Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 2.578
Filter
1.
Arch. endocrinol. metab. (Online) ; 66(6): 883-894, Nov.-Dec. 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1403256

ABSTRACT

ABSTRACT The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.

2.
Ciênc. Saúde Colet. (Impr.) ; 27(12): 4389-4396, Dec. 2022. graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1404191

ABSTRACT

Resumo Objetivou-se relatar a experiência no gerenciamento de pesquisa-ação sobre inquérito de hepatite C junto à comunidade carcerária no Triângulo Mineiro, Minas Gerais. A proposta foi desenvolvida entre março de 2019 e março de 2020, alcançando 240 pessoas, com o intuito de conter a disseminação do agravo por meio de inquérito, testagem e acompanhamento dos casos positivos. Adotou-se ação intersetorial, com articulação entre universidades, sociedade médica, hospital de ensino e Secretaria de Estado de Justiça e Segurança Pública. As estratégias para o gerenciamento da pesquisa-ação foram: cenários e atores do estudo, registro e formalização da atividade, aplicação dos testes e manejo dos internos reagentes. Dificuldades foram identificadas quanto à acomodação de rotinas entre equipe de pesquisadores e funcionamento próprio da penitenciária, o que exigiu treinamento ostensivo entre as partes e articulações gerenciais. Considera-se que o relato, quando destaca as estratégias adotadas para a condução da pesquisa, colabora para a organização de investigações futuras que visem acessar essa população ainda invisibilizada.


Abstract We aimed to report the experience in managing action research on hepatitis C investigation in the prison community in the Triângulo Mineiro region, Minas Gerais, Brazil. The proposal was developed from March 2019 to March 2020, reaching 240 people to contain the spread of the disease through a survey, testing, and monitoring of positive cases. We adopted intersectoral action with articulation between Universities, Medical Society, Teaching Hospital, and State Secretariat for Justice and Public Security. Strategies for the management of action research are described: study settings and stakeholders, registration and formalization of the activity, application of tests, and management of reagent inmates. We identified difficulties regarding the accommodation of routines among the research team and the proper functioning of the penitentiary, which required extensive training between the parties and managerial articulations. We consider that the report collaborates with the organization of future research aimed at accessing this still invisible population, the prison community when it highlights the strategies adopted to conduct the research.

3.
Nursing ( São Paulo) ; 25(293): 8812-8827, out.2022. ilus
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1402416

ABSTRACT

Objetivo: identificar e refletir o uso da tecnossocialidade no cotidiano das pessoas com cirrose hepática para a promoção da saúde.Método:revisão integrativa desenvolvida de junho a dezembro de 2021 .A busca pelos estudos foi atemporal realizada nas bases da PUBMED, Scopus e Biblioteca Virtual em Saúde,a partir dos descritores Rede Social, Internet e Cirrose Hepática. Os estudos foram selecionados seguindo o fluxograma PRISMA.Resultados: foram inclusos 13 estudos divididos em duas categorias: 1. Tecnossocialidade: alfabetização e letramento digital, necessidade de avaliação da propriedade e proficiência tecnológica ;2. Tecnossocialidade: uso de aplicativos como ferramenta terapêutica para a promoção da saúde, estratégia de monitoramento remoto para o gerenciamento e cuidado da pessoa com cirrose. Conclusão:a tecnologia está no cotidiano das pessoas com cirrose. A alfabetização digital e o uso deaplicativos são estratégias importantespara a promoção da saúde da pessoa com cirrose hepática.(AU)


Objective: to identify and reflect on the use of technosociality in the daily lives of people with liver cirrhosis for health promotion. Method: integrative review developed from June to December 2021. The search was conducted with no time limitin the databases PUBMED, Scopus and Virtual Health Library using the descriptors Social Network, Internet and Liver Cirrhosis. The studies were selected following the PRISMA flowchart. Results: 13 studies were included divided into two categories: 1. Technosociality: digital literacy, emphasizing the need for assessment of ownership and technological proficiency; 2. Technosociality: use of applications as a therapeutic tool for health promotion, remote monitoring strategy for the management and care of the person with cirrhosis. Conclusion: technology is in the daily life of people with cirrhosis. Digital literacy and the use of applications are important strategies for health promotion of people with liver cirrhosis.(AU)


Objective: to identify and reflect on the use of technosociality in the daily lives of people with liver cirrhosis for health promotion. Method: integrative review developed from June to December 2021. The search was conducted with no time limitin the databases PUBMED, Scopus and Virtual Health Library using the descriptors Social Network, Internet and Liver Cirrhosis. The studies were selected following the PRISMA flowchart. Results: 13 studies were included divided into two categories: 1. Technosociality: digital literacy, emphasizing the need for assessment of ownership and technological proficiency; 2. Technosociality: use of applications as a therapeutic tool for health promotion, remote monitoring strategy for the management and care of the person with cirrhosis. Conclusion: technology is in the daily life of people with cirrhosis. Digital literacy and the use of applications are important strategies for health promotion of people with liver cirrhosis.(AU)


