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1.
Clinics ; 76: e2409, 2021. tab, graf
Article in English | LILACS | ID: biblio-1278910

ABSTRACT

This study aimed to perform a meta-analysis to determine the efficacy and safety of emricasan. Nine databases were searched for clinical trials investigating the efficacy of emricasan treatment in patients with liver cirrhosis or fibrosis. A manual search was conducted to identify the missing trials. The quality of the included studies was assessed using the revised Cochrane risk of bias tool. Efficacy of emricasan treatment was defined as a positive change in apoptosis-related parameters from baseline to the last follow-up visit. Overall, emricasan treatment is more effective in patients with liver cirrhosis or fibrosis than placebo (standardized mean difference [SMD] [95% confidence intervals (CI)]=0.28 [0.14; 0.41]). No significant change in model for end-stage liver disease (MELD) score between the emricasan and placebo groups was noted (SMD [95% CI]=0.18 [-0.01; 0.36]; p=0.058). A 50 mg dose of emricasan had the highest efficacy rate compared to placebo (SMD [95% CI]=0.28 [0.06; 0.50]; p=0.012), followed by the 5 mg dosing regimen (SMD [95% CI]=0.28 [0.06; 0.50]; p=0.012). Treatment with emricasan resulted in significant reductions in ALT (mean difference (MD) [95% CI]=-5.89 [-10.59; -1.20]; p=0.014) and caspase3/7 levels (MD [95%CI]=-1215.93 [-1238.53; -1193.33]; p<0.001), respectively. No significant increase in the rate of overall adverse events was noted (OR [95% CI]=1.52 [0.97; 2.37]; p=0.069). Treatment with emricasan is more effective in improving liver function and apoptosis parameters compared to placebo, with a well-tolerated safety profile. However, due to the poor quality of the analyzed studies, the small number of trials and patients, and the short follow-up periods, more robust trials are still warranted.


Subject(s)
Humans , End Stage Liver Disease , Pentanoic Acids , Severity of Illness Index , Fibrosis , Liver Cirrhosis/drug therapy
3.
Rev. chil. infectol ; 37(1): 82-84, feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1092726

ABSTRACT

Resumen Se comunica el caso clínico de un varón, con antecedentes de una cirrosis hepática alcohólica y gota, usuario crónico de antiinflamatorios, incluyendo corticoesteroides. Consultó por una melena secundaria a una úlcera bulbar. Durante su internación presentó fiebre, tratándose con ceftriaxona por un probable foco urinario. Por persistir febril, se realizó una paracentesis diagnóstica. En la muestra de líquido ascítico se observaron larvas de Strongyloides stercoralis. Recibió tratamiento antiparasitario con ivermectina, con buena respuesta clínica. Aunque la infección por S. stercoralis es relativamente frecuente en pacientes con cirrosis hepática alcohólica, la ascitis infectada por Strongyloides corresponde a una forma de presentación infrecuente. Este caso muestra la importancia de la paracentesis diagnóstica en todo paciente con ascitis secundaria a una cirrosis. Es importante considerar la presentación atípica de la infestación por Strongyloides en el contexto del paciente inmunocomprometido, ya que sin tratamiento puede tener una alta mortalidad.


Abstract Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.


Subject(s)
Humans , Animals , Male , Strongyloidiasis/complications , Strongyloidiasis/physiopathology , Strongyloidiasis/drug therapy , Strongyloides stercoralis/isolation & purification , Liver Cirrhosis/etiology , Liver Cirrhosis/parasitology , Liver Cirrhosis/drug therapy , Ascites/parasitology , Ivermectin/therapeutic use , Ascitic Fluid/parasitology , Treatment Outcome , Antiparasitic Agents/therapeutic use
4.
Clin. biomed. res ; 40(1): 7-13, 2020.
Article in English | LILACS | ID: biblio-1115980

ABSTRACT

Introduction: Despite the emergence of new treatments for HCV genotype 3 (HCV G3), there is still a lack of data about this particular subgroup in Brazil. Our objective was to describe clinical and sociodemographic variables and treatment profile of HCV G3 Brazilian patients. Methods: This was a descriptive, retrospective study, performed in a specialized center for HCV treatment in the South Region of Brazil. Medical records of patients diagnosed with HCV G3 were reviewed to collect clinical, sociodemographic, and treatment information. Results: Participants included total of 564 patients, with a mean age of 59.3 years (SD = 10.5). Cirrhosis was present in 54.4% of patients. The most common coexisting conditions were systemic arterial hypertension (36.6%) and diabetes mellitus (30%). Regarding treatment, 25.2% of the patients were treatment-naïve and 74.8% were currently under treatment (11.6%) or had received a previous treatment (87%). The most frequent ongoing treatment was sofosbuvir + daclatasvir (± ribavirin) (87.8%). Of the 388 patients who had at least one previous treatment, 67% achieved sustained virologic response in the last treatment. Caucasian / white, non-obese, transplanted patients, those with longer time since diagnosis and with cirrhosis were more likely to receive treatment, according to multivariate analysis. Patients with hepatocellular carcinoma were 64.1% less likely to be on treatment during the study period than those without this condition; patients with chronic kidney disease were 2.91-fold more likely to have an interruption of treatment than those without this condition. Conclusion: This study describes a large sample of Brazilian patients with HCV G3. Treatment patterns were mainly influenced by the presence of HCV complications and comorbidities.(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Hepatitis C/virology , Hepacivirus/genetics , Genotype , Antiviral Agents/therapeutic use , Ribavirin/therapeutic use , Retrospective Studies , Interferons/therapeutic use , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Carcinoma, Hepatocellular/drug therapy , Withholding Treatment , Sofosbuvir/therapeutic use , Liver Cirrhosis/drug therapy
5.
Rev. medica electron ; 41(5): 1269-1278, sept.-oct. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1094128

