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Different rotations in the acrylonitrile-butadiene-styrene extrusion process and their influence on fracture and mechanical properties
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Neto, José Costa de Macêdo

; Teixeira Junior, Renato Moreira

; Costa, João Carlos Martins da

; Kieling, Antônio Cláudio

; Nascimento, Nayara Reis do

; Bello, Roger Hoel

; Freitas, Bruno Mello de

; Pino, Gilberto Garcia del

Matéria (Rio de Janeiro)

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2023, Volume 28 N. 4 elocation e20230162

Abstract: En | Text: En | PDF: En

ABSTRACT ABS resins have wide application in the market, mainly in the manufacture of household appliances, telephones, automotive industry and others, and need to be processed by extrusion for the manufacture of products. The variables used in the process of extrusion of polymers have a direct influence on their mechanical properties. The objective of this study was to evaluate the different speeds of the extruder screw (15, 30, 45 and 60 rpm) on the mechanical properties of raw ABS after the extrusion process. Izod impact resistance and tensile tests, were also performed. The fractures of the samples tested by Izod impact were observed via optical microscopy, scanning electronic microscopy (SEM), and roughness was measured. Calorimetric tests (DSC) and thermogravimetry (TGA), as well as melt flow index (MFI), were also performed. The most significant results were observed for the extruder screw speed of 60 rpm. For the impact test, a reduction in impact energy of approximately 3% was observed, with the same result for tensile resistance. However, an increase in the value of the elastic modulus and the MFI was observed due to the increase in the degree of crystallinity, which was caused by the higher shear of the polymer mass in the screw of the extrusion equipment. Additionally, an atypical case occurred for the ABS polymer in the highest rotation, since it was the polymer that suffered the greatest shear in the polymer chains due to the degradation of the butadiene phase.

https://doi.org/10.1590/1517-7076-rmat-2023-0162

Development and in vivo evaluation of lipid-based nanocarriers containing Jatropha isabellei dry extract from the dichloromethane fraction intended for oral treatment of arthritic diseases
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Fröhlich, Janaina Kieling

; Meyer, Priscila Aguiar

; Stein, Taciane

; Tonussi, Carlos Rogério

; Lemos-Senna, Elenara

Brazilian Journal of Pharmaceutical Sciences

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2022, Volume 58 elocation e19178

Abstract: En | Text: En | PDF: En

Abstract In this study, a dichloromethane fraction dry extract from the underground parts of Jatropha isabellei (DFJi) was used to prepare lipid nanocarriers (LNCJi) aimed at providing the oral delivery of terpenic compounds in the treatment of arthritis. The lipid nanocarriers were prepared by the spontaneous emulsification method. The lipid nanocarriers displayed sizes ranging from 180 to 200 nm and zeta potential values of around -18 mV. A high value of entrapment efficiency (> 90%) was obtained for jatrophone, which was used as the chemical marker of DFJi. LNCJi stored at 4°C were demonstrated to be stable through measurements of transmitted light after analytical centrifugation of the samples. In vitro drug release studies conducted in biorelevant dissolution media demonstrated that jatrophone release was faster from LNCJi than from free DFJi. When tested in an acute arthritis model, the LNCJi exhibited antinociceptive properties after oral administration of a 50 mg/kg dose, unlike the free DFJi, although no reduction in articular diameter was observed. These results suggest that an increase in the oral absorption of DFJi constituents may have occurred through the carrying of this fraction in LNCJi, thus improving the antinociceptive activity of this compound.

https://doi.org/10.1590/s2175-97902022e19178

Autoimmune hepatitis in 828 Brazilian children and adolescents: clinical and laboratory findings, histological profile, treatments, and outcomes
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Porta, Gilda

; Carvalho, Elisa de

; Santos, Jorge L.

; Gama, Jorge

; Borges, Cristian V.

; Seixas, Renata B.P.M.

; Ferreira, Alexandre R.

; Miura, Irene K.

; Silveira, Themis R.

; Silva, Luciana R.

; Fagundes, Eleonora D.T.

; Bellomo-Brandao, Maria A.

; Sawamura, Regina

; Vieira, Sandra M.

; Melere, Melina U.

; Marques, Cibele D.F.

; Pugliese, Renata P.

; Danesi, Vera L.

; Porta, Adriana

; Marsillac, Marise E.

; Valladares, Marcia A.

; Menezes, Daniela G.

; Kieling, Carlos

; Paula, Mariana N. de

; Vasconcelos, Juliana R.