Objetivo: identificar y reflexionar sobre el uso de latecnosocialidadenla vida cotidiana de las personas concirrosis hepática para lapromoción de lasalud. Método:revisión integradora desarrollada de junio a diciembre de 2021. La búsqueda se realizo sinlímite de tiempoenlas bases PUBMED, Scopus y Virtual Health Library a partir de losdescriptoresRed Social, Internet y Cirrosis Hepática. Los estudios se seleccionaronsiguiendoel diagrama de flujo PRISMA. Resultados:incluyeron 13 estudios, divididos en dos categorías: 1. Tecnosocialidad: alfabetizacióndigital,evaluarlapropiedadtecnológica; 2. Tecnosocialidad: uso de aplicaciones como herramientaterapéutica para lapromoción de lasalud, estrategia de monitorización remota para lagestión y el cuidado. Conclusión:latecnología está enla vida cotidiana de las personas concirrosis. La alfabetización digital y el uso de aplicacionessonestrategiasparalapromoción de lasalud.(AU)


Subject(s)
Internet , Social Networking , Health Promotion , Liver Cirrhosis
4.
Arq. gastroenterol ; 59(1): 9-15, Jan.-Mar. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1374447

ABSTRACT

ABSTRACT Background Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. Objective To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). Methods Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. Results The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. Conclusion The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.


RESUMO Contexto A doença hepática crônica associa-se com osteoporose, osteopenia ou osteomalácia. A osteoporose e as fraturas por fragilidade óssea têm altas prevalências e são mais frequentes em pacientes com cirrose hepática do que na população geral. A busca por osteopenia e osteoporose nesta população pode permitir a intervenção precoce e modificar os desfechos desfavoráveis. Objetivo Conhecer a prevalência de osteopenia ou osteoporose e de fraturas por fragilidade óssea em portadores de cirrose hepática, fatores de risco associados e seu comprometimento na qualidade de vida. Métodos Estudo observacional e transversal realizado com 71 pacientes portadores de cirrose hepática do Serviço de Hepatologia do Hospital de Base do Distrito Federal, Brasília, DF, Brasil, no período de julho de 2017 a dezembro de 2018. Os pacientes foram submetidos à densitometria óssea de coluna lombar e colo de fêmur, raio-x de coluna lombo sacra e ao questionário Chronic Liver Disease Questionnaire (CLDQ, na sigla em inglês) para avaliação de qualidade de vida. Foi calculado o escore de Fracture Risk Assessment Tool "FRAX Maior" nos pacientes >50 anos. As análises foram realizadas para a avaliação dos fatores de risco associados à fratura de coluna lombo sacra. Resultados Dos 71 pacientes avaliados, a maioria (62%) foi diagnosticada com osteoporose ou osteopenia à densitometria. Dos 44 portadores de osteopenia ou osteoporose, 52,3% eram do sexo feminino, com idade média de 62,6±9,51 anos, sendo a maioria (72,7%) Child A, cirróticos de etiologia alcoólica (36,4%) e com qualidade de vida intermediária ao CLDQ (3,3). Dos pacientes com fratura de coluna lombo sacra, a média de idade foi de 61,6±11,1 anos, 60% eram do sexo feminino, a maioria Child A (66,7%), de etiologia alcoólica (46,7%), e apresentaram qualidade de vida intermediária ao CLDQ (3,5). A presença de osteopenia e/ou osteoporose esteve associada à fratura lombo sacra (P<0,001), sem correlação com as demais variáveis analisadas: idade, índice de massa corporal (IMC), gênero, presença e ausência de ascite, classificação de Child-Pugh, concentrações séricas de vitamina D, cálcio e fósforo, etiologia da cirrose e "FRAX maior". Conclusão A prevalência de osteodistrofia hepática foi elevada, e a ocorrência de fratura de coluna lombo sacra esteve mais associada à osteoporose e/ou osteopenia entre cirróticos estudados. A qualidade de vida se mostrou intermediária e sem diferença entre cirróticos com e sem fratura.

5.
Arq. gastroenterol ; 59(1): 102-109, Jan.-Mar. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1374455

ABSTRACT

ABSTRACT Background Bacterial infections occur in 43—59% of cirrhotic patients admitted to the intensive care unit with impact in morbidity and mortality. An increase in the frequency of multidrug-resistant (MDRO) and extensively drug-resistant (XDRO) organisms has been described in bacterial infections in cirrhotic patients with an adverse impact on survival. Objective To characterize community-acquired (CA), healthcare-associated (HCA), and hospital-acquired (HA) infections in cirrhotic patients and their impact in the occurrence of adverse outcomes. Methods This study included all cirrhotic patients admitted in an intensive care unit specialized in liver and gastrointestinal diseases in Brazil between January 2012 and June 2018. Frequency and topography of infections were retrospectively evaluated, as well as the frequency of MDRO and XDRO organisms, and their impact in occurrence of acute kidney injury, hepatorenal syndrome, acute-on-chronic liver failure, sepsis and mortality. Results A total of 374 infections were observed and classified as CA (22%), HCA (34%) and hospital-acquired (44%). Eighty-nine (54%) episodes of hospital-acquired infections were second infections. Spontaneous bacterial peritonitis (32%) and urinary tract infection (23%) were the most common infections. Culture-proven infections were positive in 61% of the cases, mainly gram-negative bacteria (73%). Acute kidney injury, hepatorenal syndrome and sepsis were observed, respectively, in 48%, 15% and 53% of the cases. MDRO and XDRO were seen, respectively, in 35% and 16%, mainly in HCA (48% vs 26% in CA infections, P=0.02) and hospital-acquired (58% vs 26% in CA infections, P=0.0009). Adverse outcomes were more frequently observed in subjects with hospital-acquired infections when compared to HCA and CA infections. Hospital-acquired, HCA and second infections were independently associated with in-hospital mortality. Conclusion Hospital-acquired, HCA and second infections are increasingly associated with either MDRO and/or XDRO and are independent predictors of in-hospital mortality. Their recognition and proper selection of appropriate empiric antibiotic regimens are important measures to reduce in-hospital mortality.


