Manifestaciones cutáneas comunes de las principales enfermedades hepáticas / Common cutaneous manifestations of major liver diseases

Las enfermedades hepáticas presentan múltiples manifestaciones sistémicas, entre las cuales se destacan los hallazgos en piel, siendo los más comunes el prurito y la ictericia; así mismo, se pueden encontrar angiomas en araña, eritema palmar, xantomas, vasculitis y cambios en anexos. Este artículo tiene como objetivo describir los principales signos y síntomas cutáneos en las enfermedades hepáticas para brindar herramientas semiológicas al clínico en su práctica diaria

Liver disease present multiple systemic manifestations, among which skin findings stand out, being the most common pruritus and jaundice. Other findings can also be manifested like spider angiomas, palmar erythema, xanthomas, vasculitis and changes in skin appendages. The objective of this article is to describe the main skin signs and symptoms of liver diseases to provide semiological tools to the physician in his daily practice.

Aspects that facilitate access to care for viral hepatitis: An evaluative research

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

Clinicopathological comparison of intrahepatic cholangiocarcinoma with and without viral hepatitis / 中华普通外科杂志

Objective:To analyze the different clinicopathological features of intrahepatic cholangiocarcinoma with and without viral hepatitis.Methods:The clinicopathological data of 79 intrahepatic cholangiocarcinoma cases from Mar 2012 to Sep 2018 at Henan Provincial People's Hospital were retrospectively analyzed.Results:Twenty-five of the 79 patients with intrahepatic cholangiocarcinoma were accompanied by viral hepatitis. Those with viral hepatitis had a lower mean age at onset than those without [(53±11) years vs. (60±11) years, P=0.011], higher proportion of male patients (80% vs. 52%, P=0.017), higher AFP positive rate (40% vs. 19%, P=0.041), lower CA19-9 positive rate (48% vs. 72%, P=0.036), tend to occur in the right liver lobe (76% vs. 44%, P=0.009), a lower rate of bile duct invasion (16% vs. 41%, P=0.03), and were more likely to be mass type (mass type proportion 96% vs. 72%, P=0.032). Conclusions:Viral hepatitis is common in intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma with and without viral hepatitis differ in clinicopathology. Intrahepatic cholangiocarcinoma with viral hepatitis is more likely to have the characteristics of hepatocellular carcinoma, while intrahepatic cholangiocarcinoma without viral hepatitis is more likely to have the characteristics of cholangiocarcinoma.

Retrospective investigation on the normal range of serum alanine aminotransferase levels in healthy adults in Ningbo area / 中华传染病杂志

Objective:To reevaluate the upper limit of normal (ULN) of serum alanine aminotransferase (ALT) by retrospectively analyzing the ALT levels in healthy people in Ningbo area.Methods:A total of 56 140 people who underwent health examination and detection of liver biochemical indexes in the Affiliated Hospital of Medical School of Ningbo University and Yinzhou Huamao Hospital of Ningbo from 2018 to 2020 were enrolled. After excluding relevant factors that may lead to liver injury, 11 411 people were included to compare the difference of serum ALT levels among different genders and age groups (20 to 29 years, 30 to 39 years, 40 to 49 years and 50 to 59 years) to determine the ALT ULN in different gender groups. Statistical methods were performed using two independent samples t test and analysis of variance. Results:The serum ALT of males was (19.20±7.90) U/L, which was higher than that of females ((13.75±6.17) U/L), with statistical significance ( t=41.16, P<0.001). The serum ALT ULN in males and in females were 35 U/L and 26 U/L, respectively. The serum ALT levels of 20 to 29, 30 to 39, 40 to 49 and 50 to 59 years old groups were (15.48±7.61) U/L, (16.21±7.40) U/L, (17.36±7.52) U/L and (18.77±7.57) U/L, respectively.The difference was statistically significant ( F=71.51, P<0.001). Serum ALT level in 50 to 59 years old group was higher than that in 20 to 29 years old group, and the difference was statistically significant ( t=13.11, P<0.01). In males, the ALT ULN of 20 to 29 years old was the lowest of 34.43 U/L, and highest of 35.29 U/L in 40 to 49 years old. In females, the ALT ULN in the 20 to 29 years old group was the lowest of 23.01 U/L, and the ALT ULN in the 50 to 59 years old group was the highest of 30.79 U/L. ALT ULN increased with age in females. The serum ALT of males was higher than that of females in all age groups ( t=29.55, 26.91, 13.43 and 4.62, respectively, all P<0.05). Conclusions:The serum ALT level is significantly correlated to gender and age. The serum ALT ULNs of healthy adult are 35 U/L in males and 26 U/L in females in Ningbo area.

