High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study

Abstract BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.

Clinical and laboratory parameters as predictors of long-term outcome according to the etiology of underlying chronic liver disease in patients who underwent liver transplantation for hepatocellular carcinoma treatment

OBJECTIVES: This study aimed to analyze clinical and laboratory parameters and their association with long-term outcomes in patients who underwent liver transplantation for hepatocellular carcinoma treatment, according to the etiology of the underlying chronic liver disease, in order to identify predictors of response to this therapeutic modality. METHODS: Demographic, clinical, and laboratory data from a cohort of 134 patients who underwent orthotopic liver transplantation for hepatocellular carcinoma treatment at a referral center in Brazil were retrospectively selected and compared according to the etiologic group of the underlying chronic liver disease. Events, defined as tumor recurrence or death from any cause, and event-free survival were also analyzed, and multivariate analysis was performed. RESULTS: The etiologies comprised hepatitis C and B virus infection, alcohol abuse, and cryptogenic disorder. Although liver transplantation was performed outside the Milan criteria in 33.3% of the subjects, according to pathologic examination of the explanted liver, the Model for End-Stage Liver Disease score was low (<22) in most patients (70.6%) and recurrence was identified in only 10 (7.9%) patients. Events occurred in 37 patients (28.5%), and the median event-free survival was 75 months (range, 24-116 months). No difference among etiologic groups was found in the parameters analyzed, which were not independently associated with outcome. CONCLUSION: Clinical and laboratory characteristics according to etiologic groups were not different, which might have led to comparable long-term outcomes among these patient groups and failure to identify predictors that could aid in better selection of subjects for liver transplantation in the management of this cancer.

The presence of Helicobacter pylori in the liver depends on the Th1, Th17 and Treg cytokine profile of the patient

The hypothesis that Helicobactermight be a risk factor for human liver diseases has arisen after the detection of Helicobacter DNA in hepatic tissue of patients with hepatobiliary diseases. Nevertheless, no explanation that justifies the presence of the bacterium in the human liver has been proposed. We evaluated the presence of Helicobacterin the liver of patients with hepatic diseases of different aetiologies. We prospectively evaluated 147 patients (106 with primary hepatic diseases and 41 with hepatic metastatic tumours) and 20 liver donors as controls. Helicobacter species were investigated in the liver by culture and specific 16S rDNA nested-polymerase chain reaction followed by sequencing. Serum and hepatic levels of representative cytokines of T regulatory cell, T helper (Th)1 and Th17 cell lineages were determined using enzyme linked immunosorbent assay. The data were evaluated using logistic models. Detection of Helicobacter pylori DNA in the liver was independently associated with hepatitis B virus/hepatitis C virus, pancreatic carcinoma and a cytokine pattern characterised by high interleukin (IL)-10, low/absent interferon-γ and decreased IL-17A concentrations (p < 10-3). The bacterial DNA was never detected in the liver of patients with alcoholic cirrhosis and autoimmune hepatitis that are associated with Th1/Th17 polarisation. H. pylori may be observed in the liver of patients with certain hepatic and pancreatic diseases, but this might depend on the patient cytokine profile.

Associação entre uso de hemocomponentes e mortalidade em cinco anos após transplante hepático / Association between the use of blood components and the five-year mortality after liver transplant / Asociación entre el uso de hemocomponentes y la mortalidad en cinco años después de transplante hepático

JUSTIFICATIVA E OBJETIVOS: A cirurgia de transplante hepático (TH) continua associada a sangramento importante em 20 por cento dos casos, e diversos autores têm demonstrado os riscos relacionados ao uso de hemocomponentes. O objetivo deste estudo foi avaliar o impacto do uso de hemocomponentes durante toda a hospitalização na sobrevida em cinco anos de pacientes submetidos a TH. MÉTODOS: Um total de 113 pacientes submetidos ao TH foi avaliado retrospectivamente. Diversas variáveis, incluindo uso de hemocomponentes no intraoperatório e durante toda a hospitalização, foram categorizadas e avaliadas por meio de análise univariada, pelo teste de Fisher. O nível de significância adotado foi de 5 por cento. Os resultados com p < 0,2 foram submetidos a uma análise multivariada pelo modelo de regressão logística multinominal. RESULTADOS: Doenças parenquimatosas, disfunção renal pré-operatória e maior tempo de internação no CTI e hospitalar se associaram a maior mortalidade em cinco anos após o TH (p < 0,05). Ao contrário do uso de hemocomponentes no intraoperatório, a transfusão acumulada de concentrado de hemácias, plasma fresco congelado e concentrado de plaquetas durante toda a internação hospitalar foi associada à maior mortalidade em cinco anos após o transplante de fígado (p < 0,01). CONCLUSÕES: O estudo alerta para a relação existente entre o uso de hemocomponentes durante a hospitalização e o aumento da mortalidade em cinco anos após o TH.

