    Acesso aberto (Open Access)
    Efeito do condroitim sulfato na fibrogênese hepática induzida por ligadura do ducto biliar em ratos
    (Universidade Federal de São Paulo (UNIFESP), 2017-10-26) Guedes, Pedro Luiz Rodrigues [UNIFESP]; Nagaoka, Márcia Regina [UNIFESP]; http://lattes.cnpq.br/3554142919645884; http://lattes.cnpq.br/4997715000909196; Universidade Federal de São Paulo (UNIFESP)
    Introdução: Uma das causas de fibrose hepática é a colestase, que causa morte celular e desencadeia a liberação de citocinas e quimiocinas, levando à infiltração de leucócitos e à deposição de matriz extracelular. O tratamento atual da fibrose hepática é baseado na retirada do agente causador, por isso é importante a investigação de estratégias novas e eficazes para o tratamento da fibrose hepática. Muitos estudos destacam a ação do condroitim sulfato em diferentes tipos de células, com consequente redução da expressão de citocinas. O objetivo deste trabalho foi analisar os efeitos do condroitim sulfato (CS) sobre o modelo experimental de colestase extra-hepática induzida pela ligadura do ducto biliar comum (BDL). Metodologia: Ratos Wistar (6-8 semanas) foram submetidos a BDL e receberão injeção intraperitoneal de CS (120 mg/kg peso) ou veículo por 1, 2, 7, 14, 21 ou 28 dias; os animais sham foram utilizados como controle. Ao final do período de tratamento, os animais foram eutanasiados e amostras de fígado e sangue retiradas. Foram analisadas as atividades de alanina e aspartato aminotransferases séricas (ALT e AST, respectivamente) e, caspase-3 e catepsina B em homogenatos de fígado utilizando os substratos fluorométricos Ac-DEVD-AMC e Abz-GIVRAK(Dnp)-OH, respectivamente. Em espécimes de fígado foi realizada análise morfométrica usando o programa Axiovision 4,8, além de avaliar a apoptose por reação de TUNEL e regeneração hepática por imuno-histoquímica para o antígeno nuclear de proliferação celular (PCNA).. Os resultados foram expressos pela média ± EPM. A análise estatística de valores padronizados foi realizada por ANOVA unidirecional com post-hoc de Tukey. Resultados: Animais BDL apresentaram atividades séricas de ALT e AST 2-3 vezes maiores do que os sham. BDL levou ao progressivo desenvolvimento de septos fibróticos, confirmado pela área de colágeno (%) após 7 (11 ± 1, n = 7), 14 (14 ± 1, n = 10), 21 (23 ± 1, n = 4) e 28 (34 ± 3, n = 7) dias de indução, enquanto os grupos sham tiveram a arquitetura normal do fígado preservada. O tratamento com CS reduziu o conteúdo de colágeno após 21 dias (14 ± 1, n = 6) e significativamente (p <0,001) após 28 dias (16 ± 2, n = 6) em relação ao não-tratado. Não foram observadas alterações significativas nas atividades da catepsina B de todos os grupos estudados. Verificou-se aumento progressivo da atividade da caspase-3 (relativo ao sham) no grupo BDL 2d (1,4 ± 0,1, n = 5), BDL 7d (2,2 ± 0,6, n = 7) e 14d (3,3 ± 0,5, n = 10; ANOVA, p < 0,001) quando comparados aos respectivos grupos sham. Interessante, CS reduziu significativamente (p= 0,024) a atividade de caspase-3 após 14 dias de tratamento (1,7 ±0,7, n = 9) quando comparado com o grupo BDL 14d. Os animais BDL apresentaram mais células apoptóticas por campo (% do total) aos 14 dias (0,58±0,04) do que aos 7 (0,25±0,02), 21 (0,33±0,02) e 28 dias (0,29±0,01). O tratamento com CS reduziu significativamente (p = 0,030) a quantidade de células em apoptose nos animais 14d (0,43±0,04). BDL levou ao aumento significativo na quantidade relativa (%) de células epiteliais biliares e de hepatócitos com núcleo marcado com anti-PCNA. O tratamento com CS levou ao aumento significativo de hepatócitos em proliferação (No relativo) nos animais 14d (2,9±0,1 – ANOVA; p = 0,003) e 21d (3,5±0,2 - ANOVA; p < 0,001) quando comparados aos respectivos BDL não tratados (14d: 2,1±0,1 e 21d: 2,2±0,21). Conclusão: Este trabalho mostra que a CS pode reduzir os primeiros sinais de apoptose, retardar o desenvolvimento de fibrose hepática e, portanto, cirrose, além de promover a regeneração hepática em modelo experimental de ligadura do ducto biliar.