Efficacy of transjugular intrahepatic portosystemic shunt in treatment of primary biliary cholangitis with portal hypertension / 临床肝胆病杂志

Objective To investigate the long-term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of primary biliary cholangitis (PBC) with portal hypertension. Methods A retrospective analysis was performed for 102 patients who received TIPS in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2015 to August 2021, and these patients were divided into PBC group with 41 patients and viral hepatitis cirrhosis group with 81 patients. Related indicators were collected, including routine blood test results, liver and renal function, coagulation function, portal vein thrombosis, hepatic encephalopathy, and etiology of TIPS treatment shortly after admission, preoperative portal venous pressure, and stents used in surgery, and Child-Pugh score was calculated. Follow-up data were collected and analyzed, including postoperative upper gastrointestinal rebleeding, stent dysfunction, hepatic encephalopathy, and the data on survival and prognosis. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for survival difference analysis. Results In the PBC group and the viral hepatitis cirrhosis group, the median percentage of reduction in portal venous pressure after surgery was 33.00% and 35.00%, respectively, and there was no significant difference between the two groups ( P > 0.05). At the end of follow-up, there were no significant differences between the PBC group and the viral hepatitis cirrhosis group in stent dysfunction rate (14.63% vs 24.69%, χ 2 =1.642, P > 0.05), upper gastrointestinal rebleeding rate (17.07% vs 24.69%, χ 2 =0.917, P > 0.05), the incidence rate of overt hepatic encephalopathy (12.20% vs 7.41%, χ 2 =0.289, P > 0.05), and disease-specific death rate (14.63% vs 9.88%, χ 2 =0.229, P > 0.05). Conclusion For PBC patients with portal hypertension, TIPS can achieve the same efficacy as the treatment of portal hypertension caused by viral hepatitis cirrhosis and can also effectively reduce portal hypertension without increasing the incidence rate of complications and disease-specific death rate. Therefore, it is a safe and effective treatment method.

Research advances in cytomegalovirus hepatitis / 临床肝胆病杂志

Cytomegalovirus hepatitis is a liver disease caused by human cytomegalovirus infection and is one of the most common liver diseases in children and immunocompromised individuals. This disease has no specific clinical manifestations and is easily confused with other types of viral hepatitis, which may lead to delayed treatment or mistreatment. Therefore, the early diagnosis of cytomegalovirus hepatitis is of vital importance, and patients should be given timely and effective treatment with appropriately selected antiviral drugs and course of treatment. This article reviews the recent research advances in the etiology, epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of cytomegalovirus hepatitis.

Aspectos que fragilizam o acesso das pessoas com hepatites virais aos serviços de saúde / Aspectos que debilitan el acceso de la persona com hepatitis virales a la atención em servicios de salud / Aspects that weaken access of people with viral hepatitis to healthcare services

Resumo Objetivo analisar os aspectos que fragilizam o acesso à atenção às hepatites virais. Método pesquisa avaliativa, desenvolvida no Estado de Mato Grosso, com os gestores da Secretaria de Estado de Saúde e os profissionais dos serviços de referência. Para a coleta de dados realizaram-se entrevistas, utilizou-se a Análise de Conteúdo, na vertente temática e, para a discussão as dimensões do modelo de análise de acesso universal aos serviços de saúde. Resultados a dimensão política apresenta pouca participação da gestão federal e estadual na proposição de diretrizes, coordenação e pactuação. Na dimensão econômico-social o baixo investimento na rede pública e a dificuldade de fixação de profissionais especialistas. Na dimensão organizacional a regulação do acesso, da assistência e a logística do tratamento sofrem com as barreiras geográficas, além do baixo uso do monitoramento e a avaliação. Na dimensão técnica a pouca formação profissional e a ausência de projeto compartilhado em rede. Na dimensão simbólica os fatores culturais, de crença, valores e subjetividade interferem no acesso. Conclusão e implicações para a prática os resultados colaboram para direcionar ações de enfrentamento, almejando alcançar as metas pactuadas para a Agenda 2030.