RESUMO Contexto As infecções bacterianas ocorrem em 43—59% dos pacientes cirróticos internados em unidade de terapia intensiva com impacto na morbimortalidade. Um aumento na frequência de bactérias multirresistentes e com resistência estendida foi descrito em infecções bacterianas em pacientes cirróticos, com um impacto adverso na sobrevida. Objetivo Caracterizar as infecções adquiridas na comunidade, relacionadas aos cuidados de saúde (RCS) e hospitalares em pacientes cirróticos e seu impacto na ocorrência de desfechos adversos. Métodos Este estudo incluiu todos os pacientes cirróticos internados em uma unidade de terapia intensiva especializada em doenças hepáticas e gastrointestinais no Brasil entre janeiro de 2012 e junho de 2018. A frequência e topografia das infecções foram avaliadas retrospectivamente, bem como a frequência de bactérias multirresistentes e resistência estendida, e seu impacto na ocorrência de lesão renal aguda, síndrome hepatorrenal, insuficiência hepática crônica agudizada, sepse e mortalidade. Resultados Um total de 374 infecções foram observadas e classificadas como infecções adquiridas na comunidade (22%), RCS (34%) e infecções hospitalares (44%). Oitenta e nove (54%) episódios de infecções hospitalares foram identificadas como segunda infecção. Peritonite bacteriana espontânea (32%) e infecção do trato urinário (23%) foram as infecções mais comuns. As infecções comprovadas por cultura foram positivas em 61% dos casos, principalmente ocasionadas por bactérias gram-negativas (73%). Lesão renal aguda, síndrome hepatorrenal e sepse foram observados respectivamente, em 48%, 15% e 53% dos casos. Bactérias multirresistentes e resistência estendida foram observadas respectivamente, em 35% e 16%, principalmente nos RCS (48% vs 26% em infecções adquiridas na comunidade, P=0,02) e infecções hospitalares (58% vs 26% em infecções adquiridas na comunidade, P=0,0009). Os resultados adversos foram observados com mais frequência em indivíduos com infecções nosocomiais em comparação com infecções relacionadas aos cuidados de saúde e comunitárias. Infecções hospitalares, RCS e ocorrência de uma segunda infecção foram independentemente associadas à mortalidade intra-hospitalar. Conclusão Infecções hospitalares, relacionadas aos cuidados de saúde e reinfecções estão cada vez mais associadas a bactérias multirresistentes e/ou resistência estendida e são preditores independentes de mortalidade intra-hospitalar. Seu reconhecimento e seleção adequada de regimes antibióticos empíricos apropriados são medidas importantes para reduzir a mortalidade intra-hospitalar.

6.
Rev. colomb. gastroenterol ; 37(1): 24-32, Jan.-Mar. 2022. tab, graf
Article in English | LILACS | ID: biblio-1376902

ABSTRACT

Abstract Introduction: Cirrhosis is the final stage of chronically progressive liver diseases of various etiologies. It is a common disease, with a variable prevalence in each country. Its peak incidence occurs between 40 and 50 years of age, predominantly in men. Aims: To compare a cohort of patients diagnosed with cirrhosis, evaluate their complications and survival according to etiology, describe clinical and laboratory aspects, and determine the role of a fatty liver. Materials and methods: A retrospective cohort study was carried out with patients who held a specialized hepatology consultation in the center of liver and digestive diseases (CEHYD) in Bogotá, Colombia, between January 2010 and June 2019. Results: We reviewed a total of 1,200 medical records (56.8 % women). There were no statistically significant differences in median survival between groups by etiology, sex, presence or absence of complications, or Child. We noted that the older the age at the diagnosis of cirrhosis, the higher the risk of death; HR 1.04 (95 % CI 1.02-1.075). For each month that follow-up increases, the risk of death decreases by 90 %; HR 0.1 (95 % CI 0.03-0.29). For each month that the follow-up of complications increases, the risk of death is reduced by 2 %; HR 0.98 (95 % CI 0.97-0.99). Conclusions: Survival by etiology was similar in the different groups. Nonalcoholic steatohepatitis (NASH) was the leading cause of cirrhosis in this cohort. Efforts should focus on its diagnosis and management in the early stages.