; Ferreira, Cristina T.

; Perin, Nilza

; Resende, Leonardo R.

; Maia, Jussara

; Tommaso, Adriana M.A. De

; Hessel, Gabriel

Jornal de Pediatria

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aug 2019, Volume 95 N. 4 Pages 419 - 427

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Este estudo com acompanhamento de longo prazo visou a avaliar o quadro clínico, os achados laboratoriais, o perfil histológico, os tratamentos e os resultados de crianças e adolescentes com hepatite autoimune. Métodos: Foram analisados os prontuários médicos de 828 crianças e adolescentes com HAI. Foi usado um questionário para coletar os dados anônimos sobre o quadro clínico, os achados bioquímicos e histológicos e os tratamentos. Resultados: De todos os pacientes, 89,6% tinham hepatite autoimune-1 e 10,4% hepatite autoimune-2. O sexo feminino foi predominante nos dois grupos. A idade média no início dos sintomas foi 111,5 (6; 210) e 53,5 (8; 165) meses nos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente. Foi observado início clínico agudo em 56,1% e 58,8% e sintomas insidiosos em 43,9% e 41,2% dos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente. A probabilidade de insuficiência hepática foi 1,6 vezes maior para hepatite autoimune-2; 3,6% e 10,6% dos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente, apresentaram insuficiência hepática fulminante; o risco foi 3,1 vezes maior para hepatite autoimune-2. Os níveis de gamaglobulina e imunoglobulina G foram significativamente maiores nos pacientes com hepatite autoimune-1, ao passo que os níveis de imunoglobulina A e C3 foram menores em pacientes com hepatite autoimune-2; 22,4% dos pacientes apresentaram cirrose e a remissão bioquímica foi atingida em 76,2%. A taxa de sobrevida atuarial foi de 93,0%. Um total de 4,6% pacientes foram submetidos a transplante de fígado e 6,9% morreram (hepatite autoimune-1: 7,5%; hepatite autoimune-2: 2,4%). Conclusões: Nesta grande série clínica de crianças e adolescentes brasileiros, a hepatite autoimune-1 foi mais frequente e os pacientes com hepatite autoimune-2 mostraram maiores taxas de remissão da doença com respostas mais rápidas aos tratamentos. Os pacientes com hepatite autoimune-1 apresentaram maior risco de óbito.

Abstract Objective: This large study with a long-term follow-up aimed to evaluate the clinical presentation, laboratory findings, histological profile, treatments, and outcomes of children and adolescents with autoimmune hepatitis. Methods: The medical records of 828 children and adolescents with autoimmune hepatitis were reviewed. A questionnaire was used to collect anonymous data on clinical presentation, biochemical and histological findings, and treatments. Results: Of all patients, 89.6% had autoimmune hepatitis-1 and 10.4% had autoimmune hepatitis-2. The female sex was predominant in both groups. The median age at symptom onset was 111.5 (6; 210) and 53.5 (8; 165) months in the patients with autoimmune hepatitis 1 and autoimmune hepatitis-2, respectively. Acute clinical onset was observed in 56.1% and 58.8% and insidious symptoms in 43.9% and 41.2% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively. The risk of hepatic failure was 1.6-fold higher for autoimmune hepatitis-2. Fulminant hepatic failure occurred in 3.6% and 10.6% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively; the risk was 3.1-fold higher for autoimmune hepatitis-2. The gamma globulin and immunoglobulin G levels were significantly higher in autoimmune hepatitis-1, while the immunoglobulin A and C3 levels were lower in autoimmune hepatitis-2. Cirrhosis was observed in 22.4% of the patients; biochemical remission was achieved in 76.2%. The actuarial survival rate was 93.0%. A total of 4.6% underwent liver transplantation, and 6.9% died (autoimmune hepatitis-1: 7.5%; autoimmune hepatitis-2: 2.4%). Conclusions: In this large clinical series of Brazilian children and adolescents, autoimmune hepatitis-1 was more frequent, and patients with autoimmune hepatitis-2 exhibited higher disease remission rates with earlier response to treatment. Patients with autoimmune hepatitis-1 had a higher risk of death.

https://doi.org/10.1016/j.jped.2018.04.007 1614 downloads

Influência da segregação granulométrica e do emprego de aditivos de moagem na adequação de cinzas de casca de arroz como coproduto
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Calheiro, Daiane