ABSTRACT

RESUMEN La cirrosis es un estado reversible de fibrosis hepática, que se ha convertido en la 8a causa de muerte en los Estados Unidos y la 9 a causa de muerte en Cuba. Este artículo repasa el tratamiento práctico de la cirrosis basado en la revisión de ensayos clínicos obtenidos de buscadores como MEDLINE, HINARI y Scielo, durante los últimos años. Las principales causas de cirrosis hepática incluyen las hepatitis crónicas por virus B, C, alcoholismo, y la esteatohepatitis no alcohólica. La desnutrición ocurre en 20 a 60 % de los pacientes con cirrosis, por lo cual las dietas hipo proteicas están bajo revisión, se recomienda el control estricto de la sal, el uso de medicamentos debe ser valorado estrictamente, y hacer un uso juicioso de los hipotensores cuando la tensión arterial media sea inferior a 82 mm de Hg, los beta bloqueadores no selectivos tienen su indicación en varices esofágicas desarrolladas, por otro lado se recomienda la cautela en analgésicos y los inhibidores de la bomba de protones, no restringiéndose el uso de estatinas. Con respecto a los procederes invasivos, el uso de métodos quirúrgicos deben ser evaluados en situaciones extremas, donde el índice MELD puede ayudar en cuanto al pronóstico y mortalidad esperada. La paracentesis en las ascitis refractaria debe ser masiva apoyada con el uso de albúmina, y se debe realizar lo más rápido posible en la sospecha de peritonitis bacteriana espontanea. Por lo que se puede concluir que el uso adecuado de la nutrición, el control de las complicaciones y los factores de riesgo puede llevar a la reversibilidad de la cirrosis hepática (AU).


SUMMARY Cirrhosis is a reversible status of the liver fibrosis, being the 8th cause of death in the United States and the 9th cause of death in Cuba. This article reviews the practical treatment of cirrhosis based on the review of clinical research published in MEDLINE, HINARI and Scielo, during the last years. The main causes of hepatic cirrhosis include the chronic hepatitis caused by B and C viruses, alcoholism, and the non-alcoholic steato-hepatitis. Malnutrition occurs in 20-60 % of the patients with cirrhosis, therefore low protein diets are under revision; it is recommended a strict use of salt; the use of drugs should be strictly evaluated. Hypotensive drugs should be cautiously used when the average arterial tension is lower than 82 Hg mm. Non-selective beta-blockers are indicated in developed esophageal varices. It is also recommended to be cautious with analgesics and proton pump inhibitors while the statins use is not restricted. Regarding the invasive procedures, surgery should be evaluated very carefully, and the MELD index can help with respect to prognosis and expected mortality. In refractory ascites, paracentesis should be massive relayed on albumin use, and should be carried out as soon as possible in the suspicion of spontaneous bacterial peritonitis. In conclusion, the adequate nutrition use, the control of complications and risk factors, could lead to reversibility of hepatic cirrhosis (AU).


Subject(s)
Humans , Liver Cirrhosis/drug therapy , Liver Cirrhosis/etiology , Liver Cirrhosis/physiopathology , Liver Cirrhosis/mortality , Liver Cirrhosis/epidemiology , Liver Cirrhosis/diagnostic imaging
6.
J. bras. nefrol ; 41(2): 300-303, Apr.-June 2019. graf
Article in English | LILACS | ID: biblio-1012547

ABSTRACT

ABSTRACT A 16-year-old female patient previously diagnosed with autosomal recessive polycystic kidney disease (ARPKD) presented with acute bilateral pneumonia, upper gastrointestinal bleeding caused by ruptured esophageal varices, ascites, and lower limb edema. She required intensive care and an endoscopic procedure to treat the gastrointestinal bleeding. The analysis of the differential diagnosis for chronic liver disease indicated she had a spontaneous splenorenal shunt. Ultrasound-guided biopsy revealed the patient had cirrhosis, as characteristically seen in individuals with ARPKD. She had no symptoms at discharge and was referred for review for a combined transplant.


RESUMO Relato de caso de uma paciente adolescente de 16 anos de idade com diagnóstico prévio de doença renal policística autossômica recessiva (DRPAR), que apresentou quadro agudo de pneumonia bilateral e hemorragia digestiva alta por ruptura de varizes esofágicas, bem como ascite e edema de membros inferiores. Necessitou de estabilização clínica intensiva e tratamento endoscópico do sangramento digestivo. Após investigação dos diagnósticos diferenciais da hepatopatia crônica, diagnosticou-se shunt esplenorrenal espontâneo, e realizou-se biópsia hepática guiada por ecografia com diagnóstico de cirrose, espectro típico da DRPAR. Recebeu alta hospitalar assintomática e foi encaminhada para avaliação de transplante duplo.


Subject(s)
Humans , Female , Adolescent , Arteriovenous Anastomosis/pathology , Polycystic Kidney, Autosomal Recessive/complications , Caroli Disease/complications , Liver Cirrhosis/complications , Arteriovenous Anastomosis/diagnostic imaging , Referral and Consultation , Renal Veins/diagnostic imaging , Biopsy , Brazil , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Intensive Care Units, Pediatric , Treatment Outcome , Polycystic Kidney, Autosomal Recessive/drug therapy , Polycystic Kidney, Autosomal Recessive/diagnostic imaging , Caroli Disease/pathology , Caroli Disease/drug therapy , Magnetic Resonance Angiography , Adrenergic beta-Agonists/therapeutic use , Diuretics, Potassium Sparing/therapeutic use , Liver Cirrhosis/pathology , Liver Cirrhosis/drug therapy
7.
Arq. gastroenterol ; 55(4): 343-345, Oct.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-983844