Resumen Objetivo analizar los aspectos que debilitan el acceso a la atención a las hepatitis virales. Método investigación evaluativa, desarrollada en el Estado de Mato Grosso, con los gestores del Departamento de Salud del Estado y los profesionales de los servicios de referencia. Para la recolección de datos fueron realizadas entrevistas, se utilizó el Análisis de Contenido, en el aspecto temático, y para discutir las dimensiones del modelo de análisis de acceso universal a los servicios de salud. Resultados la dimensión política presenta poca participación de la administración federal y estatal en la propuesta de lineamientos, coordinación y acuerdo. En la dimensión económico-social la baja inversión en la red pública y dificultad para fijar profesionales especializados. En la dimensión organizacional, la regulación de la logística de acceso, asistencia y tratamiento sufren con las barreras geográficas, además del bajo uso de monitoreo y evaluación. En la dimensión técnica poca formación y ausencia de proyecto compartido en red. En la dimensión simbólica los factores culturales, la creencia, los valores y la subjetividad interfieren en el acceso. Conclusión e implicaciones para la práctica los hallazgos colaboran para reflejar las acciones de afrontamiento destinadas a alcanzar los objetivos acordados para la Agenda 2030.

Abstract Objective to analyze the aspects that weaken the access to viral hepatitis care. Method evaluative research, developed in the State of Mato Grosso, with managers of the State Health Department and professionals from reference services. For data collection, interviews were conducted. Content analysis was used in a theme-based approach and, for the discussion, the dimensions of the analysis model of universal access to health services. Results The political dimension presents little participation of federal and state management in the proposition of guidelines, coordination, and pacts. In the economic-social dimension, the low investment in the public network and the difficulty in hiring specialist professionals were identified. In the organizational dimension, the regulation of access, assistance, and the logistics of treatment suffers from geographic barriers, besides the low use of monitoring and evaluation. In the technical dimension, the little professional training and the absence of a shared network project were noticed. In the symbolic dimension, cultural factors, beliefs, values, and subjectivity interfere with access. Conclusion and implications for the practice the results collaborate to direct confrontation actions, aiming to reach the goals agreed upon for the 2030 Agenda

Tendência dos casos notificados de hepatites virais no estado de mato grosso - brasil / Trend of viral hepatitis cases notified in the state of mato grosso - brazil / Tendencia de los casos notificados de hepatitis viral en el estado de mato grosso, brasil

RESUMO Objetivo: analisar as tendências temporais dos casos notificados de hepatites virais em Mato Grosso - BR, no período de 2010 a 2019. Método: estudo epidemiológico do tipo ecológico, com coleta de dados no Sistema de Informação de Agravos de Notificação. Para análise da tendência temporal foi realizada transformação logarítmica dos coeficientes e procedimento de Prais-Winsten para análise de regressão linear generalizada. Resultados: foram registrados 9.043 casos de hepatites virais: hepatites A (13,62%), B (67,19%), C (18,07%), D (0,49%) e ausência de registros hepatite E. Houve maior prevalência de casos notificados em 2014 (12,36%) e menor em 2018 (8,16%). A hepatite C (IC95% 2,5; 3,4) foi a única com tendência crescente, enquanto A (IC95% -4,8; -4,6), B (IC95% -0,9; -1,2) e D (IC95% -0,2; -3,9) apresentaram tendência decrescente. Conclusão: conclui-se que é imprescindível a continuidade e melhoria das ações de enfrentamento para eliminação desses agravos no estado em face de suas tendências e incidência.

ABSTRACT Objective: to analyze the time trends of viral hepatitis cases notified from 2010 to 2019 in Mato Grosso - BR. Method: an epidemiological study of the ecological type, with data collection in the Notifiable Diseases Information System. For the analysis of the time trend, a logarithmic transformation of the coefficients and the Prais-Winsten procedure for generalized linear regression analysis were performed. Results: 9,043 viral hepatitis cases were recorded: Hepatitis A (13.62%), Hepatitis B (67.19%), Hepatitis C (18.07%) and Hepatitis D (0.49%), with no Hepatitis E records. The prevalence of cases notified was higher in 2014 (12.36%) and lower in 2018 (8.16%). Hepatitis C (95% CI: 2.5; 3.4) was the only one with an increasing trend, while Hepatitis A (95% CI: -4.8; -4.6), Hepatitis B (95% CI: -0.9; -1.2) and Hepatitis D (95% CI:-0.2; -3.9) presented a decreasing trend. Conclusion: in view of their trends and incidence, it is concluded that it is indispensable to continue and improve coping actions to eradicate these diseases in the state.