; Fernandes, Iara Janaína

; Kieling, Amanda Gonçalves

; Moraes, Carlos Alberto Mendes

; Kulakowski, Marlova Piva

; Brehm, Feliciane Andrade

Matéria (Rio de Janeiro)

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jun 2016, Volume 21 N. 2 Pages 270 - 281

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A cinza de casca de arroz (CCA) é um resíduo proveniente da combustão da casca de arroz utilizada como biomassa na produção de energia. Esta cinza é gerada em grandes quantidades e possui baixa massa específica, o que dificulta o seu gerenciamento, pois demanda muito espaço para o devido armazenamento e descarte. A CCA possui um elevado teor de sílica em sua composição, fator este que pode torná-la um material atrativo para vários segmentos industriais. Neste contexto, este trabalho tem como objetivo avaliar a influência do beneficiamento físico da cinza de casca de arroz, por meio de processos de segregação granulométrica e moagem, com e sem o uso de aditivos, nas características deste material e na sua adequação como coproduto. A metodologia experimental utilizada para o desenvolvimento deste trabalho envolveu a segregação e moagem da CCA (com e sem aditivos de moagem), caracterização química, física e estrutural das amostras de CCA bruta, segregadas e moídas. Os resultados obtidos indicam que a segregação granulométrica se apresenta como fator determinante para a utilização da CCA como coproduto. Com relação à moagem, pode-se verificar que o diâmetro médio das partículas diminui e a massa específica das amostras aumenta, com o aumento do tempo de moagem. Entretanto, verifica-se que os aditivos usados neste trabalho, nas concentrações testadas, não influenciam significativamente na redução do diâmetro das partículas.

ABSTRACT The rice husk ash (RHA) is a residue from the rice husk combustion used as biomass in energy production. This ash is generated in large amount and due to its low density it makes complicate its management, in addition it demands a lot of space for proper storage and disposal. The RHA has high silica content in its composition, a factor that may turn it in an attractive material for several industries. In this context, this work aims to evaluate the influence of physical processing of rice husk ash through the sieve segregation processes and grinding with and without the additives use, the characteristics of this material and its suitability as a co-product. The experimental methodology used to develop this work involved the segregation and grinding of the RHA (with and without grinding additives), chemical, physical and structural characterization of samples raw-based RHA, segregated and ground. The results indicate that the particle size segregation presents as a determinant factor for the use of RHA as coproduct. With regard to the grinding, it can be seen that the average diameter of the particles decreases and the density of the samples increases with increasing milling time. However, it appears that the used additives did not significantly influence the reduction of particle diameter in the concentrations tested.

https://doi.org/10.1590/S1517-707620160002.0027 1743 downloads

Frequency of and factors associated with vascular complications after pediatric liver transplantation ,
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Orlandini, Mariana

; Feier, Flávia Heinz

; Jaeger, Brunna

; Kieling, Carlos

; Vieira, Sandra Gonçalves

; Zanotelli, Maria Lucia

Jornal de Pediatria

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apr 2014, Volume 90 N. 2 Pages 169 - 175

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: avaliar a frequência e os fatores associados a complicações vasculares após transplante hepático pediátrico.MÉTODO: os fatores de risco foram avaliados em 99 pacientes com mais de 18 anos de idade comdoença hepática crônica submetidos a transplante hepático cadavérico (THC) entre marc¸o de1995 e novembro de 2009 no Hospital de Clínicas de Porto Alegre, Brasil. As variáveis analisadasincluíram: idade, sexo e peso dos doadores e receptores; indicac¸ão de transplante; escores PELD/MELD; aspectos técnicos; complicações vasculares pós-operatórias; e sobrevida.RESULTADOS: ocorreram complicações vasculares em 19 pacientes (19%). Os eventos arteriais foram mais comuns, tendo ocorrido precocemente no pós-operatório, e foram associados a altas taxas de perda do enxerto e mortalidade. Em uma análise multivariada, foram identificadosos seguintes fatores: diâmetro da veia porta < 3 mm, proporc¸ão de peso do doador/receptor (DRWR), tempo de isquemia prolongado e uso de enxertos arteriais.CONCLUSÃO: A escolha do tratamento depende do momento do diagnóstico; contudo, nessa série, a cirurgia de revisão, ou correc¸ão cirúrgica, produziu resultados piores que a angioplastia per-cutânea. A redução dos fatores de risco e a detecção precoce de complicações vasculares sãofundamentais para um transplante bem-sucedido.