ABSTRACT

ABSTRACT BACKGROUND: The infection for the hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality through its evolution to liver cirrhosis, end-stage liver complications and hepatocellular carcinoma. Currently, the new drugs for the HCV infection, based on direct antiviral agents, have changed the outcomes in this setting. OBJECTIVE: To assess death incidence, during the wait for the treatment with the new drugs, and to analyze which independent variable (age, sex, ascite, HDA, albumin, α-fetoprotein, platelets and Meld score) had relation with death. METHODS: Prospective study with cirrhotic patients by HCV. Inclusion: cirrhotic patients by hepatic biopsy (METAVIR), clinic or image, detectable RNA (HCV). Exclusion: Other stages of hepatic fibrosis and hepatocellular carcinoma. Descriptive statistic in continue variables. Fisher Exact and Kaplan Meier and Cox Regression Analysis to assess the association of variables studied with death. P<0.05. RESULTS: A total of 129 patients were included. Of this, 73% were men. Mean age was 57.8±12.1, albumin of 3.5±0.6 mg/dL, platelets of 123.4±59.6 and Meld score of 10.59±3.56. The time of observation was 11.2±3.26 months, and the number of death 9/129 (6,9%). The Kaplan-Meier showed association between death with albumin lower than 2.9 (0.0006), MELD score higher than 15 (0.007) and α-fetoprotein higher than 40 ng/mL (<0.0001). Adjusted Cox Regression Analysis showed that α-fetoprotein higher than 40 ng/ml could be considered an independent risk for death. CONCLUSION: We conclude that, patients with advanced cirrhosis should be prioritized for treatment with direct antiviral agents.


RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (VHC) é uma das principais causas de morbidade e mortalidade relacionada ao fígado, através de sua evolução para cirrose hepática, complicações hepáticas em estágio terminal e carcinoma hepatocelular. Atualmente, os novos fármacos para a infecção pelo VHC, baseados nos novos antivirais de ação direta (AADs), modificaram os resultados nesse cenário. OBJETIVO: Avaliar a incidência de morte, durante a espera pelo tratamento com as novas drogas, e analisar quais variáveis independentes (idade, sexo, ascite, HDA, albumina, α-fetoproteína, plaquetas e escore de MELD) tiveram relação com o óbito. MÉTODOS: Estudo prospectivo com pacientes cirróticos pelo VHC. Inclusão: pacientes cirróticos por biópsia hepática (METAVIR), clínica ou imagem, RNA detectável (VHC). Exclusão: Outras fases de fibrose hepática e carcinoma hepatocelular. Estatística descritiva em variáveis contínuas. Exato de Fisher e Kaplan Meier e Análise de Regressão de Cox para avaliar a associação das variáveis estudadas com o óbito. P<0,05. RESULTADOS: Um total de 129 pacientes foram incluídos. Destes, 73% eram homens. A idade média foi de 57,8±12,1, a albumina de 3,5±0,6 mg/dL, as plaquetas de 123,4±59,6 e o escore de MELD de 10,59±3,56. O tempo de observação foi de 11,2±3,26 meses e o número de mortes 9/129 (6,9%). O Kaplan-Meier mostrou associação entre o óbito com albumina menor que 2,9 (0,0006), escore MELD maior que 15 (0,007) e α-fetoproteína maior que 40 ng/mL (<0,0001). A análise de regressão de Cox ajustada mostrou que α-fetoproteína maior que 40 ng/mL poderia ser considerada um risco independente para morte. CONCLUSÃO: Concluímos que pacientes com cirrose avançada devem ser priorizados para tratamento com AADs.


Subject(s)
Humans , Male , Female , Antiviral Agents/therapeutic use , Waiting Lists , Liver Cirrhosis/mortality , Liver Cirrhosis/drug therapy , Incidence , Prospective Studies , Risk Factors , Hepacivirus , Hepatitis C, Chronic/complications , Liver Cirrhosis/etiology , Liver Cirrhosis/virology , Liver Neoplasms/mortality , Middle Aged
8.
Arq. gastroenterol ; 55(1): 28-32, Apr.-Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-888235

ABSTRACT

ABSTRACT BACKGROUND: Acid suppression has been associated with adverse events; such as, enteric infections. Proton pump inhibitors (PPI) are frequently prescribed in patients with cirrhosis, but is unclear if PPI are associated with the development of bacterial infections in these patients. OBJECTIVE: To assess the impact of PPI intake on the development of bacterial, viral and fungal infections in patients with cirrhosis. METHODS: An observational, retrospective, historic cohort study. The exposed cohort included patients with cirrhosis with chronic use of PPI. The non-exposed cohort had not been using PPI. The follow-up period was 3 years, searching in the medical records for any events of bacterial infection confirmed by bacteriological culture. RESULTS: One hundred and thirteen patients met the selection criteria, 44 (39%) had chronic use of PPI; of them, 28 (63.6%) patients had not a clear clinical indication to justify the prescription of PPI. Twenty four (21.2%) patients developed bacterial infections during the follow-up period. In the univariate analysis, decompensated cirrhosis (Child B/C), presence of ascites, history of variceal bleeding, and chronic consumption of PPI were risk factors related to the development of infections. But, in the adjusted multivariate analysis only the chronic use of PPI was associated with development of infections (RR=3.6; 95% CI=1.1-12.3; P=0.04). CONCLUSION: There is an over-prescription of PPI without a justified clinical indication. The long-term consumption of PPI in patients with cirrhosis is associated with the development of bacterial infections; therefore these drugs must be carefully prescribed in this specific population.


RESUMO CONTEXTO: A supressão de ácido tem sido associada a efeitos adversos, tais como infecções entéricas. Inibidores da bomba protônica são frequentemente prescritos em pacientes com cirrose, mas não está claro se o inibidor de bomba de próton (IBP) está associado ao desenvolvimento de infecções bacterianas nesses pacientes. OBJETIVO: Avaliar o impacto da ingestão de IBP no desenvolvimento de infecção bacteriana, viral e fúngica em pacientes com cirrose. MÉTODOS: Foi realizado estudo de coorte observacional, retrospectivo, histórico. A coorte exposta incluiu pacientes com cirrose e com uso crônico de IBP. A coorte de não expostos não estava usando IBP. O período de seguimento foi de 3 anos, procurando-se nos registros médicos qualquer evento de infecção bacteriana, confirmada pela cultura bacteriológica. RESULTADOS: Cento e treze pacientes preencheram os critérios de seleção, 44 (39%) pacientes faziam uso crônico de IBP; deles, 28 (63,6%) não tinham uma indicação clínica clara para justificar a prescrição de IBP. Vinte e quatro (21,2%) pacientes desenvolveram infecções bacterianas durante o período de seguimento. Na análise univariada, cirrose descompensada (Child B/C), presença de ascite, história de hemorragia varicosa e consumo crônico de IBP foram fatores de risco relacionados ao desenvolvimento de infecções. Porém, na análise multivariada ajustada, somente o uso crônico de IBP foi associado ao desenvolvimento de infecções (RR=3,6; 95% CI = 1.1-12.3; P=0,04). CONCLUSÃO: Há uma prescrição excessiva de PPI sem uma indicação clínica justificada. O consumo de longo prazo do IBP em pacientes com cirrose é associado ao desenvolvimento de infecções bacterianas. Portanto, essas drogas devem ser cuidadosamente prescritas nesta população específica.