  • Imagem de Miniatura
    Item
    Embargo
    Efetividade do protocolo de seguimento dos pacientes portadores de carcinoma hepatocelular submetidos a transplante de fígado no Estado de São Paulo
    (Universidade Federal de São Paulo, 2024-08-28) Takenaka, Vanessa Suemi [UNIFESP]; Gonzales, Adriano Miziara [UNIFESP]; Massarollo, Paulo Celso Bosco; Pugliese, Vincenzo; http://lattes.cnpq.br/2026297584459610; http://lattes.cnpq.br/5725342608697013; http://lattes.cnpq.br/6234829429056217; http://lattes.cnpq.br/1650050413368675
    Objetivo: Avaliar o percentual de falha na identificação de pacientes portadores de carcinoma hepatocelular (CHC) submetidos à transplante hepático (TxH) fora dos critérios válidos no Brasil - Critérios de Milão/Brasil (CMB) no momento do transplante, avaliar as variáveis clínico-epidemiológicas e sobrevida global destes pacientes. Métodos: Foram coletadas informações do banco de dados da Central de Transplantes do Estado de São Paulo, de pacientes submetidos à TxH com doador falecido em situação especial por CHC, no período entre janeiro de 2012 a janeiro de 2022. Classificados em dois grupos: Dentro do CMB e fora do CMB, baseado no estadiamento anatomopatológico dos fígados explantados. Resultados: Dos 1115 pacientes transplantados em São Paulo nesse período por CHC, 988 (88,6%) estavam dentro dos CMB no momento do TxH e 127 (11,4%) foram transplantados fora dos CMB. Comparando os grupos os pacientes que foram inscritos após downstaging (11,6% dentro CMB e 25,2% fora CMB -p<0,001), estadiamento na inscrição como CMB (dentro CMB 16,9% e fora CMB 21,3%; p = 0,015), estadiamento no exame de imagem pré-TxH (dentro CMB 22,8% e fora CMB 44,1% ; p <0,001), e maior nível de AFP no exame de inscrição analisando o log AFP (p=0,004) e AFP pré-transplante (dentro CMB de 74,63 ng/mL e fora CMB de 252,27 ng/mL – p=003), foram os que tiveram maior chance de serem transplantados além do CMB. A sobrevida em 5 anos dos pacientes dentro dos CMB foi de 68% e dos pacientes que estavam fora dos CMB de 46%, com diferença estatisticamente significativa (p< 0,0001). Conclusões: O protocolo de seguimento para assegurar que os pacientes portadores de CHC sejam submetidos a transplante de fígado dentro dos critérios estabelecidos falha em 11,4%, com pior sobrevida nesse grupo. Os pacientes com maior risco de serem transplantados além dos critérios são: submetidos à downstaging, estadiamento mais avançado na inscrição e no pré-TxH, e maior nível de AFP no exame de inscrição e pré-TxH.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Importância da resitência insulínica na hepatite C crônica
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2007-06-01) Parise, Edison Roberto [UNIFESP]; Oliveira, Ana Claudia de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To revise the importance of insulin resistance in the development of chronic hepatitis C and its interference in the response to the antiviral treatment of these patients. DATA SOURCE: Bibliographic revision of published papers in the MEDLINE and the authors data. DATA SYNTHESIS: In the last years several published papers have demonstrated an important relationship between insulin resistance and chronic hepatitis C. Increased prevalence of type 2 diabetes mellitus, the development of hepatic steatosis (specially in non-3 genotype), a more rapid progression of hepatic disease and reduction in the sustained virological response to treatment with pegylated interferon plus ribavirin have been associated with insulin resistance in patients infected with HCV. The mechanism implied in the insulin resistance is the enhanced production of tumor necrosis factor by the HCV core. Tumor necrosis factor affects insulin receptor substrate phosphorylation, resulting in decreased glucose uptake and compensatory hyperinsulinemia. Increased liver iron accumulation and modification in the levels of adipocytokinemia can have an additional effect on insulin sensitivity in chronic C hepatitis. CONCLUSIONS: Diagnosing and treating insulin resistance in patients with chronic hepatitis C could not only avoid complications but also prevent disease progression and increased the sustained virological rate to treatment with pegylated interferon plus ribavarin.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Infecção pelo vírus da hepatite E em pacientes com infecção crônica pelo vírus da hepatite C