BACKGROUND AND OBJECTIVES: Liver transplant (LT) surgery is associated with significant bleeding in 20 percent of cases, and several authors have demonstrated the risks related to blood components. The objective of the present study was to evaluate the impact of using blood components during hospitalization in five-year survival of patients undergoing LT. METHODS: One hundred and thirteen patients were evaluated retrospectively. Several variables, including the use of blood components intraoperatively and throughout hospitalization, were categorized and evaluated by univariate analysis using Fisher's test. A level of significance of 5 percent was adopted. Results with p < 0.2 underwent multivariate analysis using multinomial logistic regression. RESULTS: Parenchymal diseases, preoperative renal dysfunction, and longer stay in hospital and ICU are associated with greater five-year mortality after LT (p < 0.05). Unlike the intraoperative use of blood components, the accumulated transfusion of packed red blood cell, frozen fresh plasma, and platelets during the entire hospitalization was associated with greater five-year mortality after liver transplantation (p < 0.01). CONCLUSIONS: This study emphasizes the relationship between the use of blood components during hospitalization and increased mortality in five years after LT.

JUSTIFICATIVA Y OBJETIVOS: La cirugía de transplante hepático (TH), continúa asociada al sangramiento importante en un 20 por ciento de los casos, y diversos autores ya han demostrado los riesgos relacionados con el uso de hemoderivados. El objetivo de este estudio fue evaluar el impacto del uso de hemoderivados durante toda la hospitalización en la sobrevida en cinco años de pacientes sometidos a TH. MÉTODOS: Un total de 113 pacientes sometidos a TH fueron evaluados retrospectivamente. Diversas variables, incluyendo el uso de hemoderivados en el intraoperatorio y durante toda la hospitalización, fueron categorizadas y evaluadas por medio de análisis univariado, por el test de Fisher. El nivel de significancia adoptado fue de un 5 por ciento. Los resultados con p < 0,2 fueron sometidos a un análisis multivariado por el modelo de regresión logística multinominal. RESULTADOS: Enfermedades parenquimatosas, disfunción renal preoperatoria y un mayor tiempo de internación en UCI y hospitalario, se asociaron a una mayor mortalidad en cinco años después del TH (p < 0,05). Al contrario del uso de hemoderivados en el intraoperatorio, la transfusión acumulada de concentrado de hematíes, plasma fresco congelado y concentrado de plaquetas durante todo el ingreso se asoció a una mayor mortalidad en cinco años posteriores al transplante de hígado (p < 0,01). CONCLUSIONES: El estudio es un alerta sobre la relación existente entre el uso de hemoderivados durante el ingreso y el aumento de la mortalidad en cinco años posteriores al TH.

Involvement of central nervous system in the schistosomiasis

The involvement of the central nervous system (CNS) by schistosomes may or may not determine clinical manifestations. When symptomatic, neuroschistosomiasis (NS) is one of the most severe presentations of schistosomal infection. Considering the symptomatic form, cerebral involvement is almost always due to Schistosoma japonicum and the spinal cord disease, caused by S. mansoni or S. haematobium. Available evidence suggests that NS depends basically on the presence of parasite eggs in the nervous tissue and on the host immune response. The patients with cerebral NS usually have the clinical manifestations of increased intracranial pressure associated with focal neurological signs; and those with schistosomal myeloradiculopathy (SMR) present rapidly progressing symptoms of myelitis involving the lower cord, usually in association with the involvement of the cauda esquina roots. The diagnosis of cerebral NS is established by biopsy of the nervous tissue and SMR is usually diagnosed according to a clinical criterion. Antischistosomal drugs, corticosteroids and surgery are the resourses available for treating NS. The outcome is variable and is better in cerebral disease.