Subject(s)
Humans , Male , Female , Aged , Bacterial Infections/etiology , Proton Pump Inhibitors/adverse effects , Liver Cirrhosis/drug therapy , Drug Prescriptions/statistics & numerical data , Retrospective Studies , Risk Factors , Analysis of Variance , Follow-Up Studies , Risk Assessment , Inappropriate Prescribing/statistics & numerical data , Liver Cirrhosis/microbiology , Middle Aged
9.
Rev. cuba. plantas med ; 22(1)ene.-mar. 2017. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-901496

ABSTRACT

Introducción: las plantas medicinales han sido utilizadas con fines terapéuticos desde tiempos antiguos sobre diversas enfermedades, en este sentido, se han reportado por la medicina tradicional una gran variedad de plantas con actividad gastrointestinal y efecto hepatoprotector. Las plantas utilizadas en este estudio fueron Bidens odorata Cav. L., Tecoma stans L., Equisetum hyemale L., Rosmarinus officinalis L., Cynaya scolymus L., Peumus boldus L. y Linum usitatissimum L. Objetivo: demostrar el efecto hepatoprotector de una mezcla de siete plantas (EHAM7) en ratas cirróticas inducidas con tetracloruro de carbono (CCl4). Métodos: se utilizaron las semillas de L. usitatissimum y las hojas y flores secas del resto de las plantas. Se formaron grupos de ratas control y ratas cirróticas con y sin tratamiento con la mezcla. A los animales cirróticos se les indujo el daño hepático intraperitonealmente con 0,2 mL de una mezcla de CCl4 y aceite mineral. Por otra parte, se les administraron oralmente 200 mg/kg del EHAM 7 re-suspendido en solución salina durante una semana y posteriormente cada tercer día durante ocho semanas. Los animales fueron sacrificados y se determinó el perfil hepático (transaminasas, bilirrubina y proteínas) y lipídico (triglicéridos, colesterol y lipoproteínas) en muestras de suero sanguíneo; el hígado se utilizó para los estudios histológicos. Resultados: el EHAM7 mostró efecto hepatoprotector en los animales cirróticos sobre los parámetros séricos correspondientes al perfil hepático y al perfil lipídico, lo cual se correlaciona con las características histológicas del hígado. Conclusión: el EHAM7 presenta efecto hepatoprotector en ratas cirróticas inducidas con CCl4, debido a que dicha mezcla presenta compuestos polifenólicos con actividad antioxidante(AU


Introduction: Medicinal plants have been used for therapeutic purposes against a great variety of diseases since ancient times. A large number of plants with gastrointestinal activity and hepatoprotective effect have been used in traditional medicine. The plants examined in the present study were Bidens odorata Cav. L., Tecoma stans L., Equisetum hyemale L., Rosmarinus officinalis L., Cynaya scolymus L., Peumus boldus L. and Linum usitatissimum L. Objective: Demonstrate the hepatoprotective effect of a mixture of seven plants (EHAM7) in carbon tetrachloride (CCl4) induced cirrhotic rats. Methods: The study used seeds of L. usitatissimum and dry flowers and leaves of the remaining plants. Groups were formed of control and cirrhotic rats with and without treatment with the mixture. Hepatic damage was induced intraperitoneally into the cirrhotic animals with 0.2 ml of a mixture of CCl4 and mineral oil. The rats were also administered 200 mg/kg EHAM7 resuspended in saline solution orally during a week and then every third day during eight weeks. The animals were sacrificed and determination was made of the hepatic profile (transaminases, bilirubin and proteins) and lipid profile (triglycerides, cholesterol and lipoproteins) in blood serum samples. The liver was preserved for histological examination. Results: EHAM7 was found to have an hepatoprotective effect on the serum parameters corresponding to the hepatic and lipid profiles of cirrhotic animals, which correlates with the histological characteristics of the liver. Conclusion: EHAM7 has a hepatoprotective effect in CCl4 induced cirrhotic rats, since the mixture contains polyphenolic compounds with antioxidant activity(AU)


Subject(s)
Animals , Plants, Medicinal , Carbon Tetrachloride , Hepatoprotector Drugs , Liver Cirrhosis/drug therapy
10.
Ann. hepatol ; 16(1): 86-93, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838090

