ABSTRACT
AIM: The present study aimed to identify variables associated with sarcopenia in cirrhotic outpatients using clinical data, anthropometric measures and lab tests. In a single centre prospective study, 261 cirrhotic outpatients were followed on average for 2 years. The diagnostic criteria of sarcopenia were applied according to the current guidelines, combining muscle strength and appendicular muscle mass index. METHODS: Age, sex, liver disease aetiology and the Model of End-Stage Liver Disease score were included as independent variables, as well as mid-arm circumference (MAC), body mass index and triceps skinfold. Multiple logistic regression was applied including all independent variables (maximum model). Then, the analysis was performed only with the variables that were significant in the first analysis (parsimonious model). Once the variable most related to sarcopenia was determined by the two models, the area under the receiver operator characteristic curve was calculated. Mortality rates were described for patients with and without sarcopenia. RESULTS: Sarcopenia was diagnosed in 14 subjects (5.36%), and the variable best associated with sarcopenia was MAC (P < 0.01). The 1-year mortality rate of 35.71% found among subjects with sarcopenia was not significantly higher (P = 0.07) than the 15.38% observed among those without this condition. CONCLUSIONS: Before examinations requiring ionising radiation, patients with cirrhosis can be submitted to simple screening tools to identify those who have a high risk of sarcopenia, thus promoting a cost-effective assessment.
Subject(s)
Liver Cirrhosis/complications , Outpatients , Sarcopenia/epidemiology , Anthropometry , Brazil/epidemiology , Female , Humans , Male , Middle Aged , Muscle Strength , Nutrition Assessment , Prospective Studies , Sarcopenia/complications , Sarcopenia/mortality , Severity of Illness IndexABSTRACT
Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.
ABSTRACT
A doença de Crohn é uma doença inflamatória intestinal crônica com inflamação transmural segmentar, que pode complicar com formação de fístulas e abscessos. A hidradenite supurativa (HS) é caracterizada por abscessos recorrentes e dolorosos, com predileção por áreas ricas em glândulas apócrinas como as regiões axilares, inguinais e perineal. O diagnóstico diferencial entre estas doenças é difícil e pode comprometer o tratamento. Relatamos o caso de C.R.M.A., 40 anos, feminina, branca, com doença de Crohn íleocolônica com fístula perianal e retovaginal há 12 anos, em terapia biológica desde maio 2010. Em setembro de 2010 apresentou abscesso em glúteo direito com saída de secreção purulenta refratária ao uso de ciprofloxacino e metronidazol. Ultrassonografia apresentando coleção de 30 cm3 em região glútea direita. A hipótese diagnóstica foi HS e a paciente foi submetida à ressecção cirúrgica em bloco (10 x 2 cm), com cicatrização por segunda intenção. Realizou enxerto de pele em dezembro de 2010 sem sucesso. Retornou em janeiro de 2011 com nova fístula no local da ressecção, compatível com doença de Crohn. Em fevereiro de 2011 foi submetida à drenagem dos abscessos e colocação de setons nas fístulas perianais. Atualmente em terapia biológica, com boa evolução das fístulas. A prevalência da HS varia de 0,3 a 4% da população em geral. A axila é a região mais afetada e as lesões perianais estão associadas com maior debilidade. Há relatos na literatura de associação entre a HS e a doença de Crohn de forma esporádica, e novos estudos são necessários para avaliar uma patogênese em comum. O diagnóstico diferencial deve ser realizado em todos os casos para tratamento imediato, evitando-se, assim, as complicações e a piora da qualidade de vida do doente.
Crohn?s disease is a chronic inflammatory bowel disease with segmental transmural inflammation, which complicate with formation of fistulas and abscesses. The hidradenitis suppurativa (HS) is characterized by recurrent abscesses, with a predilection for areas rich in apocrine glands such as the axillary, inguinal and perineal. The differential diagnosis between these diseases is difficult and may compromise treatment. Report case: C.R.M.A., 40 year-old, female, white, ileal and colonic Crohn?s disease complicated with perianal and rectovaginal fistula for 12 years, treated with biological therapy since May 2010. In Sep/2010 presented with an abscess in the buttock D with purulent discharge refractory to the use of ciprofloxacin and metronidazole. USG: collection of 30 cm3 in buttock D. The diagnosis was HS and the patient underwent extensive surgical removal of the affected areas (10 x 2 cm) with healing by secondary intention. Skin graft performed unsuccessfully in Dec/2010. The patient returned in jan/2011 with a new fistula at the site of resection, consistent with Crohn?s disease. In fev/2011 underwent drainage of abscesses and placement of setons in perianal fistulas. Currently in therapy with good biological evolution of fistulas. The prevalence of HS varies from 0.3 to 4% of the population in general. The axilla is the region most affected and perianal lesions are associated with greater weakness. There are published reports of association between HS and Crohn?s disease sporadically and further studies are needed to assess a common pathogenesis. The differential diagnosis should be performed in all cases planning immediate treatment, avoiding complications and worsening of the patient?s quality of life.