Mielorradiculopatia esquistossomótica / Schistosomal myeloradiculopathy

Mielorradiculopatia é uma das formas de apresentaçäo da esquistossomose. Deve-se à presença de ovos do helminto Schistosoma no Sistema Nervoso Central (SNC). Os agentes causadores da mielorradiculopatia esquistossomatica (MRE) säo o Schistosoma mansoni e o S. haematobium. No Brasil, a MRE tem como agente etiológico o S. mansoni. A lesäo do tecido nervoso resulta, basicamente, da presença do ovo do parasito e da resposta imunológica que ele evoca. Os segmentos mais acometidos säo o torácico baixo, o lombossacro e a cauda eqüina. A doença manifesta-se como uma mielorradiculopatia de evoluçäo aguda ou subaguda e o seu prognóstico depende, em parte, do tratamento precoce e, em parte, de fatores da própria entidade.

Hipertireoidismo manifestando-se como febre de origem indeterminada / Hyperthyroidism presenting as fever of unknowm origin

Trata-se de paciente adulta jovem internada no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG) para esclarecimento de doença febril de aproximadamente um ano e oito meses de evolução. Ao lado das manifestações constitucionais apresentava alterações cardíacas, hepatesplenomegalia e icterícia. O diagnóstico de hipertireoidismo foi confirmado através da dosagem dos hormônios tireoidianos. Apesar de ter sido considerado como possibilidade diagnóstica na fase inicial da investigação, não se acreditou, de princípio que tal diagnóstico pudesse explicar todas as alterações observadas. Houve regressão progressiva e completa das manifestações clínicas com o tratamento do hipertireoidismo.

A young woman was admitted to Hospital de Clínicas, Universidade Federal de Minas Gerais, with fever that had lasted for more than one year. Besides this manifestation she had cardiac alterations, hepatosplenomegaly and jaundice. Blood test revealed hyperthyroidism...

Febre de origem indeterminada (FOI): estudo prospectivo de 34 casos e revisão de literatura / Fever of unknown origin (FUO): a prospective study of 34 cases and a literature review

Estudo prospectivo de 34 pacientes adultos com quadro de febre de origem indeterminado (FOI). Os critérios para inclusão no estudo foram: doença com mais de três semanas de duração; temperatura axilar superior a 38,3°C documentada em várias oportunidades; e ausência de diagnóstico após realização de anamnese, exame físico e exames complementares indicados a partir da suspeita clínica inicial. Os casos foram conduzidos de forma individualizada de acordo com o raciocínio clínico. A distribuição dos diagnósticos entre as categorias clássicas evidenciou o seguinte: infecções, 44,1%; neoplasias, 17,6%; colagenoses, 17,6%; miscelânea, 11,8% e casos sem diagnóstico, 8,8%. Tuberculose e linfoma foram as doenças mais freqüentes. A grande maioria das doenças foram doenças comuns com manifestações atípicas. Alguns parâmetros clínicos e laboratoriais foram analisados e comparados em relação às categorias diagnósticos. Observou-se urna grande sobreposição de dados, com apenas algumas poucas diferenças ou tendências. Apresentação atípica, associação de doenças, falta de valorização adequada de todos os dados disponíveis e resultados falso-positivo ou falso-negativo de exames complementares foram os principais fatores responsáveis pela dificuldade diagnóstico. Biópsias, exames microbiológicos e métodos de imagem definiram a maior parte dos diagnósticos. A maioria dos pacientes foi beneficiada pelo tratamento específico.

A prospective study was conducted on 34 adult patients with fever of unknown origin (FUO). The criteria for inclusion in the study were: disease with more than three weeks of duration; documented axillary temperature higher than 38.3°C on several ocasions; and absence of diagnosis after taking the pacient's history, after clinical examination and after complementary tests indicated on the basis of the initial suspected conditions. The cases were conducted on an individual basis. Case distribution among classic diagnostic categories was as follows: infections, 44.1%; neoplasias, 17.6%, collagen diseases, 17.6%, micellaneous, 11.8%; and undiagnosed cases, 8.8%. Tuberculosis and lyrnphoma were the most frequent diseases. The overwhelming majority of the pathologies diagnosed were comon diseases with atypical manifestations. Some clinical and laboratory parameters were analyzed and compared in relation to diagnostic categories. There was great overlapping of the data, with only a few differences or trends. Atypical presentation, associated diseases, lack of appropriate appreciation of all data avaiable and false-positive or false-negative resulta of complementary tests were the major factors responsible for the diagnostic dificulties. Biopsies, microbiology and imaging methods were the procedures that most contributed to diagnostic definition. Most patiens benefited from specific treatment.