RESUMEN Objetivo: analizar las tendencias temporales de los casos notificados de hepatitis viral en Mato Grosso, Brasil, de 2010 a 2019. Método: estudio epidemiológico de tipo ecológico, con recolección de datos en el Sistema de Información de Enfermedades de Información Obligatoria. Para el análisis de tendencia temporal se realizó una transformación logarítmica de los coeficientes y el procedimiento de Prais-Winsten para el análisis de regresión lineal generalizada. Resultados: se registraron 9.043 casos de hepatitis viral: hepatitis A (13,62%), B (67,19%), C (18,07%), D (0,49%) y ningún registro de hepatitis E. Hubo mayor prevalencia de casos notificados en 2014 (12,36%) y menor en 2018 (8,16%). La hepatitis C (IC 95% 2,5; 3,4) fue la única con tendencia creciente, mientras que la A (IC 95% -4,8; -4,6), B (IC 95% -0,9; -1,2) y D (IC 95% - 0.2; -3.9) mostraron una tendencia decreciente. Conclusión: es fundamental continuar y mejorar las acciones de afrontamiento para eliminar estas enfermedades en el estado, dadas las tendencias e incidencia que tienen.

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis / Mortalidade por hepatites no Brasil e regiões, 2001-2020: tendência temporal e análise espacial

ABSTRACT Objective: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. Methods: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). Results: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was −8.11% per year (95%CI −9.38; −6.82), while for Hepatitis B it was −4.13% (95%CI −6.03; −2.20), of Other viral hepatitis of −7.84% (95%CI −14.11; −1.11) and of Unspecified Hepatitis −5.67% per year (95%CI −6.22; −5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). Conclusion: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

RESUMO Objetivo: Analisar a distribuição espacial e a tendência temporal da taxa de mortalidade por hepatites no Brasil no período de 2001 a 2020. Métodos: Estudo ecológico, temporal e espacial sobre a mortalidade por hepatites no Brasil com dados do Sistema de Informações sobre Mortalidade (SIM/Datasus). As informações foram estratificadas por ano do diagnóstico, região do país, municípios (de residência). Foram calculadas as taxas padronizadas de mortalidade (TPM). A tendência temporal foi estimada pela regressão de Prais-Winsten e a distribuição espacial pelo Índice Global de Moran (IGM). Resultados: As maiores médias da TPM no Brasil foram para hepatite viral crônica, com 0,88 mortes para cada 100 mil habitantes (desvio padrão — DP=0,16), seguida de outras hepatites virais, com 0,22/100 mil (DP=0,11). No Brasil, a tendência temporal da mortalidade por hepatite A foi de −8,11% ao ano (intervalo de confiança de 95% — IC95% −9,38; −6,82), enquanto por hepatite B foi de −4,13% (IC95% −6,03; −2,20); de outras hepatites virais, foi de −7,84% (IC95% −14,11; −1,11) e de hepatite não especificada, de −5,67% ao ano (IC95% −6,22; −5,10). A mortalidade por hepatite viral crônica cresceu 5,74% (IC95%3,47; 8,06) no norte e 4,95% no nordeste (IC95% 0,27; 9,85). O Índice de Moran (I) para hepatite A foi de 0,470 (p<0,001), para hepatite B de 0,846 (p<0,001), hepatite viral crônica=0,666 (p<0,001), outras hepatites virais=0,713 (p<0,001) e hepatites não especificadas=0,712 (p<0,001). Conclusão: A tendência temporal das hepatites A, B, de outras hepatites virais e das não especificadas foi de diminuição no Brasil, enquanto a mortalidade por hepatites crônicas foi de crescimento nas Regiões Norte e Nordeste.

Brazilian registry for the elimination of hepatitis C in dialysis units: a call to action for Nephrology / Registro brasileiro para eliminação da hepatite C nas unidades de diálise: um chamado para a Nefrologia

Abstract Infection by the hepatitis C virus is more prevalent in patients on dialysis than in the general population in Brazil, and has been associated with worse outcomes. Current therapy for hepatitis C is highly effective, safe, and widely available in Brazil, with coverage provided to dialysis patients with chronic kidney disease, which makes the elimination of hepatitis C a viable target. The Brazilian Society of Nephrology, the Brazilian Society of Hepatology, and the Brazilian Liver Institute developed the "Brazilian Registry for the Elimination of Hepatitis C in Dialysis Units". This project aims to identify, treat, and monitor the response to treatment of patients on chronic dialysis infected with the hepatitis C virus in Brazil. This article presents the issue and invites Brazilian nephrologists to rally around the achievement of a significant goal.

Resumo A infecção pelo vírus da hepatite C é mais prevalente em pacientes em diálise do que na população geral no Brasil e implica um pior prognóstico. O tratamento atual para hepatite C é altamente eficaz, seguro e disponível no país, inclusive para a população de pacientes crônicos em diálise, o que torna a eliminação do vírus da hepatite C uma meta viável. A Sociedade Brasileira de Nefrologia, a Sociedade Brasileira de Hepatologia e o Instituto Brasileiro do Fígado desenvolveram o "Registro Brasileiro para Eliminação da Hepatite C nas Unidades de Diálise". O projeto visa identificar pacientes em diálise crônica com vírus da hepatite C no Brasil, além de tratar e monitorar a resposta virológica após o tratamento. Este breve artigo apresenta o problema e convida os nefrologistas brasileiros a unirem forças nesse objetivo comum.

