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ABSTRACT This study aimed to report the first case of a patient with hepatosplenic schistosomiasis mansoni, refractory ascites and portal vein thrombosis treated with a transjugular intrahepatic portosystemic shunt (TIPS), at the Instituto de Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. After the procedure, the patient recovered favorably and progressed with portal pressure reduction and no deterioration of the liver function. Endovascular shunt modification is a conservative medical approach that often helps in reducing symptoms significantly, making it a less invasive and a safer alternative to liver transplantation for the treatment of schistosomiasis with portal hypertension.

https://doi.org/10.1590/s1678-9946202264026

Leukocyte ratios are useful early predictors for adverse outcomes of COVID-19 infection
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Farias, João Pedro

; Silva, Pedro Paulo Costa e

; Codes, Liana

; Vinhaes, Diana

; Amorim, Ana Paula

; D’Oliveira, Ricardo Cruz

; Farias, Alberto Queiroz

; Bittencourt, Paulo Lisboa

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volumen 64 elocation e73

Resumen: En | Texto: En | PDF: En

ABSTRACT Leukocyte biomarkers, including the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte-(MLR), platelet-to-lymphocyte (PLR) ratios and systemic immune-inflammation index (SII) have been associated with severity and mortality of patients with COVID-19. The purpose of this study was to evaluate the association of baseline leukocyte biomarkers calculated in the emergency department (ED) with the disease severity and mortality. This was a retrospective cohort study that evaluated 1,535 (mean age 57+18 years) patients with SARS-CoV-2 infection in the ED of a single reference center. Outcomes were severity, defined as intensive care unit (ICU) admission requirement, and in-hospital mortality. All leukocyte biomarkers were calculated in the ED before the hospital admission. Their ability to predict the severity and mortality was measured using receiver operating characteristic (ROC) curves. Severity and mortality were observed in 30.9% and 12.6% of the patients, respectively, and were significantly correlated with NLR, MLR, PLR and SII, but only NLR was independently associated with both outcomes on multivariate analysis. Analysis of ROC curves revealed that NLR (0.78 for severity and 0.80 for mortality) and SII (0.77 for severity and 0.75 for mortality) had the best ability to predict mortality, when compared to other ratios. The highest AUC was observed for NLR, employing cut-off points of 5.4 for severity and 5.5 for mortality. Leukocyte biomarkers, particularly NLR, are capable of predicting the severity and mortality of patients with SARS-CoV-2 infection and could be important adjunct tools to identify patients in the ED that are more prone to develop adverse outcomes.

https://doi.org/10.1590/s1678-9946202264073

Hepatitis E virus infection increases the risk of diabetes and severity of liver disease in patients with chronic hepatitis C virus infection
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Zitelli, Patricia Momoyo Yoshimura

; Gomes-Gouvêa, Michele

; Mazo, Daniel F.

; Singer, Julio da Motta

; Oliveira, Claudia P.M.S.

; Farias, Alberto Queiroz

; Pinho, João Renato

; Tanigawa, Ryan Yukimatsu

; Alves, Venâncio Avancini Ferreira

; Carrilho, Flair José

; Pessoa, Mário Guimarães

Clinics

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2021, Volumen 76 elocation e3270

Resumen: En | Texto: En | PDF: En

OBJECTIVES: Co-infection with hepatitis A or B viruses may aggravate liver injury in patients infected with hepatitis C virus (HCV). However, few studies have assessed co-infection with hepatitis E virus (HEV) and HCV. Therefore, this study aimed to assess the prevalence and impact of HEV infection among Brazilian patients with chronic HCV infection. METHODS: This observational study included adult patients with chronic HCV infection who were naive to antiviral therapy from January 2013 to March 2016. A total of 181 patients were enrolled, and HEV serology and PCR were performed for all patients. RESULTS: Seropositivity for anti-HEV IgG was detected in 22 (12.0%) patients and anti-HEV immunoglobulin M in 3 (1.6%). HEV RNA showed inconclusive results in nine (4.9%) patients and was undetectable in the remaining patients. HEV serology positive patients had more severe liver disease, characterized by liver fibrosis ≥3 versus ≤2 (p<0.001), Aspartate Aminotransferase-to-Platelet Ratio Index of ≥1.45 (p=0.003), and Fibrosis-4 score of ≥3.25 (p=0.001). Additionally, the odds of HEV-positive patients developing diabetes mellitus were 3.65 (95% CI 1.40-9.52) times the corresponding odds of HEV-negative patients. A case-control-based histological analysis (n=11 HEV-HCV-positive patients and n=22 HCV-positive patients) showed no significant differences between the groups. CONCLUSIONS: This prevalence is higher than that reported in previous studies of the general population in Brazil. Thus, HEV infection may influence the severity of liver disease and may represent an additional risk of developing diabetes mellitus in patients with HCV infection.

