Vitamina B12 e homocisteína em pacientes com DHGNA: revisão sistemática e metanálise / Vitamin b12 and homocysteine levels in patients with nafld: a systematic review and metanalysis

ABSTRACT BACKGROUND: The vitamin B12 absorption can be affected in patients with nonalcoholic fatty liver disease (NAFLD), and low serum vitamin B12 levels has been related to the high homocysteine (HCY) levels and to the degree of NAFLD. OBJECTIVE: To carry out a systematic review and metanalysis of serum vitamin B12 and HCY levels in patients with NAFLD. METHODS: Original studies including serum vitamin B12 and HCY levels in humans with NAFLD were included. The searches were performed in four databases. RESULTS: 159 studies were identified, and after excluding the duplicates and non-eligible titles, eight original articles were included. Six out of eight showed higher B12 levels in NAFLD patients (404.9±136.2 pg/mL in relation to controls 353.91±117.3 pg/mL). Seven of the eight studies also showed higher HCY levels in NAFLD patients (14.2±3.44 umol/L in relation to controls 11.05±3.6 umol/L). The results for serum vitamin B12 and HCY levels were submitted to metanalysis, showing no difference in the vitamin B12 levels between patients with NAFLD and controls. However, the levels of Hcy were higher in NAFLD patients than in controls. CONCLUSION: There was no relashionship between the vitamin B12 levels and NAFLD. The levels of HCY were significantly higher in patients with NAFLD, suggesting this could be a potential marker for liver damage.

RESUMO CONTEXTO: A absorção de vitamina B12 pode ser afetada em pacientes com doença hepática gordurosa não alcoólica (DHGNA), e baixos níveis séricos de vitamina B12 têm sido relacionados a níveis elevados de homocisteína (HCI) ao grau de DHGNA. OBJETIVO: Realizar revisão sistemática e metanálise dos níveis séricos de vitamina B12 e de HCI em pacientes com DHGNA. MÉTODOS: Estudos originais que incluíssem avaliação dos níveis séricos de vitamina B12 e de HCI em humanos com DHGNA foram incluídos. As buscas foram realizadas em quatro bases de dados. RESULTADOS: Foram identificados 159 estudos e, após exclusão das duplicatas e dos não elegíveis, oito artigos originais foram incluídos. Seis dos oito artigos apresentaram níveis mais elevados de vitamina B12 nos pacientes com DHGNA (404,9±136,2 pg/mL) em relação aos controles (353,91±117,3 pg/mL). Sete dos oito estudos determinaram os níveis de HCI, estando aumentados em pacientes com DHGNA (14,2±3,44 umol/L) em relação aos controles (11,05±3,6 umol/L). Os resultados dos níveis séricos de vitamina B12 e HCI foram submetidos à metanálise, mostrando que não há diferença nos níveis de vitamina B12 entre os pacientes com DHGNA e os controles. No entanto, os níveis de HCI foram maiores nos pacientes com DHGNA do que nos controles. CONCLUSÃO: Não houve relação entre DHGNA e nível sérico de vitamina B12. Os níveis de HCI foram significativamente maiores em pacientes com DHGNA, sugerindo que esse poderia ser um potencial marcador de lesão hepática.

Avaliação de pacientes com hepatite autoimune atendidos em ambulatório de referência do sul do Brasil / Evaluation of patients with autoimmune hepatitis in a specialized outpatient clinic in southern brazil

ABSTRACT BACKGROUND: Autoimmune hepatitis (AIH) is a chronic liver disease, characterized by necroinflammation and autoimmune etiology. Studies evaluating the characteristics of patients with AIH are scarce in Brazil. OBJECTIVE: Our objective was to evaluate the profile of patients with AIH in a specialized center in Southern Brazil and to verify factors related to treatment response. METHODS: this was a retrospective cohort study, which analyzed demographic, epidemiological, clinical, laboratory, and histologic data. Patients with AIH diagnosed according to the criteria of the International Autoimmune Hepatitis Group (IAIHG) were included. In liver biopsies, the degree of fibrosis, histological activity, presence of hepatocyte rosettes, plasma cell infiltrates, and confluent necrosis were evaluated. In the statistical analysis, the significance level was 5%. RESULTS: Forty adults patients diagnosed with AIH were included. The evaluated population predominantly consisted of women (75.0%) and the average age at diagnosis was 44.2 years. The association with extrahepatic autoimmune diseases occurred in 20.0% of cases. Clinically, 35.0% of patients presented with acute onset hepatitis, 37.5% with cirrhosis, and 27.5% with other forms of presentation. The most common clinical manifestation was jaundice (47.5%). Thirty-five patients were treated, and of these, 97.1% used prednisone combined with azathioprine. The average treatment time was 2.7 years. Response to treatment was complete or partial in 30 (85.7%) and absent in 5 (14.3%) patients. There was no statistically significant difference when evaluating response to treatment in relation to forms of presentation, histological findings, and the presence of autoantibodies. Regarding fibrosis, regression was observed in 18.75% of the cases. CONCLUSION: Most patients with AIH were young at presentation and of female sex. The association with extrahepatic autoimmune diseases and cirrhosis at presentation was seen in a considerable proportion of patients. Treatment was effective, but there were no clinical, histological or serological parameters capable of predicting treatment response.