    (Universidade Federal de São Paulo (UNIFESP), 2017-09-25) Bricks, Guilherme [UNIFESP]; Castelo Filho, Adauto [UNIFESP]; Granato, Celso Francisco Hernandes [UNIFESP]; Senise, Jorge Figueiredo [UNIFESP]; Celso Francisco Hernandes Granato: http://lattes.cnpq.br/7880516839350591 ; Jorge Figueiredo Senise: http://lattes.cnpq.br/0363646811603656 ; http://lattes.cnpq.br/0107536337908259; http://lattes.cnpq.br/3128106813335431; Universidade Federal de São Paulo (UNIFESP)
    Resumo Introdução: O impacto da infecção pelo vírus da hepatite E (HEV) em pacientes com infecção crônica pelo vírus da hepatite C (HCV) é pouco conhecido. Objetivos: Avaliar a associação entre presença de anticorpos anti-HEV e cirrose hepática em pacientes com infecção crônica pelo HCV; estimar a soroprevalência do HEV nesses pacientes, assim como descrever os fatores de risco associados; e avaliar a associação entre infecção prévia pelo HEV e resistência à insulina. Métodos: Entre outubro de 2015 e dezembro de 2016, foram avaliados 618 pacientes de três centros de referência do estado de São Paulo com infecção crônica pelo HCV. Avaliou-se presença de anticorpos da classe IgG contra o vírus da hepatite E por método imunoenzimático (WANTAI HEV-IgG ELISA). Amostras com resultados reagentes e indeterminados foram testadas para presença de anticorpos anti-HEV IgM. Resultados: A soroprevalência encontrada foi de 10,2% (IC 95% 8,0 – 12,8%). Maior soroprevalência apresentou associação independente com idade superior a 60 anos (OR = 2,13; p = 0,001), história de contato prévio com porcos (OR = 2,06; p = 0,02) e hemofilia (OR = 35,69; p = 0,004). Soropositividade para hepatite E, ajustada para sexo, idade e genótipo do HCV, apresentou forte tendência de associação com presença de cirrose hepática (OR = 1,72; IC 95% 0,96 – 3,07; p = 0,06). Presença de anticorpos contra o HEV apresentou associação independente com resistência insulínica (OR: 4,24; p = 0,05). Discussão e Conclusões: Pacientes com infecção crônica pelo HCV estão sob risco de superinfecção pelo vírus da hepatite E em São Paulo. Contato com porcos é fator de risco para a infecção, indicando possível zoonose de transmissão alimentar ou por contato com os dejetos dos animais. Alta prevalência em hemofílicos sugere possibilidade de transmissão alternativa por via parenteral. A tendência de associação entre infecção prévia pelo vírus da hepatite E e cirrose sugere aceleração da progressão de fibrose hepática em pacientes com hepatite C crônica. Infecção prévia pelo vírus da hepatite E se associa à presença de resistência insulínica, podendo esta ser manifestação extra-hepática sustentada após resolução da infecção pelo vírus.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Liver fibrosis progression in HIV/hepatitis C virus coinfected patients with normal aminotransferases levels
    (Sociedade Brasileira de Medicina Tropical - SBMT, 2012-08-01) Pace, Fábio Heleno de Lima; Ferreira, Lincoln Eduardo Vieira de Castro; Silva, Antonio Eduardo Benedito [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de Juiz de Fora Centro de Referência em Hepatologia Departamento de Gastroenterologia; Universidade Federal de Juiz de Fora Unidade de Endoscopia Digestiva; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: Approximately 30% of hepatitis C virus (HCV) monoinfected patients present persistently normal alanine aminotransferase (ALT) levels. Most of these patients have a slow progression of liver fibrosis. Studies have demonstrated the rate of liver fibrosis progression in hepatitis C virus-human immunodeficiency virus (HCV-HIV) coinfected patients is faster than in patients infected only by HCV. Few studies have evaluated the histological features of chronic hepatitis C in HIV-infected patients with normal ALT levels. METHODS: HCV-HIV coinfected patients (HCV-RNA and anti-HIV positive) with known time of HCV infection (intravenous drugs users) were selected. Patients with hepatitis B surface antigen (HBsAg) positive or hepatitis C treatment before liver biopsy were excluded. Patients were considered to have a normal ALT levels if they had at least 3 normal determinations in the previous 6 months prior to liver biopsy. All patients were submitted to liver biopsy and METAVIR scale was used. RESULTS: Of 50 studied patients 40 (80%) were males. All patients were treated with antiretroviral therapy. The ALT levels were normal in 13 (26%) patients. HCV-HIV co-infected patients with normal ALT levels had presented means of the liver fibrosis stages (0.77±0.44 versus 1.86±1.38; p<0.001) periportal inflammatory activity (0.62±0.77 versus 2.24±1.35; p<0.001) and liver fibrosis progression rate (0.058±0.043 fibrosis unit/year versus 0.118±0.102 fibrosis unit/year) significantly lower as compared to those with elevated ALT. CONCLUSIONS: HCV-HIV coinfected patients with persistently normal ALTs showed slower progression of liver fibrosis. In these patients the development of liver cirrhosis is improbable.