https://doi.org/10.6061/clinics/2021/e3270

GUT MICROBIOTA, PREBIOTICS, PROBIOTICS, AND SYNBIOTICS IN GASTROINTESTINAL AND LIVER DISEASES: PROCEEDINGS OF A JOINT MEETING OF THE BRAZILIAN SOCIETY OF HEPATOLOGY (SBH), BRAZILIAN NUCLEUS FOR THE STUDY OF HELICOBACTER PYLORI AND MICROBIOTA (NBEHPM), AND BRAZILIAN FEDERATION OF GASTROENTEROLOGY (FBG)
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BARBUTI, Ricardo Correa

; SCHIAVON, Leonardo Lucca

; OLIVEIRA, Cláudia P

; ALVARES-DA-SILVA, Mário Reis

; SASSAKI, Lígia Yukie

; PASSOS, Maria do Carmo F

; FARIAS, Alberto Queiroz

; BARROS, Luisa Leite

; BARRETO, Bruno Paes

; ALBUQUERQUE, Gisela Bandeira de Melo Lins de

; ALVES, Amanda Mandarino

; NAVARRO-RODRIGUEZ, Tomás

; BITTENCOURT, Paulo Lisboa

Arquivos de Gastroenterologia

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Dic 2020, Volumen 57 Nº 4 Paginas 381 - 398

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Nos últimos anos, um volume crescente de evidências indica que os microrganismos estão envolvidos na manutenção da saúde humana e também estão relacionados a várias doenças, tanto intestinais quanto extraintestinais. Alterações na microbiota intestinal parecem ser um elemento chave na patogênese de doenças hepáticas e gastrointestinais, incluindo doença hepática gordurosa não-alcoólica, doença hepática alcoólica, cirrose hepática, doenças inflamatórias intestinais, síndrome do intestino irritável e diarreia associada ao Clostridium difficile. Em 2019, a Sociedade Brasileira de Hepatologia (SBH) em colaboração com o Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM) e a Federação Brasileira de Gastroenterologia (FBG) realizaram um encontro exclusivamente voltado para a discussão sobre microbiota e uso de prebióticos, probióticos e simbióticos em doenças hepáticas e gastrointestinais. Este texto resume os principais pontos discutidos durante o evento, e tem a intenção de fornecer informações práticas sobre o assunto, abordando as descobertas mais recentes e indicando áreas para estudos futuros.

ABSTRACT Over the last years, there is growing evidence that microorganisms are involved in the maintenance of our health and are related to various diseases, both intestinal and extraintestinal. Changes in the gut microbiota appears to be a key element in the pathogenesis of hepatic and gastrointestinal disorders, including non-alcoholic fatty liver disease, alcoholic liver disease, liver cirrhosis, inflammatory bowel disease, irritable bowel syndrome, and Clostridium difficile - associated diarrhea. In 2019, the Brazilian Society of Hepatology (SBH) in cooperation with the Brazilian Nucleus for the Study of Helicobacter Pylori and Microbiota (NBEHPM), and Brazilian Federation of Gastroenterology (FBG) sponsored a joint meeting on gut microbiota and the use of prebiotics, probiotics, and synbiotics in gastrointestinal and liver diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to provide practical information about this topic, addressing the latest discoveries and indicating areas for future studies.