Safety and efficacy of metabolic surgery in patients with viral hepatitis cirrhosis / 中华普通外科杂志

Objective:To investigate the safety and efficacy of metabolic surgery in obese and type 2 diabetes patients with viral hepatitis cirrhosis.Methods:The data of 8 patients with viral hepatitis cirrhosis undergoing metabolic surgery at Department of General Surgery ,Beijing Tiantan Hospital, Capital Medical University from Aug 2012 to Dec 2021 were retrospectively analyzed.Results:Among the 8 patients, 2 underwent laparoscopic Roux-en-Y gastric bypass and 6 underwent laparoscopic sleeve gastrectomy. The Child-Pugh classification of all patients before operation was classified as Grade A. The operation process was successful with no complications such as ascites, bleeding , digestive tract and gastric leakage or obstruction during the perioperative period. There was no abnormal liver function and decompensation during the median 2.5 year's (3 month to 8 years) follow-up period. The weight loss after the operation was obvious, when 1 year after operation, percentage of excess weight loss (EWL%)>54.78% and the surgery was also conducive to the control of blood glucose in diabetes patients.Conclusion:Metabolic surgery is safe and feasible for obese and type 2 diabetes patients with viral hepatitis cirrhosis.

Research advances in glucose and lipid metabolism disorders in different types of chronic liver diseases / 临床肝胆病杂志

The liver is an important metabolic organ in the body. Studies have shown that chronic liver disease is closely associated with glucose and lipid metabolism disorders, and different types of liver diseases often show different characteristics of glucose and lipid metabolism. This article reviews the epidemiological characteristics, disease severity, pathogenesis, and treatment methods of glucose and lipid metabolism disorders in different types of chronic liver diseases, so as to improve the awareness among clinicians.

Research advances in sodium taurocholate cotransporting polypeptide in hepatobiliary diseases / 临床肝胆病杂志

Sodium taurocholate cotransporting polypeptide (NTCP) is not only an important transporter for bile acid absorption into the liver, but also a functional receptor for HBV and HDV, and extensive studies have been performed for its structure, function, gene characteristics, and expression and regulation mechanisms. NTCP is also associated with chronic viral hepatitis, nonalcoholic fatty liver disease, liver fibrosis, primary biliary cholangitis, and hepatocellular carcinoma. This article elaborates on the role of NTCP in various hepatobiliary diseases, so as to provide new direction for the diagnosis and treatment of related diseases.

Viral hepatitis caused by occupational accidents: distribution of cases in Brazil, 2007-2014 / Hepatites virais por acidentes de trabalho: distribuição dos casos no Brasil, 2007-2014 / Hepatitis viral por accidentes de trabajo: distribución de casos en Brasil, 2007-2014

Background and Objectives: to analyze the distribution of cases of viral hepatitis due to occupational accidents in Brazil from 2007 to 2014. Methods: this is an ecological study of a descriptive nature of notifications of viral hepatitis registered in the Information System for Notifiable Diseases. Results: they point out that the mean incidence of viral hepatitis due to occupational accidents in Brazil was 2 cases/1,000,000 of the economically active and employed population. There was an increasing trend in the Midwest region (p=0.02), among women (p=0.01) and those aged 38 to 49 years and 50 and older (p=0.01). The decreasing time trend was observed among those up to 37 years old and for non-black race/skin color (p=0.04). Conclusion: the temporal distribution was stationary in most regions and states in Brazil, increasing among female workers over 38 years old and decreasing among non-black women and under 37 years old.(AU)

Justificativa e Objetivos: analisar a distribuição dos casos de hepatites virais por acidentes de trabalho no Brasil de 2007 a 2014. Métodos: trata-se de um estudo ecológico de natureza descritiva das notificações de hepatites virais registradas no Sistema de Informação de Agravos de Notificação. Resultados: apontam que a incidência média de hepatites virais por acidentes de trabalho no Brasil foi de 2 casos/1.000.000 da população economicamente ativa e ocupada. Houve tendência de aumento na região Centro-Oeste (p=0,02), entre as mulheres (p=0,01) e entre 38 a 49 anos e 50 anos ou mais (p=0,01). A tendência temporal decrescente foi observada entre aqueles com até 37 anos e para raça/cor da pele não preta (p=0,04). Conclusão: a distribuição temporal foi estacionária na maioria das regiões e estados do Brasil, aumentando entre as trabalhadoras acima de 38 anos e diminuindo entre as mulheres não negras e com menos de 37 anos.(AU)