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Low bone mineral density in noncholestatic liver cirrhosis: prevalence, severity and prediction
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2003-09-01) Figueiredo, Fátima Aparecida Ferreira; Brandão, Cynthia [UNIFESP]; Perez, Renata de Mello [UNIFESP]; Barbosa, Walnei Fernandes [UNIFESP]; Kondo, Mario [UNIFESP]; University of the State of Rio de Janeiro Department of Internal Medicine; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: Metabolic bone disease has long been associated with cholestatic disorders. However, data in noncholestatic cirrhosis are relatively scant. AIMS: To determine prevalence and severity of low bone mineral density in noncholestatic cirrhosis and to investigate whether age, gender, etiology, severity of underlying liver disease, and/or laboratory tests are predictive of the diagnosis. PATIENTS/METHODS: Between March and September/1998, 89 patients with noncholestatic cirrhosis and 20 healthy controls were enrolled in a cross-sectional study. All subjects underwent standard laboratory tests and bone densitometry at lumbar spine and femoral neck by dual X-ray absorptiometry. RESULTS: Bone mass was significantly reduced at both sites in patients compared to controls. The prevalence of low bone mineral density in noncholestatic cirrhosis, defined by the World Health Organization criteria, was 78% at lumbar spine and 71% at femoral neck. Bone density significantly decreased with age at both sites, especially in patients older than 50 years. Bone density was significantly lower in post-menopausal women patients compared to pre-menopausal and men at both sites. There was no significant difference in bone mineral density among noncholestatic etiologies. Lumbar spine bone density significantly decreased with the progression of liver dysfunction. No biochemical variable was significantly associated with low bone mineral density. CONCLUSIONS: Low bone mineral density is highly prevalent in patients with noncholestatic cirrhosis. Older patients, post-menopausal women and patients with severe hepatic dysfunction experienced more advanced bone disease. The laboratory tests routinely determined in patients with liver disease did not reliably predict low bone mineral density.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Non-invasive diagnosis of liver fibrosis in chronic hepatitis C
    (Baishideng Publ Grp Co Ltd, 2014-03-21) Schiavon, Leonardo de Lucca; Narciso-Schiavon, Janaína Luz; Carvalho-Filho, Roberto José de [UNIFESP]; Universidade Federal de Santa Catarina (UFSC); Universidade Federal de São Paulo (UNIFESP)
    Assessment of liver fibrosis in chronic hepatitis C virus (HCV) infection is considered a relevant part of patient care and key for decision making. Although liver biopsy has been considered the gold standard for staging liver fibrosis, it is an invasive technique and subject to sampling errors and significant intra-and inter-observer variability. Over the last decade, several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection, with variable performance. Besides the clear advantage of being noninvasive, a more objective interpretation of test results may overcome the mentioned intra-and inter-observer variability of liver biopsy. in addition, these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk. However, in general, these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extrahepatic conditions. These methods are either serum markers (usually combined in a mathematical model) or imaging modalities that can be used separately or combined in algorithms to improve accuracy. in this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C, their advantages, limitations and application in clinical practice. (c) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Perfil nutricional de pacientes com hepatite C crônica genótipo 1: relação com os aspectos histológicos