https://doi.org/10.1590/s0004-2803.202000000-72 2240 descargas

RECOMMENDATIONS FOR INVASIVE PROCEDURES IN PATIENTS WITH DISEASES OF THE LIVER AND BILIARY TRACT: REPORT OF A JOINT MEETING OF THE BRAZILIAN SOCIETY OF HEPATOLOGY (SBH), BRAZILIAN SOCIETY OF DIGESTIVE ENDOSCOPY (SOBED) AND BRAZILIAN SOCIETY OF INTERVENTIONAL RADIOLOGY AND ENDOVASCULAR SURGERY (SOBRICE)
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SCHIAVON, Leonardo de Lucca

; EJIMA, Flávio Hayato

; MENEZES, Marcos Roberto de

; BITTENCOURT, Paulo Lisboa

; MOREIRA, Aírton Mota

; FARIAS, Alberto Queiroz

; CHAGAS, Aline Lopes

; ASSIS, André Moreira de

; MATTOS, Ângelo Zambam de

; SALOMÃO, Bruno Chaves

; TERRA, Carlos

; MARTINS, Fernanda Prata Borges

; CARNEVALE, Francisco Cesar

; REZENDE, Guilherme Ferreira da Motta

; PAULO, Gustavo Andrade de

; PEREIRA, Gustavo Henrique Santos

; MOTTA-LEAL-FILHO, Joaquim Maurício da

; MENESES, Juliana de

; COSTA, Lucas Santana Nova da

; CARNEIRO, Marcos de Vasconcelos

; ÁLVARES-DA-SILVA, Mário Reis

; SOARES, Mayra Veloso Ayrimoraes

; PEREIRA, Osvaldo Ignácio

; XIMENES, Rafael Oliveira

; DURANTE, Renata Filardi Simiqueli

; FERREIRA, Valério Alves

; LIMA, Vinícius Machado de

Arquivos de Gastroenterologia

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Jun 2019, Volumen 56 Nº 2 Paginas 213 - 231

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO As doenças do fígado e das vias biliares são causas comuns de morbidade e mortalidade. Procedimentos invasivos com finalidade diagnóstica e terapêutica são frequentemente recomendados nos casos de doenças hepatobiliares. O reconhecimento das indicações e limitações das técnicas comumente empregadas é crucial para uma adequada seleção dos pacientes, maximizando os resultados positivos e reduzindo o risco de complicações. Em 2018, a Sociedade Brasileira de Hepatologia (SBH), em colaboração com a Sociedade Brasileira de Radiologia Intervencionista e Cirurgia Endovascular (SOBRICE) e a Sociedade Brasileira de Endoscopia Digestiva (SOBED) realizaram um encontro exclusivamente voltado para a discussão dos procedimentos invasivos nas doenças hepatobiliares. Este texto resume as principais recomendações discutidas durante o evento, e tem a intenção de auxiliar clínicos, gastroenterologistas, hepatologistas, radiologistas e endoscopistas no uso adequado dos procedimentos invasivos para manejo de pacientes com doenças hepatobiliares.

ABSTRACT Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepatology (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.

https://doi.org/10.1590/s0004-2803.201900000-42 2181 descargas

UPDATE OF THE BRAZILIAN SOCIETY OF HEPATOLOGY RECOMMENDATIONS FOR DIAGNOSIS AND MANAGEMENT OF AUTOIMMUNE DISEASES OF THE LIVER
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COUTO, Cláudia Alves

; TERRABUIO, Debora Raquel Benedita

; CANÇADO, Eduardo Luiz Rachid

; PORTA, Gilda

; LEVY, Cynthia

; SILVA, Antônio Eduardo Benedito

; BITTENCOURT, Paulo Lisboa

; CARVALHO FILHO, Roberto José de

; CHAVES, Dalton Marques

; MIURA, Irene Kazue

; CODES, Liana

; FARIA, Luciana Costa

; EVANGELISTA, Andreia Silva

; FARIAS, Alberto Queiroz

; GONÇALVES, Luciana Lofêgo

; HARRIZ, Michelle

; LOPES, Edmundo Pessoa de Almeida

; LUZ, Gustavo Oliveira

; OLIVEIRA, Patrícia Marinho Costa

; OLIVEIRA, Elze Maria Gomes

; SCHIAVON, Janaina Luz Narciso

; SEVÁ-PEREIRA, Tiago

Arquivos de Gastroenterologia

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Jun 2019, Volumen 56 Nº 2 Paginas 232 - 241