ABSTRACT

Abstract: Background and aims. Pegylated interferon (Peg-INF) and ribavirin (RBV) based therapy is suboptimal and poorly tolerated. We evaluated the safety, tolerability and efficacy of a 24-week course of sofosbuvir plus daclatasvir without ribavirin for the treatment of hepatitis C virus (HCV) recurrence after liver transplantation (LT) in both HCV-monoinfected and human immunodeficiency virus (HIV)-HCV coinfected patients. Material and methods. We retrospectively evaluated 22 consecutive adult LT recipients (16 monoinfected and 6 coinfected with HIV) who received a 24-week course of sofosbuvir plus daclatasvir treatment under an international compassionate access program. Results. Most patients were male (86%), with a median age of 58 years (r:58-81y). Median time from LT to treatment onset was 70 months (r: 20-116 m). HCV genotype 1b was the most frequent (45%), 55% had not responded to previous treatment with Peg-INF and RBV and 14% to regiments including first generation protease inhibitors. Fifty-six percent of the patients had histologically proven cirrhosis and 6 had ascites at baseline. All patients completed the 24-week treatment course without significant side effects except for one episode of severe bradicardya, with only minor adjustments in immunosuppressive treatment in some cases. Viral suppression was very rapid with undetectable HCV-RNA in all patients at 12 weeks. All 22 patients achieved a sustained virological response 12 weeks after treatment completion. Conclusion. The combination of sofosbuvir plus daclatasvir without ribavirin is a safe and effective treatment of HCV recurrence after LT in both monoinfected and HIV-coinfected patients, including those with decompensated cirrhosis.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Antiviral Agents/administration & dosage , HIV Infections/virology , Liver Transplantation/adverse effects , Hepatitis C/drug therapy , Hepacivirus/drug effects , End Stage Liver Disease/surgery , Coinfection , Sofosbuvir/administration & dosage , Imidazoles/administration & dosage , Liver Cirrhosis/drug therapy , Antiviral Agents/adverse effects , Recurrence , Time Factors , Virus Activation , RNA, Viral/genetics , Drug Administration Schedule , HIV Infections/diagnosis , Retrospective Studies , Treatment Outcome , Hepatitis C/diagnosis , Hepatitis C/virology , Hepacivirus/genetics , Hepacivirus/pathogenicity , Viral Load , Drug Therapy, Combination , Compassionate Use Trials , End Stage Liver Disease/diagnosis , End Stage Liver Disease/virology , Sofosbuvir/adverse effects , Imidazoles/adverse effects , Immunosuppressive Agents/administration & dosage , Liver Cirrhosis/diagnosis , Liver Cirrhosis/virology
11.
Ann. hepatol ; 16(1): 48-56, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838085

ABSTRACT

Abstract: Liver fibrosis resulting from chronic liver injury are major causes of morbidity and mortality worldwide. Among causes of hepatic fibrosis, viral infection is most common (hepatitis B and C). In addition, obesity rates worldwide have accelerated the risk of liver injury due to nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Also liver fibrosis is associated with the consumption of alcohol, or autoimmune hepatitis and chronic cholangiophaties. The response of hepatocytes to inflammation plays a decisive role in the physiopathology of hepatic fibrosis, which involves the recruitment of both pro- and anti-inflammatory cells such as monocytes and macrophages. As well as the production of other cytokines and chemokines, which increase the stimulus of hepatic stellate cells by activating proinflammatory cells. The aim of this review is to identify the therapeutic options available for the treatment of the liver fibrosis, enabling the prevention of progression when is detected in time.


Subject(s)
Humans , Animals , Liver Cirrhosis/drug therapy , Anti-Inflammatory Agents/therapeutic use , Time Factors , Signal Transduction/drug effects , Cell Communication/drug effects , Cytokines/metabolism , Treatment Outcome , Inflammation Mediators/metabolism , Disease Progression , Hepatocytes/drug effects , Hepatocytes/metabolism , Hepatocytes/pathology , Hepatic Stellate Cells/drug effects , Hepatic Stellate Cells/metabolism , Hepatic Stellate Cells/pathology , Liver/drug effects , Liver/metabolism , Liver/pathology , Liver Cirrhosis/etiology , Liver Cirrhosis/metabolism , Liver Cirrhosis/mortality , Anti-Inflammatory Agents/adverse effects
12.
Rev. Assoc. Med. Bras. (1992) ; 62(3): 243-247, May-June 2016. tab, graf
Article in English | LILACS | ID: lil-784316

ABSTRACT

SUMMARY Introduction: Hepatic encephalopathy (HE) is a bad prognostic factor in patients with liver cirrhosis and its incidence is associated with several triggering factors being the most prevalent gastrointestinal bleeding. Lactulose, despite its questionable efficacy in the literature, is considered a first line treatment in patients with HE. Objective: To evaluate the effectiveness of lactulose in preventing HE in cirrhotic patients with gastrointestinal bleeding. Method: A systematic review of the literature using the Medline scientific database. Only randomized controlled clinical trials evaluating the efficacy of lactulose for HE prophylaxis in cirrhotic patients with gastrointestinal bleeding were included. Results: The incidence of HE in the intervention group was 7%, while the control group was 26% (p=0.01). There was no significant difference in the incidence of mortality in the group treated with lactulose compared to the group that was not treated (p=0.48). Conclusion: Administering lactulose to cirrhotic patients with upper gastrointestinal bleeding reduces the incidence of hepatic encephalopathy.


RSUMO Introdução: encefalopatia hepática (EH) é fator de mau prognóstico no paciente com cirrose hepática e sua incidência está associada a vários fatores desencadeantes, sendo a hemorragia digestiva o mais prevalente. A lactulose, apesar de apresentar eficácia discutível na literatura, é considerada tratamento de primeira linha em pacientes com EH. Objetivo: avaliar a eficácia da lactulose na prevenção de EH em pacientes cirróticos apresentando hemorragia digestiva. Método: realizou-se revisão sistemática da literatura pela base de dados Medline. Foram incluídos apenas ensaios clínicos controlados e randomizados que avaliaram a eficácia da lactulose na profilaxia de EH em pacientes cirróticos com hemorragia digestiva. Resultados: a incidência de EH no grupo intervenção foi de 7% enquanto no grupo controle foi de 26% (p=0,01). Não houve diferença significante na incidência de mortalidade entre o grupo que recebeu lactulose e o que não recebeu (p=0,48). Conclusão: a administração de lactulose em pacientes cirróticos apresentando hemorragia digestiva alta diminui a incidência de encefalopatia hepática.