Resumen Introducción: la cirrosis es el estadio final de enfermedades hepáticas crónicamente progresivas de diferentes etiologías. Es una enfermedad frecuente, con una prevalencia variable en cada país. Su pico de incidencia se presenta entre los 40 y 50 años, predominantemente en hombres. Objetivos: comparar una cohorte de pacientes con diagnóstico de cirrosis, evaluar sus complicaciones y sobrevida de acuerdo con su etiología, describir los aspectos clínicos y de laboratorio, y determinar el papel del hígado graso. Materiales y métodos: se realizó un estudio de cohorte retrospectiva, en donde se incluyeron pacientes que asistieron a consulta especializada de hepatología en el centro de enfermedades hepáticas y digestivas (CEHYD), en la ciudad de Bogotá, durante enero de 2010 y junio de 2019. Resultados: se revisaron un total de 1200 historias clínicas (56,8 % mujeres). No se evidenció diferencias estadísticamente significativas en las medianas de sobrevida entre los grupos por etiologías, sexo, presencia o no de complicaciones, o Child. Se evidenció que entre mayor edad en el diagnóstico de cirrosis, el riesgo de muerte es mayor; HR 1,04 (IC 95 % 1,02-1,075). Por cada mes que aumenta el seguimiento se reduce el riesgo de muerte en 90 %; HR 0,1 (IC 95 % 0,03-0,29). Por cada mes que aumenta el seguimiento de las complicaciones se reduce el riesgo de muerte en 2 %; HR 0,98 (IC 95 % 0,97-0,99). Conclusiones: La sobrevida por etiología fue similar en los diferentes grupos. La esteatohepatitis no alcohólica (NASH) fue la principal causa de cirrosis en esta cohorte. Se deben orientar esfuerzos a su diagnóstico y manejo en fases tempranas.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Survival , Fibrosis , Fatty Liver , Non-alcoholic Fatty Liver Disease , Patients , Medical Records , Disease , Incidence , Cohort Studies , Death , Liver Diseases
7.
Säo Paulo med. j ; 140(1): 71-80, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1357462

ABSTRACT

ABSTRACT BACKGROUND: Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis. OBJECTIVE: To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality. DESIGN AND SETTING: Prospective observational study conducted in the Federal University of São Paulo. METHOD: A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters. RESULTS: The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100. CONCLUSION: Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.


Subject(s)
Humans , Child , Arrhythmias, Cardiac , Electrocardiography, Ambulatory , Prospective Studies , Heart Rate/physiology , Liver Cirrhosis/complications
8.
ABCD arq. bras. cir. dig ; 35: e1671, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1393700

ABSTRACT

ABSTRACT BACKGROUND: Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones. AIMS: This study aimed to analyze the acuity of elastography in the regression of hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy 2 months after surgery. METHODS: Patients in the preoperative period of bariatric surgery underwent an anthropometric evaluation and hepatic elastography to quantify fibrosis and hepatic steatosis. Two months after surgery, the same evaluation was performed again. RESULTS: All 17 patients who met the inclusion criteria participated in the study. Out of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels postoperatively compared to preoperatively (p=0.029, p<0.05). As for steatosis, patients who underwent Roux-en-Y gastric bypass had lower postoperative values (p=0.01, p<0.05). There was also a reduction in fibrosis postoperatively in the sleeve gastrectomy group compared to preoperatively (p=0.037, p<0.05). CONCLUSIONS: Elastography accurately demonstrated decreased hepatic steatosis and fibrosis in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y gastric bypass and sleeve gastrectomy are suitable surgical methods to improve hepatic steatosis and fibrosis within 2 months postoperatively.


RESUMO RACIONAL: A esteatose hepática não alcoólica é encontrada na maioria dos pacientes com obesidade e tem forte associação com a síndrome metabólica. O bypass gástrico em Y de Roux e a gastrectomia vertical são as duas técnicas de cirurgia bariátrica. Pacientes que são submetidos a cirurgia bariátrica tem regressão da esteatose hepática não alcoólica devido a redução do índice de massa corpórea e mudanças dos hormônios incretínicos. OBJETIVOS: analisar a acuidade da elastografia na regressão da esteatose e fibrose hepáticas em pacientes obesos submetidos a bypass gástrico em Y de Roux e gastrectomia vertical dois meses após a cirurgia. MÉTODOS: Pacientes em pré-operatório de cirurgia bariátrica foram submetidos a avaliação antropométrica e elastografia hepática para quantificação de fibrose e esteatose hepática. Dois meses após a cirurgia, a mesma avaliação foi realizada novamente. RESULTADOS: Dezessete pacientes preencheram todos os critérios de inclusão no estudo. Nove foram submetidos a gastrectomia vertical e 8 a bypass gástrico em Y de Roux. O grupo bypass gástrico em Y de Roux apresentou níveis de fibrose mais baixos no pós-operatório em comparação com o pré-operatório, (p=0,029, p<0,05). Quanto à esteatose, os pacientes que realizaram bypass gástrico em Y de Roux apresentaram valores menores no pós-operatório (p=0,01, p<0,05). No grupo gastrectomia vertical, também houve redução da fibrose no pós-operatório em relação ao pré-operatório (p=0,037, p<0,05). CONCLUSÕES: A elastografia mostrou acuidade para demonstrar diminuição da esteatose e fibrose hepáticas, no pós-operatório precoce de cirurgia bariátrica. Além disso, bypass gástrico em Y de Roux e gastrectomia vertical são métodos cirúrgicos adequados para melhorar a esteatose e fibrose hepática em um período de 2 meses de pós-operatório.