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Desde a publicação em 2015 das recomendações da Sociedade Brasileira de Hepatologia sobre a prevenção e tratamento de doenças hepáticas autoimunes, novos dados baseados em evidências científicas foram publicados na literatura, mudando o diagnóstico e tratamento da hepatite autoimune (HAI), colangite biliar primária (CBP), colangite esclerosante primária (CEP), síndromes de sobreposição de HAI, CBP e CEP e o manejo de complicações específicas além de outros tópicos relativos à HAI e doenças hepáticas colestáticas. Este manuscrito atualiza as recomendações anteriores de acordo com as melhores evidências disponíveis na literatura até o momento. O mesmo painel de experts que participou da primeira diretriz revisou todas as recomendações de acordo com os dados publicados na literatura e elaborou um manuscrito submetido subsequentemente à apreciação e revisão de todos os membros da Sociedade Brasileira de Hepatologia via homepage da sociedade. As recomendações finais atualizadas foram condensadas no presente documento.

ABSTRACT New data concerning the management of autoimmune liver diseases have emerged since the last single-topic meeting sponsored by the Brazilian Society of Hepatology to draw recommendations about the diagnosis and treatment of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), overlap syndromes of AIH, PBC and PSC and specific complications and topics concerning AIH and cholestatic liver diseases. This manuscript updates those previous recommendations according to the best evidence available in the literature up to now. The same panel of experts that took part in the first consensus document reviewed all recommendations, which were subsequently scrutinized by all members of the Brazilian Society of Hepatology using a web-based approach. The new recommendations are presented herein.

https://doi.org/10.1590/s0004-2803.201900000-43 3841 descargas

RECOMMENDATIONS OF THE BRAZILIAN SOCIETY OF HEPATOLOGY FOR THE MANAGEMENT OF ACUTE KIDNEY INJURY IN PATIENTS WITH CIRRHOSIS
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TERRA, Carlos

; MATTOS, Ângelo Zambam de

; PEREIRA, Gustavo

; FARIAS, Alberto Queiroz

; KONDO, Mario

; MATTOS, Angelo Alves de

; MEDEIROS FILHO, José Eymard Moraes de

; STRAUSS, Edna

; DUTRA, Fábio Ricardo Dantas

; MAZZA, Marcelo

; LOPES, Edmundo Pessoa

; PEREIRA, Tiago SEVÁ

; SCHIAVON, Leonardo Lucca

; CARVALHO FILHO, Roberto José de

; FAGUNDES, Cláudia

; BITTENCOURT, Paulo Lisboa

Arquivos de Gastroenterologia

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Sep 2018, Volumen 55 Nº 3 Paginas 314 - 320

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO A lesão renal aguda é uma complicação comum da cirrose, acometendo até 20% dos pacientes hospitalizados. Este tema está em rápida evolução devido aos importantes avanços em novas classificações, biomarcadores e tratamentos que ocorreram nos últimos anos. Em nome da Sociedade Brasileira de Hepatologia, um painel de especialistas em Hepatologia e Nefrologia revisou as evidência publicadas na literatura, integrando os diferentes resultados de estudos, para desenvolver a presente recomendação.

ABSTRACT Acute kidney injury is a common complication of cirrhosis, occurring in up to 20% of patients hospitalized with cirrhosis. This field is rapidly changing, with significant advances in classification, biomarkers and therapy over the last few years. On the behalf of the Brazilian Society of Hepatology, a panel of experts in Hepatology and Nephrology reviewed published evidence to integrate findings and develop the recommendations presented in this manuscript.

https://doi.org/10.1590/s0004-2803.201800000-71 4725 descargas

Hourly, Daily, and Monthly Soil Temperature Fluctuations in a Drought Tolerant Crop
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Farias, Polianna dos Santos de

; Souza, Luciano da Silva

; Paiva, Arlicélio de Queiroz

; Oliveira, Áureo Silva de

; Souza, Laércio Duarte

; Ledo, Carlos Alberto da Silva

Revista Brasileira de Ciência do Solo

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2018, Volumen 42 elocation e0170221