RESUMO CONTEXTO: A hepatite autoimune (HAI) é uma doença hepática crônica, de caráter necroinflamatório e etiologia autoimune. Os estudos que avaliam as características de pacientes com HAI são escassos no Brasil. OBJETIVO: Nosso objetivo foi avaliar o perfil dos pacientes com HAI atendidos em um centro de referência do sul do Brasil e verificar fatores relacionados à resposta ao tratamento. MÉTODOS: Este foi um estudo de coorte retrospectivo, que analisou dados demográficos, epidemiológicos e clínicos. Nas biópsias hepáticas, foram avaliados o grau de fibrose, a atividade histológica, a presença de rosetas, de infiltrado plasmocitário e de necrose confluente. Na análise estatística, o nível de significância foi de 5%. RESULTADOS: Foram incluídos 40 pacientes adultos com diagnóstico de HAI. Houve predomínio do sexo feminino (75,0%), e a média de idade no diagnóstico foi de 44,2 anos. A associação com doenças autoimunes extra-hepáticas ocorreu em 20,0% dos casos. Clinicamente, 35,0% dos pacientes se apresentaram sob forma de hepatite aguda, 37,5% com cirrose e 27,5% com outras formas de apresentação. A manifestação clínica mais comum na apresentação foi a icterícia (47,5%). Trinta e cinco pacientes foram tratados, sendo que destes, 97,1% utilizaram prednisona associada com azatioprina. A média do tempo de tratamento foi 2,7 anos. A resposta ao tratamento foi completa ou parcial em 30 (85,7%) e ausente em 5 (14,3%) pacientes. Não houve diferença estatisticamente significativa quando avaliada a resposta ao tratamento em relação à forma de apresentação, aos achados histológicos e à presença de autoanticorpos. Em relação à fibrose, foi observada regressão em 18,75% dos casos. CONCLUSÃO: A maioria dos pacientes era jovem no momento do diagnóstico e do sexo feminino. A associação com doenças autoimunes extra-hepáticas e com cirrose na apresentação foi vista em uma parcela considerável dos casos. O tratamento foi eficaz, mas não houve parâmetros clínicos, histológicos ou sorológicos capazes de prever a resposta ao tratamento.

Effectiveness of chronic hepatitis C treatment with direct-acting antivirals in the Public Health System in Brazil

ABSTRACT Introduction Chronic hepatitis C virus infection is one of the major causes of cirrhosis, hepatocellular carcinoma and liver transplantation. Treatment using direct-acting antivirals has revolutionized the treatment of hepatitis C virus, increasing long-term prognosis after cure. The goal of the present study was to evaluate the effectiveness of direct-acting antivirals in a Public Health System in southern Brazil. Methods A retrospective study evaluated all patients with chronic hepatitis C virus infection who underwent treatment at one center of the Public Health Department of the State of Rio Grande do Sul - Brazil, according to the Brazilian Clinical Protocol and Therapeutic Guidelines. The effectiveness was assessed in terms sustained virological response 12 weeks after the end of treatment. Results A total of 1002 patients who were treated for chronic hepatitis C virus infection were evaluated. The mean age was 58.6 years, 557 patients (55.6%) were male and 550 (54.9%) were cirrhotic. Overall sustained virological response was observed in 936 (93.4%) patients. There was a difference in sustained virological response rate varied according to sex, 91.6% in men and 95.7% in women (p= 0.009), length of treatment in genotype 1, 92.7% with 12 weeks and 99.1 with 24 weeks (p= 0.040), and genotype, 94.7% in genotype 1, 91.7% in genotype 2, and 91.4% in genotype 3 (p= 0.047). Conclusion The treatment of chronic hepatitis C virus infection for genotypes 1, 2 or 3 with the therapeutic regimens established by the Brazilian guidelines showed high rates of SVR, even in cirrhotic patients.

Câncer gástrico: experiência de um hospital geral / Gastric cancer: experience of a general hospital

Foram revisados 115 prontuários de pacientes internados no Hospital Nossa Senhora da Conceição, em um período de 2 anos, com diagnóstico de câncer gástrico confirmado histolopatologicamente. A incidência foi maior entre homens (2:1), sendo identificada relação entre câncer gástrico e tabagismo, presente em 58,2% dos pacientes. Não foi possível estabelecer relação etiológica com alcoolismo e com história pessoal ou familiar de outras neoplasias. A apresentação endoscópica mais freqüente foi tumor ulcerado (44,7% dos casos), sendo adenocarcinoma o tipo histopatológico mais prevalente. No estadiamento, 67% dos pacientes que realizaram ecografia ou tomografia abdominal apresentaram alterações que sugeriram a presença do tumor ou sua disseminação e 56,5% dos pacientes apresentavam neoplasia gástrica irressecável no momento do diagnóstico. Novos ensaios clínicos randomizados são necessários para o reconhecimento dos fatores de risco para esta neoplasia e possibilitar o estabelecimento de medidas de prevenção e detecção precoce do câncer gástrico em pacientes de alto risco (AU)

The registers of 115 patients with diagnosis of gastric cancer (histopathologically confirmed) from Hospital Nossa Senhora da Conceição in a 2 year period were studied. The incidence was larger among men (2:1), and a relationship between gastric cancer and tobacco smoking, present in 58,2% of the patients, was identified. It was not possible to establish etiological relationship with alcoholism and personal or family history of another neoplasm. The more frequent endoscopic presentation was ulcerated tumor (44,7% of the cases), being adenocarcinoma the more prevalent histopathologic type. Sixty seven percent of the patients that were submitted to abdominal ecography or tomography presented alterations that suggested the presence of the tumor or its dissemination, and 56,5% of the patients presented irresecable gastric cancer in the moment of the diagnosis. New randomized clinical trials are necessary for the recognition of the risk factors for this neoplasm and then establish prevention measures and early detection of gastric cancer in high risk patients (AU)