9.
HU rev ; 48: 1-8, 2022.
Article in Portuguese | LILACS | ID: biblio-1381714

ABSTRACT

Introdução: O estudo foi desenvolvido com o intuito de destacar a importância dos diagnósticos de enfermagem em pacientes cirróticos, em decorrência do aumento de casos de doenças hepáticas. Objetivo: Descrever as variáveis sociodemográficas e clínicas e elencar os diagnósticos de enfermagem da Associação Norte-Americana de Diagnósticos de Enfermagem (NANDA-I) em pacientes com cirrose hepática atendidos em uma emergência hospitalar. Material e Métodos: Pesquisa quantitativa, descritiva e transversal, realizada com 59 pacientes atendidos em uma emergência de um hospital universitário no sul do Brasil, no período de abril a junho de 2018. Resultados: Prevaleceu durante a pesquisa a população do sexo masculino com 66,1% e de baixo nível educacional, tendo o álcool como principal etiologia da doença com 44,1% e a presença de comorbidades como a hipertensão com 14,8% e o diabetes com 15,6%. Foram identificados seis diagnósticos de enfermagem com maior prevalência: risco de infecção, risco de desequilíbrio eletrolítico, nutrição desequilibrada (menor do que as necessidades corporais), dor aguda, volume de líquidos excessivo e risco de sangramento. Conclusão: As características sociodemográficas apresentadas neste estudo corroboram os achados já amplamente conhecidos em doença hepática. Os diagnósticos de enfermagem identificados foram condizentes com as repercussões fisiopatológicas da cirrose hepática, destacando-se o predomínio dos diagnósticos de risco.


Introduction: The study was developed with the aim of highlighting the importance of nursing diagnoses in cirrhotic patients, due to the increase in cases of liver disease. Objective: Describe the sociodemographic and clinical variables and list the nursing diagnoses of the North American Association of Nursing Diagnoses (NANDA-I) in patients with liver cirrhosis treated in a hospital emergency. Material and Methods: Quantitative, descriptive and cross-sectional research, conducted with 59 patients seen in an emergency department of a university hospital in southern Brazil, from April to June 2018. Results: There was a predominance during the research of the male population with 66.1% and of low educational level, with approximately 54.2% having completed elementary school, with alcohol as the main etiology of the disease with 44.1% and the presence of comorbidities such as hypertension with 14.8% and diabetes with 15.6%. Six nursing diagnoses with higher prevalence were identified: risk of infection, risk of electrolyte imbalance, unbalanced nutrition (less than body needs), acute pain, excessive fluid volume and risk of bleeding. Conclusion: The sociodemographic characteristics presented in this study corroborate the already widely known findings in liver disease. The nursing diagnoses identified were consistent with the pathophysiological repercussions of liver cirrhosis, highlighting the predominance of risk diagnoses.


Subject(s)
Nursing Diagnosis , Liver Cirrhosis , Emergency Service, Hospital , Acute-On-Chronic Liver Failure , Health Services Needs and Demand
10.
Journal of Clinical Hepatology ; (12): 2150-2154, 2022.
Article in Chinese | WPRIM | ID: wpr-942678

ABSTRACT

Portal vein thrombosis (PVT) is one of the common complications in patients with decompensated liver cirrhosis, including non-neoplastic PVT and portal vein tumor thrombus after the onset of primary liver cancer. It can lead to the deterioration of liver function, aggravate the portal hypertension-related adverse events including esophagogastric variceal bleeding, reduce the survival rate of patients after liver transplantation, and even threaten the life of patients in severe cases. Therefore, it is of great clinical significance to further explore the risk factors and early predictive factors for PVT. This article elaborates on the recent advances in the early predictive factors for non-neoplastic PVT in liver cirrhosis from the aspects of the three elements of thrombosis, the severity of liver injury, and the endoscopic treatment of esophagogastric varices. The analysis of related research shows that some early predictive factors are clearly associated with the formation of PVT, which provides help for the early identification of PVT; however, specific predictive values may be unclear or have certain differences, which needs to be confirmed by multicenter prospective studies.

11.
Journal of Clinical Hepatology ; (12): 2146-2149, 2022.
Article in Chinese | WPRIM | ID: wpr-942677

ABSTRACT

Small intestinal bacterial overgrowth (SIBO) is characterized by changes in the number or species of small intestinal flora. Patients with liver cirrhosis often have intestinal congestion, edema, and delayed peristalsis and develop SIBO, which can further aggravate intestinal abnormalities. In patients with liver cirrhosis, SIBO can lead to significant adverse clinical outcomes, and since the increase in intestinal permeability may cause bacterial translocation into systemic circulation, SIBO is considered an important risk factor in the pathogenesis of liver cirrhosis, spontaneous bacterial peritonitis, and hepatic encephalopathy. Antibiotics, especially rifaximin, are the most effective therapies for SIBO, and in addition, studies are being conducted to investigate the efficacy of potential therapies such as prokinetic agents, probiotics, non-selective β-receptor blocker, and liver transplantation.