    (Universidade Federal de São Paulo (UNIFESP), 2015-08-31) Silva, Vanessa Aparecida de Santis e [UNIFESP]; Silva, Ivonete Sandra de Souza e [UNIFESP]; Gomes, Ferraz, Maria Lucia Cardoso [UNIFESP]; http://lattes.cnpq.br/1870810357457710; http://lattes.cnpq.br/5846912595934815; http://lattes.cnpq.br/8717455240610691; Universidade Federal de São Paulo (UNIFESP)
    Introdução: Diferentes fatores são responsáveis pela progressão da fibrose na infecção crônica pelo vírus da hepatite C, mas o papel dos fatores nutricionais na progressão da doença não está definido. Este estudo teve como objetivo avaliar o estado nutricional e o perfil dietético de pacientes com hepatite C crônica candidatos a tratamento e sua associação com achados histopatológicos. Métodos: Foi conduzido um estudo transversal em pacientes com hepatite C crônica genótipo 1 virgens de tratamento, entre 2011 e 2013. Foram analisados, antes do tratamento, os seguintes aspectos: biópsia hepática, medidas antropométricas e análise qualitativa e quantitativa do consumo alimentar. Resultados: setenta pacientes foram estudados. A maioria dos pacientes apresentava obesidade (34%) ou sobrepeso (20%) de acordo com índice de massa corporal (IMC) e risco para doenças cardiovasculares de acordo com a circunferência da cintura elevada (79%). Na análise qualitativa do consumo alimentar, 59% apresentavam uma dieta inadequada. Conforme análise quantitativa, 59% tinham consumo insuficiente de calorias, 36% consumo excessivo de proteínas e 63% consumo excessivo de gorduras saturadas. Com relação à histologia, 68% apresentavam grau de atividade inflamatória maior ou igual a 2, 65% mostraram esteatose hepática e 25% possuíam grau de fibrose >2. Na análise comparativa entre as medidas antropométricas e achados histológicos, somente a circunferência da cintura elevada mostrou associação com esteatose hepática (p=0,05). Não houve associação entre consumo alimentar qualitativo e quantitativo com parâmetros histológicos. Conclusão: a maioria dos pacientes apresentava consumo alimentar inadequado de acordo com parâmetros qualitativos e consumo excessivo de gordura saturada, além de excesso de gordura abdominal, que esteve associada à esteatose hepática. Portanto, aconselhamento nutricional deveria ser implementado em pacientes candidatos a tratamento para hepatite C crônica visando evitar distúrbios nutricionais que podem impactar negativamente no manejo dos pacientes.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Polysomnographic sleep aspects in liver cirrhosis: A case control study
    (Baishideng Publ Grp Co Ltd, 2013-06-14) Teodoro, Vinicius Vasconcelos [UNIFESP]; Bragagnolo Junior, Mauricio Augusto [UNIFESP]; Lucchesi, Ligia Mendonça [UNIFESP]; Cavignolli, Daniel [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Kondo, Mario [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    AIM: To study sleep aspects and parameters in cirrhotic patients and assess the role of liver dysfunction severity in polysomnographic results.METHODS: This was a case-control study. Patients with a diagnosis of liver cirrhosis were consecutively enrolled in the study. Clinical examinations and laboratory liver tests were performed in all patients, and disease severity was assessed using the Child-Pugh score. the control group consisted of age- and gender-matched healthy volunteers. All individuals answered a questionnaire about habits, behaviors, and complaints related to sleep and were submitted to polysomnography. Sleep parameters were compared between the two groups, and separate analyses were performed among classes of Child-Pugh classification in the cirrhotic group.RESULTS: Forty-two cirrhotic patients and forty-two controls were enrolled. Compared to the control group, the cirrhotic group exhibited lower sleep efficiency (mean +/- SD: 73.89% +/- 14.99% vs 84.43% +/- 8.55%, P < 0.01), increased latency (151.27 +/- 93.24 min vs 90.62 +/- 54.74 min, P < 0.01) and a lower percentage of rapid eye movement (REM) sleep (14.04% +/- 5.64% vs 20.71% +/- 6.77%, P < 0.05) as well as a higher frequency of periodic limb movements (10.56 +/- 2.85/h vs 2.79 +/- 0.61/h, P < 0.01). the comparison of sleep parameters among Child A, B and C cirrhotic patients revealed a significant reduction of REM sleep stage occurrence in individuals with severe liver disease (Child C patients) compared to Child A/B patients (polysomnography percentage of REM sleep stage of patients Child A: 16.1% +/- 1.2%; Child B: 14.9% +/- 1.2%; Child C: 8.6% +/- 1.6%, P < 0.05).CONCLUSION: Cirrhosis was associated with shorter sleep time, reduced sleep efficiency, increased sleep latency, increased REM latency and reduced REM sleep. Additionally, disease severity influences sleep parameters. (c) 2013 Baishideng. All rights reserved.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Remembering the forgotten non-communicable diseases