Subject(s)
Humans , Male , Female , Gastrointestinal Agents/therapeutic use , Hepatic Encephalopathy/prevention & control , Gastrointestinal Hemorrhage/drug therapy , Lactulose/therapeutic use , Liver Cirrhosis/drug therapy , Randomized Controlled Trials as Topic , Hepatic Encephalopathy/mortality , Reproducibility of Results , Treatment Outcome , Gastrointestinal Hemorrhage/mortality , Liver Cirrhosis/mortality
13.
Gastroenterol. latinoam ; 27(supl.1): S64-s68, 2016. ilus
Article in Spanish | LILACS | ID: biblio-907657

ABSTRACT

Hepatitis C virus infection is one of the main causes of liver disease affecting more than 180 million of people worldwide. In Chile it affects approximately 50,000 individuals. Chronic infection usually occurs with a long time of symptomless inflammation which defines a high risk of cirrhosis, hepatocellular carcinoma and liver transplantation. Effective antiviral therapy, defined as sustained virologic response (SVR) improves the prognosis of the infected subject. Current treatment regimens with direct acting antivirals have achieved high rates of therapeutic efficacy (SVR > 90 percent in different groups) with an appropriate safety profile. The addition of ribavirin increases the antiviral effect and reduces the duration of therapy. Cirrhotic patients are at greatest risk for developing complications, particularly liver cancer, and they have priority for treatment indication. Classically, cirrhotic show lower rates of effectiveness and high risk of adverse effects, but with the new antivirals, these patients can achieve high recovery rates. Therapy improves liver function and further decreases the viral reinfection after liver transplantation, so cirrhotic patients in the waiting list should be treated unless they have contraindications or high risk of side effects. Effective therapy is also associated with lower risk of developing hepatocellular carcinoma, but cirrhotic patients should keep vigilance programs despite effective treatment.


La infección crónica por virus de la hepatitis C es una de las principales causas de enfermedad hepática a nivel mundial, afectando a más de 180 millones de personas. En Chile, se estima que existen unos 50.000 infectados. La infección habitualmente cursa con largos períodos de inflamación asintomática que determinan un alto riesgo de desarrollo de cirrosis, carcinoma hepatocelular y trasplante hepático. La terapia antiviral efectiva, definida como respuesta viral sostenida (RVS) mejora el pronóstico global de los infectados. Los esquemas terapéuticos actuales, con antivirales de acción directa, han logrado altas tasas de eficacia terapéutica (RVS > 90 por ciento en la mayoría de los grupos) con un adecuado perfil de seguridad. El uso de ribavirina ha logrado potenciar el efecto antiviral y reducir la duración de la terapia. Los pacientes cirróticos son un grupo de mayor riesgo para el desarrollo de complicaciones, particularmente hepatocarcinoma, por lo que tienen prioridad para la indicación de tratamiento. Clásicamente, los cirróticos han tenido menores tasas de efectividad y alto riesgo de efectos adversos, pero con los nuevos antivirales, estos pacientes pueden lograr altas tasas de curación. La terapia mejora la función hepática y adicionalmente disminuye la reinfección viral post trasplante hepático, por lo que todos los cirróticos deberían tratarse pre trasplante, a menos que tengan contraindicaciones o alto riesgo de efectos adversos. La terapia efectiva también se asocia a menor riesgo de desarrollo de hepatocarcinoma, pero los pacientes cirróticos deben mantenerse en programas de seguimiento a pesar de un tratamiento efectivo.


Subject(s)
Humans , Antiviral Agents/therapeutic use , Hepatitis C/complications , Hepatitis C/drug therapy , Liver Cirrhosis/complications , Liver Cirrhosis/drug therapy , Carcinoma, Hepatocellular/prevention & control , Liver Neoplasms/prevention & control , Ribavirin/therapeutic use
15.
Recife; s.n; 2015. 68 p. ilus, graf.
Thesis in Portuguese | LILACS | ID: lil-772861

ABSTRACT

As lesões crônicas do fígado são resultantes de agressões persistentes, onde a desorganização e destruição do tecido podem desencadear processos de regeneração e fibrose. Para que a integridade e homeostase do órgão sejam restauradas, várias vias intracelulares e intercelulares são ativadas. Uma delas é a através da liberação de moléculas pró-fibrogênicas, a exemplo da lectina solúvel bgalactosídea, a galectina-3 (Gal-3). A alta expressão dessa lectina tem sido associada a fibrogênese no fígado. A descoberta de moléculas capazes de se ligar à Gal-3 e inibir a sua ação são importantes no desenvolvimento de terapias antifibrosantes. A pectina cítrica modificada (PCM) e a N-acetilactosamina (LacNAc) demonstraram ação benéfica no tratamento de doenças fibróticas, incluindo renais e cardíacas, contudo, pouco se sabe sobre suas eficácias na fibrose hepática. Diante disso, o objetivo deste estudo foi investigar os efeitos das administrações da PCM e LacNAc quanto aos níveis de Gal-3 e fibrose em modelo experimental de lesão hepática crônica. Inicialmente, a fibrose hepática foi induzida em camundongos C57BL/6 pela administração de tetracloreto de carbono a 20 por cento diluído em azeite de oliva. Grupos de camundongos com dois ou quatro meses de lesão foram tratados com PCM (1 por cento e 5 por cento, fornecida ad libitum) e com LacNAc, por via intraperitoneal. Adicionalmente, camundongos knockouts para o gene da Gal-3 (Gal-3-/-) foram utilizados como um controle. Subsequentemente às intervenções, análises morfométricas, bioquímicas, imunológicas e de biologia molecular foram realizadas. Na análise morfométrica, não se verificou alteração no percentual de tecido fibroso entre os grupos tratados com PCM...


Subject(s)
Humans , Animals , Mice , Liver Cirrhosis/drug therapy , /antagonists & inhibitors , Pectins/administration & dosage , Pectins/therapeutic use , Amino Sugars , Chronic Disease
16.
Rev. bras. enferm ; 67(5): 692-699, Sep-Oct/2014. tab
Article in Portuguese | LILACS, BDENF | ID: lil-731217

ABSTRACT

Estudo prospectivo, tipo coorte que visou identificar a influência da sobrecarga de trabalho da Enfermagem na ocorrência de incidentes sem lesão e eventos adversos em 399 pacientes internados em Unidades de Terapia Intensiva (UTI). Para coleta de dados, foi aplicado um questionário estruturado e feita análise de prontuários. Nessas admissões, aproximadamente 78% dos incidentes sem lesão e eventos adversos em pacientes foram relacionados à esfera da Enfermagem. Essas ocorrências foram atribuídas à sobrecarga de trabalho, aumentaram o número de dias de internação e o risco de óbito dos pacientes estudados. É fundamental que os gerentes de enfermagem atuem no processo de gestão de pessoas no âmbito hospitalar, evitando a sobrecarga de trabalho e proporcionando, consequentemente, aumento da segurança do paciente.