OBJECTIVE:to evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation.METHOD:risk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival.RESULTS:vascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss and mortality rates. In the multivariate analysis, the following factors were identified: portal vein diameter < 3 mm, donor-to-recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts.CONCLUSION:the choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation.

https://doi.org/10.1016/j.jped.2013.08.010 2610 downloads

The effects of anesthetic regimen in 90% hepatectomy in rats
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Kieling, Carlos Oscar

; Backes, Ariane Nadia

; Maurer, Rafael Lucyk

; Cruz, Carolina Uribe

; Osvaldt, Alessandro Bersch

; Silveira, Themis Reverbel da

; Matte, Ursula da Silveira

Acta Cirúrgica Brasileira

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oct 2012, Volume 27 N. 10 Pages 702 - 706

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar a influência do regime anestésico sobre a recuperação anestésica, a sobrevida em 72 horas e a glicemia após hepatectomia parcial de 90% em ratos. MÉTODOS: Trinta ratos Wistar machos adultos foram distribuídos em dois grupos conforme o regime anestésico: combinação de ketamina e xilazina intraperitoneal ou isoflurano inalatório. Para prevenção de hipoglicemia foi administrada glicose intraperitoneal e adicionado glicose (20%) na água de beber. RESULTADOS: A recuperação anestésica no grupo ketamina e xilazina foi mais prolongada. Durante primeira hora após hepatectomia, nenhum rato anestesiado com ketamina e xilazina despertou. Todos do grupo isoflurano estavam ativos minutos após final da cirurgia. A sobrevida em 72 horas foi menor (Log rank=0,0001) no grupo ketamina e xilazina (0,0%) que no grupo isoflurano (26,7%). Glicemia em 6 horas do grupo ketamina e xilazina (63±31,7 mg/dL) foi menor (p=0,017) que no grupo isoflurano (98 ±21,2 mg/dL). Prolongado tempo de recuperação anestésica com ketamina e xilazina diminuiu sobrevida e glicemia após hepatectomia 90%. CONCLUSÃO: Anestesia com isoflurano reduziu tempo de recuperação e hipoglicemia, além de aumentar a sobrevida nas primeiras horas, possibilitando uma janela terapêutica adequada para estudos experimentais.

PURPOSE: To evaluate the influence of the anesthetic regimen on anesthetic recovery, survival, and blood glucose levels following a 90% partial hepatectomy in rats. METHODS: Thirty adult male Wistar rats were divided into two groups according to their anesthetic regimens: intraperitoneal ketamine and xylazine or inhaled isoflurane. In order to prevent hypoglycemia, glucose was administered intraperitoneally and glucose (20%) was added to the drinking water. RESULTS: Anesthetic recovery time was longer in the ketamine and xylazine group. The survival rate after 72 hours was lower (log rank=0.0001) in the ketamine and xylazine group (0.0%) than in the isoflurane group (26.7%). The blood glucose after six hours was lower (p=0.017) in the ketamine and xylazine group (63±31.7 mg/dL) than in the isoflurane group (98±21.2 mg/dL). The prolonged anesthesia recovery time associated with ketamine and xylazine decreased the survival rate and blood glucose levels after 90% hepatectomy. CONCLUSION: Isoflurane anesthesia reduced the recovery time and incidence of hypoglycemia and increased the survival rate in the early hours, providing a therapeutic window that is suitable for experimental studies.

2809 downloads

Biliary atresia: the Brazilian experience
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De Carvalho, Elisa

; Dos Santos, Jorge Luiz

; Da Silveira, Themis Reverbel

; Kieling, Carlos Oscar

; Rodrígues Silva, Luciana

; Porta, Gilda

; Kazue Miura, Irene

; Alves De Tommaso, Adriana María

; Bellomo Brandâo, María Àngela

; Rodrígues Ferreira, Alexandre

; De Deus Macêdo, José Roberto

; De Almeida Neto, José Tenório

Revista chilena de pediatría

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oct 2012, Volume 83 N. 5 Pages 502 - 502

Abstract: En | Text: En | PDF: En

788 downloads

Atresia biliar: a experiência brasileira
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de Carvalho, Elisa

; dos Santos, Jorge Luiz

; da Silveira, Themis Reverbel

; Kieling, Carlos Oscar

; Rodrigues Silva, Luciana

; Porta, Gilda

; Kazue Miura, Irene

; Alves De Tommaso, Adriana Maria

; Bellomo Brandão, Maria Ângela

; Rodrigues Ferreira, Alexandre

; de Deus Macêdo, José Roberto

; de Almeida Neto, José Tenório

Revista de la Sociedad Boliviana de Pediatría

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2012, Volume 51 N. 3 Pages 201 - 210