    (Biomed Central Ltd, 2014-10-22) Lopez, Alan D.; Williams, Thomas N.; Levin, Adeera; Tonelli, Marcello; Singh, Jasvinder A.; Burney, Peter G. J.; Rehm, Juergen; Volkow, Nora D.; Koob, George; Ferri, Cleusa P. [UNIFESP]; Univ Melbourne; Univ London Imperial Coll Sci Technol & Med; KEMRI Wellcome Trust Res Programme; Univ British Columbia; VA Med Ctr; Univ Alabama Birmingham; Mayo Clin; Ctr Addict & Mental Hlth; Tech Univ Dresden; Univ Toronto; UofT; NIDA; NIAAA; Hosp Alemao Oswaldo Cruz; Universidade Federal de São Paulo (UNIFESP)
    The forthcoming post-Millennium Development Goals era will bring about new challenges in global health. Low- and middle-income countries will have to contend with a dual burden of infectious and non-communicable diseases (NCDs). Some of these NCDs, such as neoplasms, COPD, cardiovascular diseases and diabetes, cause much health loss worldwide and are already widely recognised as doing so. However, 55% of the global NCD burden arises from other NCDs, which tend to be ignored in terms of premature mortality and quality of life reduction. Here, experts in some of these 'forgotten NCDs' review the clinical impact of these diseases along with the consequences of their ignoring their medical importance, and discuss ways in which they can be given higher global health priority in order to decrease the growing burden of disease and disability.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Teste respiratório da 13C-metacetina na doença hepática crônica pelo vírus C
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2006-03-01) Oliveira, Ana Claudia de [UNIFESP]; Reber, Marialice; Lanzoni, Valeria Pereira [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: The 13C-methacetin breath test is a non-invasive method to evaluate hepatic microssomal function that allows a quantitative assessment of the functional hepatic mass. AIM: To evaluate the clinical usefulness of the 13C-methacetin breath test in patients with hepatitis C chronic liver disease. PATIENTS AND METHODS: Seventy eight patients with chronic hepatitis C and 13 matched healthy controls were studied. HCV patients were classified as having chronic hepatitis (n = 51), cirrhosis (n = 27), being seven with decompensated disease (presence of ascite, jaundice and/or encephalopathy). HbsAg/HIV co-infected patients, chronic alcohol drinker, having other chronic diseases and those using drugs that could interfere with hepatic cytochrome P450, were excluded. The disease stage and activity in biopsy fragments were determined according the Brazilian Society of Hepatology criteria. Breath test was performed with 75 mg of 13C-methacetin, and the 13CO2 in the expired air was measured through a nondispersive infra red spectrometry. The delta over baseline, and the cumulative recovery of 13CO2 at 40 (13C-methacetin breath test 40 min) and 120 minutes (13C-methacetin breath test 120 min) were calculated. RESULTS: 13C-methacetin breath test parameters correlate only with hepatic staging but not with necroinflammatory (activity) parameters, being the best correlation found between hepatic staging and the 13C-methacetin breath test 120 minutes. The mean values for 13C-methacetin breath test 120 min was significantly reduced in the cirrhotic groups (19.2 ± 7.1% for compensated and 14.7 ± 4.0% for decompensated cirrhotics) than in control (29.9 ± 4.5%) and chronic hepatitis (27.8 ± 6.1%) groups. The best diagnostic accuracy for the diagnosis of cirrhosis among HCV patients was found for 13C-methacetin breath test 120 min with 81% of sensibility and 77% of specificity. CONCLUSION: 13C-methacetin breath test is correlated with structural changes in HCV-related chronic hepatic diseases and the cumulative recovery at 120 minutes is a sensitive parameter to identify the presence of hepatic cirrhosis in these patients.