12.
Journal of Clinical Hepatology ; (12): 2141-2145, 2022.
Article in Chinese | WPRIM | ID: wpr-942676

ABSTRACT

Reconstructed rebalanced hemostasis exists in patients with liver cirrhosis, while such balance is unstable and can be easily broken by stress factors, which may lead to bleeding or thrombosis. There is a lack of effective strategies to prevent and solve the disrupted balance in clinic due to the complex pathogenesis of rebalanced hemostasis, limited testing methods, and insufficient awareness among clinicians. With reference to the articles in recent years, this article summarizes the mechanism of rebalanced hemostasis in liver cirrhosis and the causes of bleeding and thrombosis and discuss the association between blood transfusion and rebalanced hemostasis and the selection of anticoagulant drugs during thrombosis, in order to provide a theoretical basis and new ideas for solving related issues in clinical practice.

13.
Journal of Clinical Hepatology ; (12): 2040-2045, 2022.
Article in Chinese | WPRIM | ID: wpr-942657

ABSTRACT

Objective To investigate the effect of Yangxue Rougan pills on a rat model of liver fibrosis induced by multiple factors and the mechanism of action of Yangxue Rougan pills in the treatment of liver fibrosis. Methods A total of 50 male rats were randomly divided into blank control group, multi-factor model group, Fuzheng Huayu capsule group, and high-, middle-, and low-dose Yangxue Rougan pill groups. The rats in the blank control group were given normal water and feed, and those in the other groups were given modified high-fat low-protein diet and 5% alcohol, as well as subcutaneous injection of olive oil solution containing 40% carbon tetrachloride and intraperitoneal injection of pig serum 0.5 mL per rat, twice a week for 12 consecutive weeks. Since week 7, the rats in the high-, middle-, and low-dose Yangxue Rougan pill groups were given Yangxue Rougan pills at a dose of 9.5, 4.75, and 2.38 g/kg, respectively, those in the Fuzheng Huayu capsule group were given Fuzheng Huayu capsules at a dose of 0.75 g/kg, and those in the blank control group and the multi-factor model group were given an equal volume of distilled water by gavage every day for 6 consecutive weeks. The rats were treated at week 12. HE staining and Masson staining were used to observe the degree of liver fibrosis in rats, and PCR and Western blot were used to measure the expression of TGF-β1, Smad3, and Smad7 in the liver. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Dunnett's t -test was used for further comparison between two groups. Results Compared with the blank control group, the multi-factor model group had a severely damaged lobular structure and a significantly higher degree of liver fibrosis, with the formation of pseudolobules with different sizes; compared with the multi-factor model group, the Yangxue Rougan pill groups had a significant improvement in the degree of liver fibrosis, with the most significant therapeutic effect in the high- and middle-dose Yangxue Rougan pill groups. Compared with the blank control group, the multi-factor model group had significant increases in the expression of TGF-β1 and Smad3 and a significant reduction in the expression of Smad7 in liver tissue (all P < 0.05); compared with the multi-factor model group, the Yangxue Rougan pill groups had a significant reduction in the expression of TGF-β1 and a significant increase in the expression of Smad7 (all P < 0.05); compared with the multi-factor model group, the high- and middle-dose Yangxue Rougan pill groups had a significant reduction in the expression of Smad3 (both P < 0.05). Conclusion Yangxue Rougan pills can significantly inhibit liver fibrosis in rats by downregulating the expression of TGF-β1 and Smad3 and upregulating the expression of Smad7, and therefore, the TGF-β1/Smad signaling pathway is one of the mechanisms of action of Yangxue Rougan pills in improving liver fibrosis.

14.
Journal of Clinical Hepatology ; (12): 2034-2039, 2022.
Article in Chinese | WPRIM | ID: wpr-942656

ABSTRACT

Objective To investigate the effect of metformin on liver fibrosis in a mouse model of Budd-Chiari syndrome and its mechanism. Methods A total of 30 male C57 mice were randomly divided into sham-operation group (SHAM group) with 6 mice, sham operation+ metformin group (SHAM+M group) with 5 mice, Budd-Chiari model group (BCS group) with 10 mice, and Budd-Chiari model+metformin group (BCS+M group) with 9 mice. The mice in the model group were treated with partial ligation of the inferior vena cava, those in the SHAM group were not treated with ligation, and those in the metformin group were given 0.1% metformin in drinking water besides modeling. The mice were sacrificed after 6 weeks. HE staining and picrosirius red staining were used to observe liver histopathology and collagen deposition; immunohistochemistry was used to measure the expressions of α-smooth muscle actin (α-SMA) and fibrinogen; quantitative real-time PCR was used to measure the mRNA expression of hypoxia-inducible factor 1α (HIF-1α) and type Ⅰ collagen (collagen 1), and Western blot was used to measure the relative protein expression levels of HIF-1α, vascular endothelial growth factor (VEGF), fibrinogen, α-SMA, and collagen 1. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups. Results Pathological staining showed that compared with the SHAM group, the BCS group had significant liver fibrosis, disordered arrangement of hepatocytes near the central vein, sinusoidal expansion with red blood cell deposition and a small amount of inflammatory cell infiltration, and collagen deposition. The BCS group had significant increases in the mRNA expression levels of HIF-1α and collagen 1 and the protein expression levels of α-SMA, collagen 1, HIF-1α, VEGF, and fibrinogen (all P < 0.05); compared with the BCS group, the BCS+M group had significant alleviation of liver fibrosis, red blood cell deposition, and collagen deposition and significant reductions in the mRNA expression levels of HIF-1α and collagen 1 and the protein expression levels of α-SMA, collagen 1, HIF-1α, VEGF, and fibrinogen (all P < 0.05). Conclusion Metformin can improve congestive liver fibrosis caused by Budd-Chiari syndrome, possibly by reducing microthrombus in hepatic sinusoid and inhibiting the HIF-1α/VEGF pathway.