Resumen: En | Texto: En | PDF: En

ABSTRACT Soil temperature is a physical property of great agricultural importance in the soil-plant relationship and in energy exchange with the atmosphere. This study was conducted in a degraded Cambissolo Háplico Ta Eutrófíco (Cambisol; Inceptisol) in the Irecê Identity Territory, Bahia, Brazil, aiming to evaluate the hourly, daily, and monthly fluctuations of soil temperature at depth, and soil thermal diffusivity in the castor bean crop. Hourly soil temperature data from February 4, 2014, to September 30, 2015, were obtained by using thermocouple sensors (copper-constantan) horizontally installed at 0.05, 0.10, and 0.20 m depths. Soil thermal diffusivity was estimated by phase and amplitude methods. Results showed that, for most days, the soil temperature was at the level recommended for castor bean. The maximum and minimum hourly and daily soil temperatures were observed in October and July, respectively, and the maximum soil temperature values occurred at 4 p.m. (0.05 m), 5 p.m. (0.10 m), and 7 p.m. (0.20 m). Soil temperature variability is low, requiring few measurement points to estimate this factor in an area. The amplitude method led to soil thermal diffusivity values compatible with results in the literature. The absence of a relationship between thermal diffusivity and soil moisture was attributed to the clay-loam soil texture, predominance of micropores, and iron oxides allowing greater approximation to the soil particles, with high thermal diffusivity even under low soil moisture conditions.

https://doi.org/10.1590/18069657rbcs20170221 2756 descargas

HIGHER VALUES IN LIVER ELASTOGRAPHY AND MELD SCORE ARE MORTALITY PREDICTORS ON LIVER TRANSPLANT WAITING LIST
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NACIF, Lucas Souto

; PARANAGUA-VEZOZZO, Denise C

; MATSUDA, Alina

; ALVES, Venancio Avancini Ferreira

; CARRILHO, Flair J

; FARIAS, Alberto Queiroz

; D’ALBUQUERQUE, Luiz Carneiro

; ANDRAUS, Wellington

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2018, Volumen 31 Nº 1 elocation e1360

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Racional: A elastografia hepática tem sido relatada nos carcinomas hepatocelulares (CHC); porém, não é claro identificar o risco de morbimortalidade na lista de transplante hepático. Objetivo: Avaliar a morbimortalidade com elastografia transitória e escore MELD. Método: Pacientes adultos com cirrose na triagem para transplante de fígado foram incluídos no estudo. Resultados: Foram incluídos 103 pacientes (sem CHC n=58 (66%), CHC n=45 (44%). O escore MELD médio foi de 14,7±6,4, a hipertensão portal foi de 83,9% e o valor médio de elastografia transitória foi de 32,73±22,5 kPa. O valor médio de ARFI (Impulsão de Força de Radiação Acústica) do parênquima hepático foi de 1,98 (0,65-3,2) m/s e 2,16 (0,59-2,8) m/s no grupo CHC. O grupo CHC foi significativamente associado à infecção por vírus da hepatite C (OR 26,84, p<0,0001), níveis mais altos de alfa-feto proteína sérica (OR 5,51; p=0,015), hipertensão portal clínica (OR 0,25; p=0,032) e pontuação MELD semelhante (p=0,693). Os valores de AUROCs (Area Under the Receiver Operating Characteristics) mostraram sensibilidade e especificidade para a alfa-feto proteína sérica (limite de 9,1 ng/ml), valor elastografia transitória (valor de corte 9 kPa) e valor ARFI (valor de corte 2,56 m/s) de 50% e 86%, 92% e 17% e 21% e 92%, respectivamente. O grupo de sobrevivência apresentou valor elastografia transitória médio de 31,65±22,2 kPa vs. 50,87±20,9 kPa (p=0,098) e valores mais elevados de MELD (p=0,035). Conclusão: Valores mais elevados na elastografia do fígado e nos escores MELD predizem a mortalidade.