This prospective cohort study aimed to identify the influence of nursing work overload on the occurrence of incidents without injury and adverse events in 399 patients hospitalized in Intensive Care Units (ICU). For data collection, a structured questionnaire was administered and an analysis of medical records was performed. In these admissions, approximately 78% of incidents without injury and adverse events in patients were related to the sphere of Nursing. These occurrences were attributed to overwork, increased the number of days of hospitalization and the risk of death of patients. It is essential that nursing managers work on the staff hospital management avoiding work overload to contribute for patient safety.


Estudio de cohorte prospectivo que tuvo como objetivo identificar la influencia de la carga de trabajo de enfermería en la ocurrencia de incidentes sin lesión y los eventos adversos en 399 pacientes ingresados en Unidades de Cuidados Intensivos (UCI). Para la recolección de datos, se administró un cuestionario estructurado y realizó el análisis de los registros en prontuarios. En estos ingresos, aproximadamente el 78% de los incidentes sin lesión y los eventos adversos en los pacientes estaban relacionados con el ámbito de la Enfermería. Estos hechos fueron atribuidos al exceso de trabajo, aumentaran el número de días de hospitalización y el riesgo de muerte de los pacientes. Es esencial que los responsables de enfermería que actúan en el proceso de gestión de las personas en los hospitales, eviten el exceso de trabajo y por lo tanto proporcionar una mayor seguridad de los pacientes.


Subject(s)
Animals , Rats , Drugs, Chinese Herbal/pharmacology , Hepatocytes/drug effects , Apoptosis/drug effects , Caspases/metabolism , Cell Division/drug effects , Cell Line , Enzyme Activation/drug effects , Hepatocytes/cytology , Liver Cirrhosis/drug therapy , Phytotherapy , Salvia miltiorrhiza
17.
Rev. bras. enferm ; 67(5): 684-691, Sep-Oct/2014. tab
Article in Portuguese | LILACS, BDENF | ID: lil-731208

ABSTRACT

Embora o trabalho seja essencial à vida humana, o contexto no qual é realizado pode desencadear tensão, desajuste e consequente adoecimento. Estudos apontam a Enfermagem como uma ocupação com alto risco para adoecimento, em especial no ambiente hospitalar. O objetivo deste estudo foi estimar a ocorrência de agravos à saúde referidos pelos trabalhadores de enfermagem em um hospital na Bahia. Estudo de corte transversal envolvendo 309 profissionais. As queixas de saúde mais frequentes relacionaram-se a sintomas osteomusculares como dor nas pernas 66,4% (192) e dor nas costas 61,8% (178); e à saúde mental com predomínio de cansaço mental 47% (131) e nervosismo 33,7% (93). Os resultados apontam que enfermeiros apresentaram maior frequência de agravos posturais e queixas de saúde mental enquanto as queixas de agravos respiratórios foram mais prevalentes entre técnicos e auxiliares. Estes resultados evidenciam necessidade de maior consciência do processo de trabalho e realização de atividades preventivas.


Although the work is essential to human life, the context in which it is done can induct tension, imbalance and consequent illness. Studies indicate nursing as an occupation with high risk for disease, particularly in the hospital environment. The aim of this study was to estimate the occurrence of health problems reported by nursing staff in a hospital in Bahia, Brazil. This is a cross-sectional study, involving 309 nursing professionals. The most frequent health complaints were related to musculoskeletal symptoms such as leg pain 66.4% (192) and back pain 61.8% (178); and to mental health with a predominance of mental fatigue 47% (131) 33 and nervousness 7% (93). The results show that nurses had a higher frequency of postural problems and mental health complaints while respiratory diseases complaints were more prevalent among technicians and assistants. These results highlight the need for greater awareness of the work process and implementation of preventive activities.


Aunque el trabajo es esencial para la vida humana, el contexto en el que se realiza puede desencadenar tensión, desequilibrio y enfermedad consecuente. Los estudios muestran la enfermería como una profesión de alto riesgo para la enfermedad, sobre todo en el medio hospitalario. El objetivo de este estudio fue estimar la incidencia de problemas de salud reportados por el personal de enfermería en un hospital de Bahia, Brasil. Trata-se de un estudio transversal con 309 profesionales. Los problemas de salud más frecuentes relacionadas con los síntomas musculo esqueléticos, como el dolor de pierna 66.4% (192) y el dolor de espalda 61,8% (178) y la salud mental, con un predominio de la fatiga mental 47% (131) 33 y el nerviosismo 7% (93). Los resultados muestran que las enfermeras tenían una mayor frecuencia de problemas de postura y quejas de salud mental mientras que las quejas de las enfermedades respiratorias son más frecuentes entre los técnicos y auxiliares. Estos resultados ponen de relieve la necesidad de una mayor conciencia sobre el proceso de trabajo y la ejecución de las actividades preventivas.


Subject(s)
Animals , Rats , Drugs, Chinese Herbal/pharmacology , Hepatocytes/cytology , Hepatocytes/drug effects , Apoptosis/drug effects , Cell Line , Cell Division/drug effects , Liver Cirrhosis/drug therapy , Liver Cirrhosis/pathology , Phytotherapy
18.
Braz. j. med. biol. res ; 47(8): 655-661, 08/2014. tab, graf
Article in English | LILACS | ID: lil-716268

ABSTRACT

Immune response plays an important role in the development of hepatic fibrosis. In the present study, we investigated the effects of quercetin on hepatitis and hepatic fibrosis induced by immunological mechanism. In the acute hepatitis model, quercetin (2.5 mg/kg) was injected iv into mice 30 min after concanavalin A (Con A) challenge. Mice were sacrificed 4 or 24 h after Con A injection, and aminotransferase tests and histopathological sections were performed. Treatment with quercetin significantly decreased the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Consistent with this observation, treatment with quercetin markedly attenuated the pathologic changes in the liver. A hepatic fibrosis model was also generated in mice by Con A challenge once a week for 6 consecutive weeks. Mice in the experimental group were treated with daily iv injections of quercetin (0.5 mg/kg). Histopathological analyses revealed that treatment with quercetin markedly decreased collagen deposition, pseudolobuli development, and hepatic stellate cells activation. We also examined the effects of quercetin on the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and transforming growth factor beta (TGF-β) pathways by immunohistochemistry and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). NF-κB and TGF-β production was decreased after treatment with quercetin, indicating that the antifibrotic effect of quercetin is associated with its ability to modulate NF-κB and TGF-β production. These results suggest that quercetin may be an effective therapeutic strategy in the treatment of patients with liver damage and fibrosis.