15.
Journal of Clinical Hepatology ; (12): 2027-2033, 2022.
Article in Chinese | WPRIM | ID: wpr-942655

ABSTRACT

Objective To investigate the mechanism of action of integrin α4 (ITGA4) in liver fibrosis based on the anti-liver fibrosis effect of sticky sugar amino acid (SSAA) in rats. Methods A rat model of liver fibrosis was induced by intraperitoneal injection of CCl 4 , and then colchicine and low-, middle-, and high-dose SSAA were used for intervention, with blank control group and SSAA group as control. After 12 weeks of experimental intervention, serum and liver samples were collected to measure the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and HE staining and Sirius Red staining were used to observe the pathological conditions of liver tissue; quantitative real-time PCR was used to measure the transcriptional level of ITGA4, integrin β1 (ITGB1), transforming growth factor-β1 (TGFβ1), alpha-smooth muscle actin (α-SMA), and TIMP2 in liver tissue; Western blot was used to measure the relative protein expression levels of ITGA4, ITGB1, TGFβ1, α-SMA, MMP2, TIMP1, and TIMP2; immunohistochemistry was used to observe the protein expression of TGFβ1 and α-SMA. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t -test was used for comparison between two groups. Results There were significant increases in AST and ALT in the CCl 4 model group, and intervention with colchicine or low-, middle-, and high-dose SSAA reduced the levels of AST and ALT, with a significant difference between the CCl 4 model group and the other groups (all P < 0.05). HE staining and Sirius Red staining showed disordered structure of hepatic lobules and an increase in collagen fibers in the CCl 4 model group, and the structure of hepatic lobules was improved after intervention with colchicine or low-, middle-, and high-dose SSAA. The CCl 4 model group had significantly higher transcriptional levels of ITGA4, TGFβ1, α-SMA, and TIMP2 than the other groups, and there were significant reductions in the transcriptional levels of each factor after intervention with colchicine or SSAA, with a significant difference between the CCl 4 model group and the other groups (all P < 0.05). The CCl 4 model group had significantly higher protein expression levels of ITGA4, TGFβ1, α-SMA, TIMP2, and TIMP1 and a significantly lower protein expression level of MMP2 than the other groups, and intervention with colchicine or SSAA inhibited the expression of ITGA4, TGFβ1, α-SMA, TIMP2, and TIMP1 and promoted the expression of MMP2. Immunohistochemistry showed that the CCl 4 model group had significantly higher expression levels of TGFβ1 and α-SMA than the other groups, which was inhibited by intervention with colchicine or SSAA. The high-dose SSAA group had the most significant effect in reducing aminotransferases, improving lobular structure, and inhibiting the protein expression of liver fibrosis factors. Conclusion The high expression of ITGA4 in the liver is associated with the development of liver fibrosis, which is consistent with the increases in the expression of TGFβ1 and α-SMA. Inhibiting the expression of ITGA4 can provide more therapeutic targets for liver fibrosis and expand the anti-liver fibrosis mechanism of SSAA.

16.
Journal of Clinical Hepatology ; (12): 2020-2026, 2022.
Article in Chinese | WPRIM | ID: wpr-942654

ABSTRACT

Objective To investigate the effect of Ganshuang granule combined with entecavir on portal vein thrombosis (PVT) in patients with hepatitis B cirrhosis. Methods A total of 356 patients with hepatitis B cirrhosis who attended and were hospitalized in The Third People's Hospital of Kunming from January 1, 2018 to December 31, 2020 were enrolled and randomly divided into combination group with 191 patients and control group with 165 patients. The patients in the combination group received Ganshuang granule combined with entecavir, and those in the control group received entecavir alone. The course of treatment was at least 24 weeks. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to analyze the cumulative incidence rate of PVT in both groups, and the log-rank test was used for comparison between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for PVT in patients with hepatitis B cirrhosis. Results The 191 patients in the combination group were followed up for 296.25 person-years in total, with a mean follow-up time of 1.55±0.65 years, and there were 8 patients with PVT, with an incidence rate of 4.19% and an incidence density of 1.41 per ten-thousand person-years. The 165 patients in the control group were followed up for 253.25 person-years in total, with a mean follow-up time of 1.53±0.67 years, and there were 20 patients with PVT, with an incidence rate of 12.12% and an incidence density of 4.79 per ten-thousand person-years. There was a significant difference in the incidence rate of PVT between the two groups ( χ 2 =7.687, P =0.006). The cumulative incidence rate of PVT plotted by the Kaplan-Meier method showed that the combination group had a significantly lower cumulative incidence rate of PVT than the control group ( χ 2 =7.226, P =0.007), with a relative risk of 3.155 (95% confidence interval [ CI ]: 1.351-7.370). The univariate Cox analysis showed that hypertension, alanine aminotransferase, aspartate aminotransferase (AST), albumin (Alb), cholinesterase, estimated glomerular filtration rate, alpha-fetoprotein, D-dimer (D-D), Child-Pugh class, and Ganshuang granule combined with entecavir were influencing factors for PVT (all P < 0.05); the multivariate Cox analysis showed that AST (hazard ratio [ HR ]=1.002, 95% CI : 1.000-1.004, P =0.025), and D-D ( HR =1.907, 95% CI : 1.554-2.338, P < 0.001) were independent risk factors for PVT in patients with hepatitis B cirrhosis, while Alb ( HR =0.844, 95% CI : 0.755-0.944, P =0.003) and Ganshuang granule combined with entecavir ( HR =0.350, 95% CI : 0.144-0.851, P =0.021) were independent protective factors against PVT in patients with hepatitis B cirrhosis. Conclusion Ganshuang granule combined with entecavir can significantly reduce the incidence rate of PVT in patients with hepatitis B cirrhosis, thereby exerting a certain preventive effect against PVT.