Justificación y Objetivos: analizar la distribución de los casos de hepatitis viral por accidentes de trabajo en Brasil de 2007 a 2014. Métodos: se trata de un estudio ecológico de carácter descriptivo de las notificaciones de hepatitis viral registradas en el Sistema de Información de Enfermedades de Declaración Obligatoria. Resultados: señalan que la incidencia media de hepatitis viral por accidente de trabajo en Brasil fue de 2 casos/1.000.000 de población económicamente activa y ocupada. Hubo una tendencia creciente en la región del Medio Oeste (p=0,02), entre las mujeres (p=0,01) y las de 38 a 49 años y 50 y más (p=0,01). La tendencia temporal decreciente se observó entre los de hasta 37 años y para raza/color de piel no negra (p=0,04). Conclusión: la distribución temporal fue estacionaria en la mayoría de las regiones y estados de Brasil, aumentando entre las trabajadoras mayores de 38 años y disminuyendo entre las mujeres no negras y menores de 37 años.(AU)

Algunas consideraciones sobre las hepatitis virales crónicas como problema de salud / Some considerations on the chronic viral hepatitis as a health problem

Introducción: Hoy día, las enfermedades infecciosas constituyen una de las causas de muerte más frecuentes, de ahí que la actual epidemia de hepatitis es un problema de salud a escala mundial. Las hepatitis B y C se propagan por medio del contacto con la sangre, el semen u otro líquido corporal de una persona infectada. Objetivo: Actualizar algunos elementos sobre las hepatitis virales crónicas como un problema de salud. Desarrollo: Se analizan aspectos de las hepatitis virales crónicas relacionados con las estadísticas globales, regionales y locales; también se abordan los indicadores de impacto, la epidemiología, las características de los virus y las formas de trasmisión. Conclusiones: Esta problemática se ha convertido en un grave problema de salud en todo el orbe y Cuba no está exenta de esta situación. El principal eslabón para prevenir y reducir el número de pacientes y la trasmisión de estas enfermedades es la atención primaria, donde el trabajo educativo y preventivo que se desarrolla en la comunidad es fundamental.

Introduction: Nowadays, infectious diseases constitute one of the most frequent causes of death, with the result that current hepatitis epidemic is a health problem worldwide. The hepatitis B and C are spread by means of the blood contact, semen or another body fluid of an infected person. Objective: To update some elements on the chronic viral hepatitis as a health problem. Development: Some aspects of the chronic viral hepatitis related to the global, regional and local statistics are analysed; the impact indicators, epidemiology, characteristics of the virus and the ways of transmission are also approached. Conclusions: This question has become a serious health problem worldwide and Cuba is not exempt of this situation. The main link to prevent and reduce the number of patients and the transmission of these diseases is the primary health care, where the educational and preventive work that is developed in the community is fundamental.

Caracterización de pacientes con Hepatitis C en el servicio de hemodiálisis. Cienfuegos 2019 / Characterization of patients with hepatients with hepatitis c in the hemodialysis service.Cienfuegos 2019

RESUMEN Fundamento: La infección por el virus de la Hepatitis C ha sido reconocida como problema de salud a nivel mundial. Objetivo: Determinar las características de los pacientes con Hepatitis C que reciben tratamiento en el servicio de hemodiálisis del Centro Especializado Ambulatorio de Cienfuegos, en el periodo de enero a agosto del 2019. Metodología Se realizó un estudio observacional, descriptivo, longitudinal retrospectivo con los 54 pacientes en hemodiálisis portadores de Hepatitis C. Las variables utilizadas fueron: edad, sexo, lugar de procedencia, tipo de acceso vascular y tiempo en tratamiento. Se utilizó como fuente de información la base de datos del Centro Provincial de Higiene, Epidemiología y Microbiología en Cienfuegos. Resultados: El mayor porcentaje de personas con Hepatitis C se concentró entre los 50 a 54 años; siendo la edad promedio 53 años, sobresalió el sexo masculino para un 84.93%, y predominó el municipio de Cienfuegos como lugar de residencia. En relación al tipo de acceso vascular, la fístula arterio -venosa aportó el 98.14%, mientras el tiempo de tratamiento que prevaleció fue de más de 3 años para un 77.8%. Conclusiones La Hepatitis C en el servicio de hemodiálisis mostró un comportamiento similar a lo descrito en la literatura.