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo: Avaliar as características epidemiológicas, clínicas e prognósticas de crianças com atresia biliar. Método: Dados sobre portoenterostomia, transplante hepático (TxH), idade no último seguimento e sobrevida foram coletados dos prontuários de pacientes acompanhados em seis centros no Brasil (1982-2008) e comparados em relação às décadas do procedimento cirúrgico. Resultados: Dos 513 pacientes, 76,4% foram submetidos a portoenterostomia [idade: 60,0-94,7 (82,6±32,8) dias] e 46,6% foram submetidos a TxH. Em 69% dos casos, o TxH foi realizado após a portoenterostomia, enquanto em 31% dos casos o TxH foi realizado como cirurgia primária. Os pacientes da região Nordeste foram submetidos a portoenterostomia mais tardiamente do que as crianças das regiões Sul (p = 0,008) e Sudeste (p = 0,0012), embora, mesmo nas duas últimas regiões, a idade no momento da portoenterostomia tenha sido superior ao desejável. Ao longo das décadas, houve aumento progres si vo do número de TxH realizados. A sobrevida global foi de 67,6%. A sobrevida aumentou nas últimas décadas (anos 1980 versus 90, p = 0,002; anos 1980 versus 2000, p < 0,001; anos 1990 versus 2000, p < 0,001). A sobrevida de 4 anos pós-portoenterostomia, com ou sem TxH, foi de 73,4%, inversamente correlacionada à idade no momento da portoenterostomia (80,77,7,60,5% para < 60,61-90, > 90 dias, respectivamente). Os pacientes transplantados apresentaram taxas de sobrevida mais elevadas (88,3%). A sobrevida de 4 anos com fígado nativo foi de 36,8%, inversamente correlacionada à idade no momento da portoenterostomia (54, 33,3, 26,6% para < 60,61-90, > 90 dias, respectivamente). Conclusões: Este estudo multicêntrico demonstrou que o encaminhamento tardio das crianças portadoras de atresia biliar ainda é um problema no Brasil, influenciando a sobrevida destes pacientes. Estratégias que proporcionam o encaminhamento precoce estão sendo desenvolvidas com o objetivo de reduzir a necessidade de transplante hepático nos primeiros anos de vida.

Objective: To evaluate epidemiological, clinical and prognostic characteristics of children with biliary atresia. Methods: Data regarding portoenterostomy, liver transplantation (LTx), age at last follow-up and survival were collected from the records of patients followed up in six Brazilian centers (1982-2008) and compared regarding decades of surgery. Results: Of 513 patients, 76.4% underwent portoenterostomy [age: 60-94.7 (82.6±32.8) days] and 46.6% underwent LTx. In 69% of cases, LTx followed portoenterostomy, whereas in 31% of cases LTx was performed as the primary surgery. Patients from the Northeast region underwent portoenterostomy later than infants from Southern (p = 0.008) and Southeastern (p = 0.0012) Brazil, although even in the latter two regions age at portoenterostomy was higher than desirable. Over the decades, LTx was increasingly performed. Overall survival was 67.6%. Survival increased over the decades (1980s vs. 1990s, p = 0.002; 1980s vs. 2000s, p < 0.001; 1990s vs. 2000s, p < 0.001). The 4-year post portoenterostomy survival, with or without LTx, was 73.4%, inversely correlated with age at portoenterostomy (80, 77.7, 60.5% for < 60, 61-90, > 90 days, respectively). Higher survival rates were observed among transplanted patients (88.3%). The 4-year native liver survival was 36.8%, inversely correlated with age at portoenterostomy (54, 33.3, 26.6% for < 60, 61-90, > 90 days, respectively). Conclusions: This multicenter study showed that late referral for biliary atresia is still a problem in Brazil, affecting patient survival. Strategies to enhance earlier referral are currently being developed aiming to decrease the need for liver transplantation in the first years of life.