ABSTRACT Background: Liver elastography have been reported in hepatocellular carcinoma (HCC) with higher values; however, it is unclear to identify morbimortality risk on liver transplantation waiting list. Aim: To assess liver stiffness, ultrasound and clinical findings in cirrhotic patients with and without HCC on screening for liver transplant and compare the morbimortality risk with elastography and MELD score. Method: Patients with cirrhosis and HCC on screening for liver transplant were enrolled with clinical, radiological and laboratory assessments, and transient elastography. Results: 103 patients were included (without HCC n=58 (66%); HCC n=45 (44%). The mean MELD score was 14.7±6.4, the portal hypertension present on 83.9% and the mean transient elastography value was 32.73±22.5 kPa. The median acoustic radiation force impulse value of liver parenchyma was 1.98 (0.65-3.2) m/s and 2.16 (0.59-2.8) m/s in HCC group. The HCC group was significantly associated with HCV infection (OR 26.84; p<0.0001), higher levels of serum alpha-fetoprotein (OR 5.51; p=0.015), clinical portal hypertension (OR 0.25; p=0.032) and similar MELD score (p=0.693). The area under the receiver operating characteristics (AUROC) showed sensitivity and specificity for serum alpha-fetoprotein (cutoff 9.1 ng/ml), transient elastography value (cutoff value 9 kPa), and acoustic radiation force impulse value (cutoff value 2.56 m/s) of 50% and 86%, 92% and 17% and 21% and 92%, respectively. The survival group had a mean transient elastography value of 31.65±22.2 kPa vs. 50.87±20.9 kPa (p=0.098) and higher MELD scores (p=0.035). Conclusion: Elastography, ultrasound and clinical findings are important non-invasive tools for cirrhosis and HCC on screening for liver transplant. Higher values in liver elastography and MELD scores predict mortality.

https://doi.org/10.1590/0102-672020180001e1360 6620 descargas

10.

VARICEAL BLEEDING: UPDATE OF RECOMMENDATIONS FROM THE BRAZILIAN ASSOCIATION OF HEPATOLOGY
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BITTENCOURT, Paulo Lisboa

; STRAUSS, Edna

; FARIAS, Alberto Queiroz

; MATTOS, Angelo Alves de

; LOPES, Edmundo Pessoa

Arquivos de Gastroenterologia

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Dic 2017, Volumen 54 Nº 4 Paginas 349 - 355

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Desde a publicação em 2010 das recomendações da Sociedade Brasileira de Hepatologia sobre a prevenção e tratamento do sangramento varicoso, novos dados baseados em evidências científicas foram publicados na literatura, mudando o manejo atual da hipertensão portal. O objetivo deste manuscrito foi atualizar as recomendações prévias da SBH, levando em consideração o novo conceito de estadiamento prognóstico da cirrose individualizando seu manejo de acordo com a presença de fibrose avançada, cirrose compensada ou descompensada. Um grupo de cinco experts revisou todas as recomendações de acordo com os dados publicados na literatura e elaborou um manuscrito submetido subsequentemente à apreciação e revisão de todos os membros da Sociedade Brasileira de Hepatologia via homepage da sociedade. As recomendações finais revisadas foram condensadas no presente documento.

ABSTRACT Since the publication of the Brazilian Association of Hepatology recommendations for the prevention and treatment of variceal bleeding in 2010, new evidence-based data were reported in the literature. This has changed our current management for portal hypertension. This review updates the previous recommendations. It takes the new prognostic staging of cirrhosis into account allowing tailored treatment for advanced fibrosis, compensated or decompensated cirrhosis. An organizing panel of five experts reviewed all recommendations according to available data, which were subsequently scrutinized by all members of the Brazilian Association of Hepatology using a web-based approach. The accepted recommendations are presented in this manuscript.

https://doi.org/10.1590/s0004-2803.201700000-79 4008 descargas

11.

Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology
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Bittencourt, Paulo Lisboa

; Terra, Carlos

; Parise, Edison Roberto

; Farias, Alberto Queiroz

; Arroyo, Vincent

; Fernandez, Javier

; Pereira, Gustavo

; Maubouisson, Luiz Marcelo

; Andrade, Guilherme Marques

; Costa, Fernando Gomes de Barros

; Codes, Liana

; Andrade, Antônio Ricardo

; Matos, Angelo

; Torres, André

; Couto, Fernanda

; Zyngier, Ivan

Arquivos de Gastroenterologia

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Dic 2015, Volumen 52 Supl. 1 Paginas 55 - 72

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO A sobrevida de pacientes cirróticos críticos aumentou significantemente nos últimos anos devido a inúmeros avanços obtidos no manejo do paciente com cirrose descompensada e com insuficiência hepática aguda grave, particularmente após a incorporação na prática clínica de uma série de estratégias baseadas em evidencias com impacto reconhecido na redução de mortalidade. Com o intuito de discutir as principais evidencias disponíveis na literatura médica sobre o assunto, a Sociedade Brasileira de Hepatologia, em conjunto com a Associação de Medicina Intensiva Brasileira e a Associação Brasileira de Transplantes de Órgãos promoveu uma reunião monotemática sobre o manejo do paciente hepatopata crítico, que ocorreu em 21 de maio de 2014 na cidade do Rio de Janeiro. O relatório da reunião foi resumido no presente manuscrito com o objetivo de nortear a prática clínica de intensivistas, gastroenterologistas e hepatologistas no manejo do paciente hepatopata em ambiente de terapia intensiva.

ABSTRACT Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.

https://doi.org/10.1590/s0004-28032015000500004 34375 descargas

12.

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver
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Bittencourt, Paulo Lisboa

; Cançado, Eduardo Luiz Rachid

; Couto, Cláudia Alves

; Levy, Cynthia

; Porta, Gilda

; Silva, Antônio Eduardo Benedito

; Terrabuio, Debora Raquel Benedita

; Carvalho Filho, Roberto José de

; Chaves, Dalton Marques

; Miura, Irene Kazue

; Codes, Liana

; Faria, Luciana Costa

; Evangelista, Andreia Silva

; Farias, Alberto Queiroz

; Gonçalves, Luciana Lofêgo

; Harriz, Michele

; Lopes Neto, Edmundo Pessoa A

; Luz, Gustavo Oliveira

; Oliveira, Patrícia

; Oliveira, Elze Maria Gomes de

; Schiavon, Janaina Luz Narciso

; Seva-Pereira, Tiago

; Parise, Edison Roberto

Arquivos de Gastroenterologia

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Dic 2015, Volumen 52 Supl. 1 Paginas 15 - 46

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Para definir as recomendações baseadas em evidências científicas sobre o diagnóstico e tratamento das doenças autoimnus do fígado, a Sociedade Brasileira de Hepatologia organizou em Outubro de 2014, encontro monotemático em São Paulo. Um Comitê organizador de sete investigadores foi selecionado pela Diretoria da Sociedade para organizar a agenda científica, assim como para selecionar vinte debatedores para fazer uma revisão sistemática e apresentar tópicos relacionados à hepatite autoimune, colangite esclerosante primária, cirrose biliar primária e suas síndromes de superposição (overlap). O texto inicial do submetidoo a apreciação e aprovação da Sociedade Brasileira de Hepatologia através de consulta a todos associados através da home page da Sociedade, O trabalho apresentado representa a versão final do trabalho original, devidamente revisado e organizado em tópicos, segundo as recomendações da Sociedade Brasileira de Hepatologia.

ABSTRACT In order to draw evidence-based recommendations concerning the management of autoimmune diseases of the liver, the Brazilian Society of Hepatology has sponsored a single-topic meeting in October 18th, 2014 at São Paulo. An organizing committee comprised of seven investigators was previously elected by the Governing Board to organize the scientific agenda as well as to select twenty panelists to make a systematic review of the literature and to present topics related to the diagnosis and treatment of autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis and their overlap syndromes. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

https://doi.org/10.1590/s0004-28032015000500002 8104 descargas

13.

Cardiohepatic Interactions - from Humoral Theory to Organ Transplantation
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Silvestre, Odilson Marcos

; Bacal, Fernando

; Ximenes, Rafael Oliveira

; Carrilho, Flair José

; D'Albuquerque, Luiz Augusto Carneiro

; Farias, Alberto Queiroz

Arquivos Brasileiros de Cardiologia

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Jun 2014, Volumen 102 Nº 6 Paginas e65 - e67

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20140079 5717 descargas

14.