Subject(s)
Animals , Female , Antioxidants/administration & dosage , Hepatitis/drug therapy , Liver Cirrhosis/drug therapy , Quercetin/pharmacology , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Concanavalin A , Collagen/analysis , Disease Models, Animal , Hepatic Stellate Cells/drug effects , Hepatic Stellate Cells/metabolism , Liposomes , Liver Cirrhosis/chemically induced , Mice, Inbred BALB C , Mitogens , NF-kappa B/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Transforming Growth Factor beta/metabolism
19.
Rev. Assoc. Med. Bras. (1992) ; 60(1): 29-34, Jan-Feb/2014. tab
Article in English | LILACS | ID: lil-710318

ABSTRACT

Objective To evaluate risk factors related to Hepatitis C treatment interruption. Methods Retrospective cohort of patients seen at the Hepatology outpatient service at Hospital dos Servidores do Estado do Rio de Janeiro, from 2001 to 2009. The factors investigated were: age, gender, genotype, degree of liver fibrosis, type of treatment, treatment time in weeks, diabetes mellitus, and systemic hypertension. Survival curves and bivariate and multivariate Cox regression models were used in the analyses. Results The risk of treatment interruption is six times greater in patients with more advanced degrees of liver fibrosis (F4) compared to those with less advanced degree (F2) in the period from 0 to 24 weeks of treatment. Genotype was found to be an important factor to explain therapy cessation after 24 weeks of treatment – the risk of stopping treatment was 2.5 times higher in patients with genotype 3 than in those with genotype 1. Conclusion Degree of liver fibrosis and genotype proved to be the main risk factors associated to treatment interruption. .


Objetivo avaliar os fatores de risco relacionados à interrupção do tratamento da hepatite C. Métodos coorte histórica dos pacientes atendidos no ambulatório de Hepatologia do Hospital dos Servidores do Estado do Rio de Janeiro, de 2001 a 2009. Os fatores investigados foram: idade, sexo, genótipo, grau de fibrose hepática, tipo de tratamento, tempo de tratamento em emanas, diabetes mellitus e hipertensão arterial sistêmica. Curvas de sobrevida e modelos de regressão Cox bivariados e multivariados foram utilizados nas análises. Resultados o risco de interrupção do tratamento é seis vezes maior em pacientes com o grau mais avançado de fibrose hepática (F4) do que naqueles com grau menos avançado (F2), no período de 0 a 24 semanas de ratamento. O genótipo mostrou ser importante fator para explicar a suspensão do tratamento a partir da 24ª semana de tratamento – o risco de interromper o tratamento foi 2,5 vezes maior em pacientes com genótipo 3 do que os com genótipo 1. Conclusão o grau de fibrose hepática e o genótipo mostraram-se os principais fatores de risco associados à interrupção do tratamento. .


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antiviral Agents/therapeutic use , Hepacivirus/genetics , Hepatitis C/drug therapy , Interferon-alpha/therapeutic use , Patient Compliance , Ribavirin/therapeutic use , Ambulatory Care , Brazil , Cohort Studies , Drug Therapy, Combination , Genotype , Hepatitis C/pathology , Liver Cirrhosis/drug therapy , Liver Cirrhosis/pathology , Retrospective Studies , Risk Factors
20.
Rev. Soc. Bras. Med. Trop ; 46(4): 472-477, Jul-Aug/2013. tab, graf
Article in English | LILACS | ID: lil-683328

ABSTRACT

Introduction This study evaluates the factors associated with the development of severe periportal fibrosis in patients with Schistosoma mansoni. Methods A cross-sectional study was conducted from April to December 2012 involving 178 patients infected with S. mansoni who were treated in the Hospital das Clínicas of Pernambuco, Brazil. Information regarding risk factors was obtained using a questionnaire. Based on the patients' epidemiological history, clinical examination, and upper abdomen ultrasound evaluation, patients were divided into 2 groups: 137 with evidence of severe periportal fibrosis and 41 patients without fibrosis or with mild or moderate periportal fibrosis. Univariate and multivariate analyses were conducted using EpiInfo software version 3.5.5. Results Illiterate individuals (30.1%) and patients who had more frequent contact with contaminated water in towns in the Zona da Mata of Pernambuco (33.2%) were at greater risk for severe periportal fibrosis. Based on multivariate analysis, it was determined that an education level of up to 11 years of study and specific prior treatment for schistosomiasis were preventive factors for severe periportal fibrosis. Conclusions The prevailing sites of the severe forms of periportal fibrosis are still within the Zona da Mata of Pernambuco, although there has been an expansion to urban areas and the state coast. Specific treatment and an increased level of education were identified as protective factors, indicating the need for implementing social, sanitary, and health education interventions aimed at schistosomiasis to combat the risk factors for this major public health problem. .


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Young Adult , Educational Status , Liver Cirrhosis/drug therapy , Portal Vein/parasitology , Schistosomiasis mansoni/drug therapy , Splenic Diseases/drug therapy , Analysis of Variance , Brazil , Case-Control Studies , Cross-Sectional Studies , Liver Cirrhosis/parasitology , Liver Cirrhosis , Portal Vein/ultrastructure , Severity of Illness Index , Schistosomiasis mansoni , Splenic Diseases/parasitology , Splenic Diseases
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