410 downloads

Mudança na suscetibilidade à hepatite A em crianças e adolescentes na última década
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Krebs, Lenita S

; Ranieri, Tani M. S

; Kieling, Carlos O

; Ferreira, Cristina T

; Silveira, Themis R. da

Jornal de Pediatria

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jun 2011, Volume 87 N. 3 Pages 213 - 218

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVOS: Estimar a prevalência de anticorpos contra hepatite A (anti-VHA) em grupo de crianças e adolescentes de laboratório público e privado em Porto Alegre e comparar com estudo realizado na década anterior. MÉTODOS: Entre 2007 e 2008 foi realizado estudo transversal onde foram incluídas, consecutivamente, 465 amostras de soros de crianças e adolescentes entre 1 e 19 anos de idade para determinar a prevalência de anticorpos anti-VHA total. As amostras foram fornecidas por laboratório público (grupo 1), que atende somente Sistema Único de Saúde, e por laboratório privado (grupo 2), representando os estratos socioeconômicos mais baixo e mais alto, respectivamente. O teste foi realizado em único laboratório (eletroquimioluminescência, Roche Diagnostics). Resultados > 20 UI/L foram considerados positivos. RESULTADOS: A soroprevalência de anti-VHA no grupo 1 foi de 37,6% e o percentual de positividade aumentou conforme a idade, variando de 19,4% entre 1-4 anos a 54,1% entre 15-19 anos. No grupo 2, a frequência de anti-VHA foi de 46,1% e foi inversamente relacionada à idade, caindo de cerca de 50,0% nas faixas etárias menores para 29,1% aos 15-19 anos. Houve diminuição significativa na prevalência do anti-VHA nas crianças de 5-9 anos do grupo 1 (p = 0,03), quando comparadas com estudo realizado na década de 1990. CONCLUSÕES: Os resultados sugerem queda na endemicidade da hepatite A em Porto Alegre na última década e indicam maior suscetibilidade à doença em crianças e adolescentes, principalmente no estrato socioeconômico mais baixo.

OBJECTIVES: To estimate the prevalence of anti-hepatitis A virus (anti-HAV) antibodies in serum samples from children and adolescents obtained at two clinical pathology laboratories in the city of Porto Alegre, south of Brazil, and to compare findings to those of a study carried out in the 1990s. METHODS: In this cross-sectional study conducted between 2007 and 2008, 465 serum samples obtained from subjects aged 1-19 years were consecutively tested to determine the prevalence of total anti-HAV antibodies. Samples were provided by a public laboratory (group 1) that serves the Unified Health System exclusively, meant to represent the lowest socioeconomic strata, and by a private laboratory (group 2), meant to represent the higher socioeconomic classes. Tests were performed at a single laboratory using commercially available electrochemiluminescence kits. Antibody levels > 20 UI/L were considered positive. RESULTS: The seroprevalence of anti-HAV in Group 1 was 37.6%. The percentage of anti-HAV reactivity increased from 19.4% in the 1-to-4 group to 54.1% in the 15-to-19 group. In Group 2, overall anti-HAV positivity was 46.1% and was inversely correlated with age, declining from roughly 50% in the youngest groups to 29.1% in the 15-to-19 group. Comparison of sample findings to those reported in a 1990s study showed a significant reduction in anti-HAV prevalence among 5-to-9-year-olds in group 1 (p = 0.03). CONCLUSIONS: The results suggest that the endemicity of hepatitis A in Porto Alegre has been declining over the past decade, and that children and adolescents, particularly those in the lowest socioeconomic strata, are more susceptible to the disease.

7438 downloads

10.

Atresia biliar: a experiência Brasileira
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Carvalho, Elisa de

; Santos, Jorge Luiz dos

; Silveira, Themis Reverbel da

; Kieling, Carlos Oscar

; Silva, Luciana Rodrigues

; Porta, Gilda

; Miura, Irene Kazue

; Tommaso, Adriana Maria Alves De

; Brandão, Maria Ângela Bellomo

; Ferreira, Alexandre Rodrigues

; Macêdo, José Roberto de Deus

; Almeida Neto, José Tenório de

Jornal de Pediatria

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dec 2010, Volume 86 N. 6 Pages 473 - 479