ABSTRACT Background Infection by the hepatitis c virus has been recognized as a health problem worldwide. Objective: To determine the characteristics of patients with hepatitis C receiving treatment in the Hemodialysis Service of the Cienfuegos Specialized Outpatient Center from January 2019 to August 2019. Methodology An observational, descriptive, longitudinal retrospective study was carried out with the 54 Hemodialysis patients with Hepatitis C. The variables used were: age, sex, place of origin, type of vascular access and time in treatment. The database of the Provincial Center for Hygiene, Epidemiology and Microbiology in Cienfuegos was used as a source of information. Results The highest percentage of people with hepatitis C was concentrated between 50 to 54 years old; The average age being 53 years, the male sex stood out for the 84.93%, with the municipality of Cienfuegos predominating as the place of residence. Regarding the type of vascular access, the arterio-venous fistula contributed the 98.14%, while the treatment time that prevailed was more than 3 years for the 77.8%. Conclusions: Hepatitis C in the hemodialysis service showed a similar behavior as described in the literature.

Effect of aspirin on the incidence rate of liver cancer in patients with viral hepatitis: A Meta-analysis / 临床肝胆病杂志

ObjectiveTo evaluate the effect of the use of aspirin on the incidence rate of liver cancer in patients with viral hepatitis. MethodsEnglish databases including PubMed, Web of Science, and Cochrane Library were searched for studies on the use of aspirin and the incidence rate of liver cancer in patients with viral hepatitis published up to July 15, 2020. Hazard ratio (HR) and 95% confidence interval (CI) were selected as pooled indicators. RevMan 5.3 was used to perform the Meta-analysis, and a descriptive analysis was performed for data that could not be pooled. ResultsNine studies were included, involving 132 066 patients with viral hepatitis. The results showed that the incidence rate of liver cancer was reduced by 31% in the patients with viral hepatitis who were treated with aspirin (HR=069, 95% CI: 0.65-0.74, P＜0.000 01). Four studies reported the incidence rate of gastrointestinal bleeding, suggesting that the use of aspirin did not significantly increase the risk of gastrointestinal bleeding in patients with viral hepatitis(P＞0.05). ConclusionAspirin therapy may help to reduce the incidence rate of liver cancer in patients with viral hepatitis and does not significantly increase the risk of gastrointestinal bleeding in such patients and the patients with liver cirrhosis. Aspirin may have a positive significance in reducing liver cancer, but the mechanism behind this clinical phenomenon remains unclear, and therefore, more clinical observation studies are needed to verify its safety and efficacy.

Hepatitis aguda por virus C: reporte de siete casos en centro de referencia en Chile

Hepatitis C virus infection is a major global public health problem. Treatment with direct-acting antivirals is intended to eradicate the chronic form of this infection by 2030. Although uncommon, the acute form of presentation is increasingly recognized, especially in some high-risk populations, such as men who have sex with men without protection. Its virological and serological diagnosis is not standardized, so clinical suspicion is essential. Its early detection allows a timely treatment. We report seven cases of acute HCV hepatitis in a national reference center, its presentation, diagnosis and treatment. We discuss populations at risk and the change in therapeutics with the use of direct-acting antiviral drugs.

Serological markers of hepatitis B virus in indigenous populations from Amazonas state, Venezuela / Marcadores serológicos del virus de hepatitis b en pueblos indígenas del estado amazonas, venezuela

RESUMEN Venezuela presenta un nivel de prevalencia intermedia de Hepatitis B, con cuatro focos de alta endemicidad asociados principalmente a población indígena. Las prevalencias halladas en el Amazonas venezolano tienen distintas distribuciones entre los pueblos, observándose diferentes particularidades epidemiológicas. El objetivo del presente trabajo fue reportar la prevalencia de VHB en población indígena de diferentes pueblos y regiones geográficas del estado Amazonas, que no habían sido evaluados hasta la fecha, mediante la determinación de los marcadores serológicos: Antígeno de Superfìcie del Virus de Hepatitis B (AgsHB) y Anticuerpos Anticore (Anti-HBc). Se estudiaron 1390 individuos de 15 pueblos indígenas (Baniva, Baré, Curripaco, Jivi, Mapoyo, Maco, Piapoco, Piaroa, Puinave, Sáliba, Warekena, Yabarana, Yanomami, Yekuana, Yeral), resultando una prevalencia de exposición al Virus de 37,6 % (Anti-HBc), y una prevalencia de infección activa de 5,6 % (AgsHB). La prevalencia de exposición al virus es proporcional a la edad. No se encontró diferencia significativa en relación al sexo. La exposición al virus en el pueblo Sáliba fue significativamente menor al resto de los pueblos indígenas (p<0,001), y la observada en Yabarana, significativamente mayor (p<0,001). Se encontró una prevalencia de AgsHB significativamente mayor (p<0,01) en el pueblo indígena Yabarana. Se puede predecir que existe relación entre prevalencia de exposición al virus de hepatitis B y la distancia geográfica al centro urbano.