Volume de líquido amniótico e os desfechos maternos em gestantes com ruptura prematura das membranas pré-termo
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Patriota, Adriane Farias

; Guerra, Gláucia Virgínia de Queiroz Lins

; Melo, Brena Carvalho Pinto de

; Santos, Alessandra Coelho

; Torres Júnior, Alberto Callou

; Souza, Alex Sandro Rolland

Revista Brasileira de Ginecologia e Obstetrícia

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Abr 2014, Volumen 36 Nº 4 Paginas 146 - 151

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Analisar entre pacientes com ruptura prematura de membranas pré-termo a associação do volume do líquido amniótico e os desfechos maternos.MÉTODOS: Estudo observacional do tipo coorte retrospectivo, realizado entre janeiro de 2008 e dezembro de 2012. Foram incluídas 86 gestantes com diagnóstico de ruptura prematura das membranas e idade gestacional entre a 24ªe a 35ª semanas, submetidas à mensuração do índice de líquido amniótico (ILA). Foram comparadas gestantes em dois pontos de cortes: com ILA <5,0 e ≥5,0 cm e ILA <3,0 e ≥3,0 cm. Foram excluídas mulheres com síndromes hipertensivas,diabetes mellitus, malformações fetais e com diagnóstico de infecção na admissão. Para análise estatística, foi utilizado o teste do χ2 ou exato de Fisher, quando pertinentes, e análise de regressão linear simples, adotando-se um nível de significância de 5%. Foi calculada a Razão de Risco (RR) e seu intervalo de confiança de 95% (IC95%).RESULTADOS: Quando avaliados os desfechos maternos em relação ao ILA ≥5,0 versus<5,0 cm, não foram encontradas diferenças estatisticamente significativas. Entretanto, em relação ao ILA <3,0 e ≥3,0 cm, foi verificado aumento do risco de corioamnionite (36,7 versus10,7%; RR: 3,4; IC95% 1,4 -8,3; p=0,004), não sendo observadas diferenças significativas para as outras variáveis estudadas. Houve ainda correlação positiva estatisticamente significativa entre o ILA e idade gestacional do parto (R2=0,78; p<0,0001).CONCLUSÕES: O ILA <3,0 cm aumenta em três vezes o risco para corioamnionite, e quanto maior o ILA, maior a idade gestacional do parto.

PURPOSE: To describe the potential influence of amniotic fluid on the maternal outcome of preterm premature rupture of membranes (PROM).METHODS: An observational, retrospective cohort study was conducted between December 2012 and January 2008 on 86 pregnant women with preterm PROM and a gestational age (GA) of 24 to 35 weeks. The amniotic fluid index (AFI) was used to measure aminiotic fluid volume. Pregnant women were compared at two cut-off points: those with AFI <5.0 and ≥5.0 cm and AFI <3.0 and ≥3.0 cm. We excluded women with hypertensive disorders, diabetesmellitus, fetal malformations and a diagnosis of infections at admission. For statistical analysis, we used the χ2test or Fisher's exact test, when appropriate, and simple linear regression analysis, with the level of significance set at 5%. We calculated the Risk Ratio (RR) and its 95% confidence interval (95%CI).RESULTS: When maternal outcomes were assessed by comparing ILA ≥5.0versus <5.0 cm, no significant differences were detected. However, when considering ILA <3.0 and ≥3.0 cm, there was an increased risk of chorioamnionitis (36.7 versus10.7%, RR: 3.4, 95%CI 1.4 -8.3, p=0.004), with no significant differences for the other variables. There was also a statistically significant positive correlation between AFI and gestational age at delivery (R2=0.78, p<0.0001).CONCLUSIONS: AFI <3.0 cm causes a three-fold increase in the risk for chorioamnionitis; also, the higher the ILA, the higher the gestational age at delivery.

https://doi.org/10.1590/S0100-720320140050.0003 3712 descargas

15.

Disfunção miocárdica relacionada à cirrose
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Silvestre, Odilson Marcos

; Farias, Alberto Queiroz

; Bacal, Fernando

Arquivos Brasileiros de Cardiologia

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Ago 2013, Volumen 101 Nº 2 Paginas 192 - 192

Resumen: Pt | Texto: Pt | PDF: Pt

https://doi.org/10.5935/abc.20130155 2235 descargas

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