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar as características epidemiológicas, clínicas e prognósticas de crianças com atresia biliar. MÉTODOS: Dados sobre portoenterostomia, transplante hepático (TxH), idade no último seguimento e sobrevida foram coletados dos prontuários de pacientes acompanhados em seis centros no Brasil (1982-2008) e comparados em relação às décadas do procedimento cirúrgico. RESULTADOS: Dos 513 pacientes, 76,4% foram submetidos a portoenterostomia [idade: 60,0-94,7 (82,6±32,8) dias] e 46,6% foram submetidos a TxH. Em 69% dos casos, o TxH foi realizado após a portoenterostomia, enquanto em 31% dos casos o TxH foi realizado como cirurgia primária. Os pacientes da região Nordeste foram submetidos a portoenterostomia mais tardiamente do que as crianças das regiões Sul (p = 0,008) e Sudeste (p = 0,0012), embora, mesmo nas duas últimas regiões, a idade no momento da portoenterostomia tenha sido superior ao desejável. Ao longo das décadas, houve aumento progressivo do número de TxH realizados. A sobrevida global foi de 67,6%. A sobrevida aumentou nas últimas décadas (anos 1980 versus 1990, p = 0,002; anos 1980 versus 2000, p < 0,001; anos 1990 versus 2000, p < 0,001). A sobrevida de 4 anos pós-portoenterostomia, com ou sem TxH, foi de 73,4%, inversamente correlacionada à idade no momento da portoenterostomia (80, 77,7, 60,5% para < 60, 61-90, > 90 dias, respectivamente). Os pacientes transplantados apresentaram taxas de sobrevida mais elevadas (88,3%). A sobrevida de 4 anos com fígado nativo foi de 36,8%, inversamente correlacionada à idade no momento da portoenterostomia (54, 33,3, 26,6% para < 60, 61-90, > 90 dias, respectivamente). CONCLUSÕES: Este estudo multicêntrico demonstrou que o encaminhamento tardio das crianças portadoras de atresia biliar ainda é um problema no Brasil, influenciando a sobrevida destes pacientes. Estratégias que proporcionam o encaminhamento precoce estão sendo desenvolvidas com o objetivo de reduzir a necessidade de transplante hepático nos primeiros anos de vida.

OBJECTIVE: To evaluate epidemiological, clinical and prognostic characteristics of children with biliary atresia. METHODS: Data regarding portoenterostomy, liver transplantation (LTx), age at last follow-up and survival were collected from the records of patients followed up in six Brazilian centers (1982-2008) and compared regarding decades of surgery. RESULTS: Of 513 patients, 76.4% underwent portoenterostomy [age: 60-94.7 (82.6±32.8) days] and 46.6% underwent LTx. In 69% of cases, LTx followed portoenterostomy, whereas in 31% of cases LTx was performed as the primary surgery. Patients from the Northeast region underwent portoenterostomy later than infants from Southern (p = 0.008) and Southeastern (p = 0.0012) Brazil, although even in the latter two regions age at portoenterostomy was higher than desirable. Over the decades, LTx was increasingly performed. Overall survival was 67.6%. Survival increased over the decades (1980s vs. 1990s, p = 0.002; 1980s vs. 2000s, p < 0.001; 1990s vs. 2000s, p < 0.001). The 4-year post-portoenterostomy survival, with or without LTx, was 73.4%, inversely correlated with age at portoenterostomy (80, 77.7, 60.5% for < 60, 61-90, > 90 days, respectively). Higher survival rates were observed among transplanted patients (88.3%). The 4-year native liver survival was 36.8%, inversely correlated with age at portoenterostomy (54, 33.3, 26.6% for < 60, 61-90, > 90 days, respectively). CONCLUSIONS: This multicenter study showed that late referral for biliary atresia is still a problem in Brazil, affecting patient survival. Strategies to enhance earlier referral are currently being developed aiming to decrease the need for liver transplantation in the first years of life.

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11.

Atresia biliar: continuamos operando tarde
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Kieling, Carlos O.

; Santos, Jorge L. dos

; Vieira, Sandra M. G.

; Ferreira, Cristina T.

; Linhares, Ana R. R.

; Lorentz, Andréa L.

; Silveira, Themis R. da

Jornal de Pediatria

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oct 2008, Volume 84 N. 5 Pages 436 - 441