ABSTRACT Venezuela has a level of intermediate prevalence of Hepatitis B, with four foci of high endemicity associated mainly to indigenous population. The prevalence found in the Venezuelan Amazon have different distributions among the peoples, observing different epidemiological particularities. The aim of this study was to report the prevalence of Hepatitis B in the indigenous population of different geographical regions of the Amazonas State that have not yet been evaluated, by determining serological markers: HBV surface antigen (HBsAg) and HBV core antibody (Anti-HBc). Blood samples were tested from 1390 individuals from 15 indigenous populations (Baniva, Baré, Curripaco, Jivi, Mapoyo, Maco, Piapoco, Piaroa, Puinave, Sáliba, Warekena, Yabarana, Yanomami, Yekuana, Yeral. Prevalence of exposure to the virus (Anti-HBc) was 37.6 % and the prevalence of active infection (HBsAg) was 5.6 %. Prevalence of exposure to the virus was directly proportional to age. No significant difference was found in relation to sex. A significant difference was found in Sáliba people who show prevalences significantly smaller than the rest of the indigenous peoples (p<0.001), while the observed in Yabarana was significantly higher (p<0.001). A significantly higher prevalence of HBsAg was found in Yabarana people (p<0.001). It can be predicted that there is a relationship between prevalence of exposure to hepatitis B virus and geographic distance to urban centers.

Uso de servicios de salud y enfermedades transmisibles de la población migrante y refugiada venezolana / Use of health services and communicable diseases of the Venezuelan migrant and refugee population

Resumen Introducción: Colombia es el principal país receptor de población migrante venezolana. Esto ha implicado identificar las necesidades en salud de esta población, como la atención y tratamiento de enfermedades infecciosas. Objetivo: Analizar el uso de servicios de salud relacionados con VIH/SIDA, malaria y hepatitis virales en migrantes y refugiados venezolanos en Colombia durante 2018 y 2019. Metodología: Estudio de investigación mixto. Se desarrollaron 12 grupos focales con mujeres y hombres venezolanos y se realizó un análisis del uso de servicios de salud por diagnósticos de VIH/SIDA, malaria y hepatitis virales, durante 2018 y 2019, en seis ciudades con un alto flujo de migración: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta y Riohacha. Resultados: El uso de servicios de salud por enfermedades infecciosas en migrantes venezolanos aumentó de 2018 (n=1,519) a 2019 (n=3,988). Los hombres fueron los que más usaron los servicios de salud por estas enfermedades. Aun así, la situación irregular migratoria, deficiencias en la atención primaria y acceso limitado a protección y detección temprana de enfermedades transmisibles, constituyen las principales barreras para migrantes y refugiados respecto a la atención en salud. Conclusiones: La migración expone a las personas al riesgo de contraer enfermedades infecciosas, así como a desigualdades y exclusión social en el acceso a servicios de salud para el control y tratamiento de estas enfermedades. Por ello, en contextos de migración se debe fortalecer la equidad en los servicios de salud con el fin de asegurar el acceso de las personas a la atención primaria, insumos, pruebas diagnósticas y tratamiento de enfermedades infecciosas.

Abstract Introduction: Colombia is the main receiving country of the Venezuelan migrant population. This has involved identifying the health needs of this population, such as the care and treatment of infectious diseases. Objective: To analyze the use of health services related to HIV/AIDS, malaria and viral hepatitis in Venezuelan migrants and refugees in Colombia during 2018 and 2019. Methodology: Mixed research study. Twelve focus groups were held with Venezuelan women and men and an analysis was made of the use of health services for HIV/AIDS, malaria, and viral hepatitis diagnoses during 2018 and 2019 in six cities with a high migration flow: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta, and Riohacha. Results: The use of health services for infectious diseases among Venezuelan migrants increased from 2018 (n=1.519) to 2019 (n=3.988). Men were the greatest users of health services for these diseases. Even so, irregular migration status, deficiencies in primary care, and limited access to protection and early detection of communicable diseases are the main barriers to health care for migrants and refugees. Conclusions: Migration exposes people to the risk of infectious diseases, as well as to inequalities and social exclusion in access to health services for the control and treatment of these diseases. Therefore, in migration contexts, equity in health services should be strengthened by ensuring people's access to primary care, inputs, diagnostic tests and treatment of infectious diseases.