ABSTRACT
OBJECTIVES: Cirrhotic patients must receive an abdominal ultrasound every 6 months as part of hepatocellular carcinoma (HCC) screening. The aim of this study was to assess if HCC screening was performed as recommended by the literature and to observe the differences between the private and public services in Brazil. METHODS: We analyzed data from the HCC screenings of 253 cirrhotic patients from the University Hospital (n=177) and private sector (n=76) in Vitória, ES, Brazil. RESULTS: Ultrasound screening was performed every 13.1 months on average (SD 9.02). In 37 out of 253 patients, the screenings were performed close to the recommended frequency; 16 were performed every 6 months, and 21 were mostly performed during the follow-up period every 6 months. In the remaining 216 cases, ultrasounds were not performed according to the guidelines; for 106 patients, less than 50% of all ultrasounds were performed every 6 months and 110 patients showed an interval greater than one year. Patients from the private sector received ultrasound screenings near the ideal in 28.9% of cases, while patients from the University Hospital received ultrasounds in only 8.4% of cases (p<0.0001). HCC was diagnosed in 30 patients (11.8%). For these 30 patients, 11 screenings were properly performed within 6 months (36.6%) and only 1 out of the 11 (9%) met the criteria for transplant. In the remaining 19 patients who did not receive the screening within 6 months, 6 (31.5%) did not meet the criteria for transplant. CONCLUSION: HCC screening in our environment was irregularly performed, mainly in the public service setting, which prevented early diagnosis in a large number of patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Carcinoma, Hepatocellular/diagnosis , Health Services Accessibility , Healthcare Disparities , Liver Neoplasms/diagnosis , Mass Screening/methods , Brazil , Cross-Sectional Studies , Early Detection of Cancer , Private Sector , Public Sector , Retrospective Studies , Socioeconomic Factors , Time Factors , UltrasonographyABSTRACT
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.
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.
Subject(s)
Humans , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/therapy , Hepatitis, Autoimmune/diagnosis , Hepatitis, Autoimmune/therapy , Liver Cirrhosis, Biliary/diagnosis , Liver Cirrhosis, Biliary/therapy , Brazil , Societies, Medical , SyndromeABSTRACT
Os objetivos do presente estudo foram: determinar a freqüência de anticorpos contra a actina G (AG) e actina F (AF) na hepatite auto-imune tipo 1 e em controles; correlacionar a positividade desses anticorpos com o anticorpo anti-microfilamento (AMF); comparar AG e AF em experimentos de adsorção de soros. 250 soros (65 HAI-1 e 185 controles) foram testados por imunofluorescência indireta e por ELISA in house e disponível comercialmente. Reatividade contra AG e AF ocorreu em, respectivamente, 40 por cento e 58,5 por cento dos pacientes com HAI-1 com o ELISA in house. Com o ELISA comercial, 93,7 por cento dos soros foram reativos para AF. Em todos os grupos controles, houve elevada freqüência de positividade para AG e AF. Não houve correlação entre as reatividades contra AG e AF e os títulos do AMF e tanto a AG quanto a AF neutralizaram o padrão do AMF/The aims of this study were: to assess the frequency of antibodies to G-actin and F-actin (GA and FA) in autoimmune hepatitis type1 and controls; to correlate the positivity of those antibodies to the reactivity to antimicrofilaments antibodies (AMF); to compare GA and FA in serum absorption experiments. 250 sera (65 AIH-1 and 185 controls) were tested by indirect immunofluorescence reaction and by ELISA developed in house and commercially purchased. Reactivity to GA and FA, respectively, was detected in 40 por cent and 58.5 por cent of AIH-1 patients by the in house ELISA. By the commercial ELISA, 93.7 por cent were reactivity to FA. All control groups had a high frequency of positivity to both FA and GA. There was no significant correlation between the reactivities to GA and FA and the titers of AMF and both GA and FA neutralized the AMF patter...
Subject(s)
Humans , Animals , Male , Female , Adult , Rabbits , Actins/immunology , Hepatitis, Autoimmune , Actins , Adsorption , Case-Control Studies , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect/statistics & numerical dataABSTRACT
O diagnostico do alcoolismo e fundamentado na informacao verbal do paciente ao seu medico. Inumeros marcadores biologicos do alcoolismo vem sendo pesquisados nas ultimas decadas. Sao parametros laboratoriais que podem fornecer informacoes a respeito do consumo e abstinencia...