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Analisar a idade na cirurgia de crianças com atresia biliar e a sobrevida sem necessidade de transplante de fígado. O estudo foi realizado no Hospital de Clínicas de Porto Alegre. MÉTODOS: Foram revisados os prontuários dos pacientes operados entre 1982 e 2007, residentes no Rio Grande do Sul. RESULTADOS: Dos 112 casos estudados de crianças com atresia biliar, 38 (33,9%) ocorreram de 1982 a 1989, 46 (41,1%) de 1990 a 1999 e 28 (25,0%) a partir de 2000. Em 12 (10,7%) casos, não foi realizada a portoenterostomia. A idade na cirurgia variou de 25 a 297 dias (mediana: 80,5; IIQ25-75: 61,3-109,0 dias); em 20,5% dos casos, a idade das crianças foi menor do que 60 dias. Não houve diferença na idade, no momento do diagnóstico, entre as 3 décadas. Os pacientes do interior do estado (mediana: 87,0; IIQ25-75: 69,0-115,0 dias) foram encaminhados significativamente (p = 0,007) mais tarde do que os da região metropolitana de Porto Alegre (RS) (mediana: 68,0; IIQ25-75: 55,5-98,0 dias). A proporção de pacientes com menos de 60 dias foi significativamente menor (p = 0,013) nos oriundos do interior. A sobrevida com fígado nativo do total dos pacientes foi de 46,2% em 2 anos, diminuindo progressivamente até 15,3% em 20 anos. Os pacientes operados com menos de 60 dias tiveram maior sobrevida com fígado nativo (log rank < 0,0001). CONCLUSÕES: A portoenterostomia se manteve tardia nos últimos 25 anos, e esse atraso determinou menor tempo de sobrevida com fígado nativo nos pacientes com atresia biliar.

OBJECTIVE: To analyze the age at surgery for children with biliary atresia and their survival periods without need for liver transplantation. The study was performed at Hospital de Clínicas de Porto Alegre, in Porto Alegre, state of Rio Grande do Sul, Brazil. METHODS: The medical records of patients operated between 1982 and 2007 who were residents of the state of Rio Grande do Sul were reviewed. RESULTS: Of the 112 cases of children with biliary atresia studied, 38 (33.9%) occurred between 1982 and 1989, 46 (41.1%) between 1990 and 1999 and 28 (25.0%) after 2000. Portoenterostomy was not performed for 12 cases (10.7%). Age at surgery ranged from 25 to 297 days (median: 80.5; IQR25-75: 61.3-109.0 days); for 20.5% of cases, the age was below 60 days. There was no age difference at diagnosis for the three decades in the study. Patients from the countryside (median: 87.0; IQR25-75: 69.0-115.0 days) were referred significantly later (p = 0.007) than those living in Porto Alegre and the metropolitan area (median: 68.0; IQR25-75: 55.5-98.0 days). The ratio of patients younger than 60 days was significantly lower (p = 0.013) for those from the countryside. Survival periods with native liver for all patients was 46.2% in 2 years, falling continuously until reaching 15.3% in 20 years. Patients operated before reaching 60 days of age had longer survival periods with native livers (log rank < 0.0001). CONCLUSIONS: Late performance of portoenterostomy was a constant in the past 25 years, and this delay led to shorter survival periods with native livers for biliary atresia patients.

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12.

Prevalence of the serpin peptidase inhibitor (alpha-1-antitrypsin) PI*S and PI*Z alleles in Brazilian children with liver disease
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Baldo, Guilherme

; Ayala, Ana

; Melendez, Matias

; Nonnemacher, Karina

; Lima, Luciane

; Segal, Sandra Leistner

; Kieling, Carlos

; Vieira, Sandra Gonçalves

; Ferreira, Cristina Targa

; Silveira, Themis Reverbel da

; Giugliani, Roberto

; Matte, Ursula

Genetics and Molecular Biology

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2008, Volume 31 N. 2 Pages 423 - 426

Abstract: En | Text: En | PDF: En

Serpin peptidase inhibitor, clade A (alpha-1 antiproteinase, antitrypsin), member 1 (SERPINA1) deficiency is one of the main genetic causes related to liver disease in children. In SERPINA1 deficiency the most frequent SERPINA1 alleles found are the PI*S and PI*Z alleles. We used the polymerase chain reaction and the amplification created restriction site (ACRS) technique to investigate the prevalence of the PI*S and PI*Z alleles in a group of Brazilian children (n = 200) with liver disease and established the general frequency of the PI*S allele in our population. We found a significant association of the PI*Z allele and liver disease, but no such relationship was found for the PI*S allele. Our results show that SERPINA1 deficiency due to the PI*Z allele, even when heterozygous, is a frequent cause of liver disease in our group of Brazilian children but that the PI*S allele does not confer an increased risk of hepatic disorders in our group of Brazilian children.

2833 downloads

13.

Diagnóstico da doença hepatobiliar na fibrose cística: um desafio
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Rocha, Renata Gonçalves

; Vieira, Sandra Maria Gonçalves

; Kieling, Carlos Oscar

; Alves, Sabrina Lima

; Genro, Sandra Krebs

; Silveira, Themis Reverbel da

Jornal de Pediatria

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apr 2005, Volume 81 N. 2 Pages 183 - 185

Abstract: Pt | Text: Pt | PDF: Pt

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