Effect of transient obstructive cholestasis on liver histology: a cross-sectional study

ABSTRACT BACKGROUND: The role of transient obstructive cholestasis on liver histology remains undetermined. OBJECTIVE: To investigate whether transient cholestasis impairs liver histology. DESIGN AND SETTING: Cross-sectional study at a public university hospital (UNICAMP), Brazil. METHODS: 169 individuals undergoing cholecystectomy, with or without cholestasis. were enrolled. Histopathological findings were correlated with clinical and biochemical characteristics. RESULTS: Biliary hepatopathy was more frequent in individuals with resolved cholestasis than in those with active obstruction or no jaundice (P < 0.01), as also were fibrosis and ductular proliferation (P = 0.02). Cholestasis was commoner in individuals with resolved obstruction than in those with no history (P < 0.01) or active cholestasis (P < 0.05). Biliary hepatopathy was associated with longer duration of cholestasis (P < 0.001) and higher bilirubin levels (P = 0.02) in individuals with active obstruction; with lower body mass index (P = 0.02) and longer cholestasis (P < 0.001) in individuals with resolved obstruction; and with longer cholestasis (P < 0.001) and longer interval between endoscopic retrograde cholangiopancreatography and surgery (P = 0.03) overall. In individuals with active obstruction, duration of cholestasis (R = 0.7; P < 0.001) and bilirubin levels (R = 0.6; P = 0.004) were independently correlated with cholestasis severity. Duration of cholestasis (R = 0.7; P < 0.001) was independently correlated with ductular proliferation severity. CONCLUSIONS: Transient cholestasis was associated with significant histopathological changes, even after its resolution. Longer duration of obstruction correlated with greater severity of histopathological changes, especially cholestasis and ductular proliferation. This emphasizes the need for early treatment of obstructive cholestasis.

Acolhimento de usuários de drogas em Unidade Básica de Saúde / Drug users hosting in a Basic Health Unit

Compreender o acolhimento a usuários de drogas em uma Unidade Básica de Saúde. Métodos: estudoqualitativo realizado por meio de entrevistas semiestruturadas com 13 sujeitos em uma Unidade Básica deSaúde de um distrito de saúde. Resultados: após a análise temática, emergiram três categorias: Acolhimentocomo encaminhamento e fatores que determinam essa prática, evidenciando que fatores como sentimentose características pessoais dos trabalhadores, falta de capacitação e percepção de menor resolutividade pelosprofissionais de enfermagem sustentaram uma lógica de encaminhamento que evitava a responsabilizaçãopelo cuidado, mantendo sua fragmentação; Acolhimento, vínculo e encaminhamento, em que vínculo ecorresponsabilização eram incipientes nas práticas, dificultando o cuidado integral; e Acolhimento e modelosde atenção predominantes, mostrando que o acolhimento apoiava-se no modelo biomédico, porém observaramsecontradições entre modelos distintos e práticas. Conclusão: faz-se necessário superar o modelo biomédico,a partir da clínica ampliada e da reestruturação na formação profissional...