17.
Journal of Clinical Hepatology ; (12): 1980-1985, 2022.
Article in Chinese | WPRIM | ID: wpr-942647

ABSTRACT

Hepatogenous diabetes (HD) is a common complication of liver cirrhosis and can reduce survival rate and increase the risk of other complications. It differs from type 2 diabetes in terms of etiology, pathogenesis, and diagnostic methods. There are currently no guidelines for HD treatment in China and globally. Although the understanding of HD in traditional Chinese medicine is gradually deepened, no consensus has been reached on its etiology, pathogenesis, and syndrome differentiation. This article reviews the traditional Chinese and Western medicine research on HD in recent years, so as to provide a reference for clinicians to develop individualized traditional Chinese and Western medicine diagnosis and treatment strategies.

18.
Journal of Clinical Hepatology ; (12): 1962-1968, 2022.
Article in Chinese | WPRIM | ID: wpr-942644

ABSTRACT

Portal hypertension is not only the outcome of liver cirrhosis, but also the main cause of gastroesophageal varices, and variceal bleeding may lead to dangerous conditions and even endanger the life of patients. Therefore, standardization of endoscopic screening, prevention of first-time bleeding, emergency hemostasis, and prevention of secondary bleeding after hemostasis are of great importance for the prevention and treatment of gastroesophageal variceal bleeding. At present, the treatment measures for emergency hemostasis mainly include circulatory resuscitation, pharmacotherapy, endoscopic therapy, interventional radiology, and transjugular intrahepatic portosystemic shunt for patients who may fail in routine treatment. Secondary preventive measures mainly include traditional nonselective β-receptor blocker (NSBB) or carvedilol combined with endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt, and balloon-occluded retrograde transvenous obliteration. In addition, traditional Chinese medicine or integrated traditional Chinese and Western medicine therapy also play an important role in the treatment of gastroesophageal variceal bleeding, especially in the fields of primary and secondary prevention. This article reviews the research advances in the role of integrated traditional Chinese and Western medicine therapy in the diagnosis and treatment of gastroesophageal variceal bleeding due to liver cirrhosis in recent years, in order to provide a reference for clinicians to select appropriate diagnosis and treatment regimens.

19.
Journal of Clinical Hepatology ; (12): 1956-1961, 2022.
Article in Chinese | WPRIM | ID: wpr-942643

ABSTRACT

Ascites is the most common complication of decompensated liver cirrhosis. Recurrent massive ascites seriously affects the quality of life and prognosis of patients, and therefore, effective control of ascites is an important link in the treatment of liver cirrhosis. Based on the clinical reports in recent years, this article reviews the advances in the integrated traditional Chinese and Western medicine diagnosis of cirrhotic ascites, conventional Western medicine treatment such as salt restriction, diuresis, and albumin supplementation, and the application of transjugular intrahepatic portosystemic shunt, ascites pump, and liver transplantation in the treatment of refractory ascites. In addition, this article introduces the application of integrated traditional Chinese and Western medicine combining disease and syndrome with staged treatment and external treatment methods with traditional Chinese medicine characteristics, as well as the perspectives of future research including real-world study.

20.
Journal of Clinical Hepatology ; (12): 1953-1955, 2022.
Article in Chinese | WPRIM | ID: wpr-942642

ABSTRACT

The combination of traditional Chinese medicine and Western medicine is an important approach to improve the treatment outcome of liver cirrhosis. Long-term diagnosis and treatment practice and clinical studies of the prevention and treatment of chronic hepatitis B cirrhosis have shown that antiviral drugs targeting the cause of the disease combined with anti-liver fibrosis traditional Chinese medicine can significantly improve the reversal rate of liver fibrosis and cirrhosis, and anti-liver fibrosis therapy can reduce the incidence rates of esophagogastric variceal bleeding and hepatocellular carcinoma in cirrhotic patients and improve the 5-year survival rate of patients with decompensated liver cirrhosis. It is necessary to conduct in-depth studies to clarify the target and mechanism of action of the main effective constituents of compound traditional Chinese medicine, strengthen the research on drug quality control standards, and obtain more high-quality evidence for clinical efficacy, so as to effectively promote the development of integrated traditional Chinese and Western medicine therapy for liver cirrhosis.

SELECTION OF CITATIONS
SEARCH DETAIL