A multisociety Delphi consensus statement on new fatty liver disease nomenclature.

The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms "nonalcoholic" and "fatty" were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease. There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction-associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol per week (140-350 g/wk and 210-420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and nonstigmatising, and can improve awareness and patient identification.

Women engaged in prostitution and COVID-19: why are they excluded from socially vulnerable groups?

This study analyzed the exposure of women engaged in prostitution in downtown São Paulo to COVID-19. This cross-sectional study had a convenience sample selected in May 2021. We interviewed 219, mostly black, middle-aged, poor women with comorbidities. Among them, 61 had shown COVID-19 symptoms, 23, tested positive for the disease, seven underwent hospitalization, and four reported post-COVID-19 complications. Only 26 (30.2%) had been vaccinated. In addition to gender, race, and class inequalities, these women suffer both from a higher risk of contracting COVID-19 due to their working conditions and from the subsequent worsening of that disease due to age and lack of vaccination.

Women engaged in prostitution and COVID-19: why are they excluded from socially vulnerable groups? / Mulheres em situação de prostituição e covid-19: por que excluídas dos grupos vulneráveis?

ABSTRACT This study analyzed the exposure of women engaged in prostitution in downtown São Paulo to COVID-19. This cross-sectional study had a convenience sample selected in May 2021. We interviewed 219, mostly black, middle-aged, poor women with comorbidities. Among them, 61 had shown COVID-19 symptoms, 23, tested positive for the disease, seven underwent hospitalization, and four reported post-COVID-19 complications. Only 26 (30.2%) had been vaccinated. In addition to gender, race, and class inequalities, these women suffer both from a higher risk of contracting COVID-19 due to their working conditions and from the subsequent worsening of that disease due to age and lack of vaccination.

RESUMO Esta pesquisa analisou a exposição de mulheres em situação de prostituição no centro de São Paulo à covid-19. Este estudo transversal contou com amostra de conveniência selecionada em maio de 2021. Entrevistou-se 219 mulheres majoritariamente negras, de meia idade, pobres e com comorbidades. Dentre essas mulheres, 61 tiveram sintomas de covid-19, 23 com teste positivo,7 foram internadas e 4 relataram complicações pós-covid-19. Somente 26 (30,2%) haviam sido vacinadas. Além das desigualdades de gênero, raça e classe, essas mulheres são expostas a um maior risco de contraírem covid-19, devido às condições de trabalho e por apresentarem doença grave relacionada à idade e falta de vacinação.

Biochar amendment improves degraded pasturelands in Brazil: environmental and cost-benefit analysis.

Most deforested lands in Brazil are occupied by low-productivity cattle ranching. Brazil is the second biggest meat producer worldwide and is projected to increase its agricultural output more than any other country. Biochar has been shown to improve soil properties and agricultural productivity when added to degraded soils, but these effects are context-dependent. The impact of biochar, fertilizer and inoculant on the productivity of forage grasses in Brazil (Brachiaria spp. and Panicum spp.) was investigated from environmental and socio-economic perspectives. We showed a 27% average increase in Brachiaria production over two years but no significant effects of amendment on Panicum yield. Biochar addition also increased the contents of macronutrients, soil pH and CEC. Each hectare amended with biochar saved 91 tonnes of CO2eq through land sparing effect, 13 tonnes of CO2eq sequestered in the soil, equating to U$455 in carbon payments. The costs of biochar production for smallholder farmers, mostly because of labour cost, outweighed the potential benefits of its use. Biochar is 617% more expensive than common fertilizers. Biochar could improve productivity of degraded pasturelands in Brazil if investments in efficient biochar production techniques are used and biochar is subsidized by low emission incentive schemes.

Alcohol-related liver disease: Clinical practice guidelines by the Latin American Association for the Study of the Liver (ALEH).

Alcohol-related liver disease (ALD) is a major cause of advanced chronic liver disease in Latin-America, although data on prevalence is limited. Public health policies aimed at reducing the alarming prevalence of alcohol use disorder in Latin-America should be implemented. ALD comprises a clinical-pathological spectrum that ranges from steatosis, steatohepatitis to advanced forms such as alcoholic hepatitis (AH), cirrhosis and hepatocellular carcinoma. Besides genetic factors, the amount of alcohol consumption is the most important risk factor for the development of ALD. Continuous consumption of more than 3 standard drinks per day in men and more than 2 drinks per day in women increases the risk of developing liver disease. The pathogenesis of ALD is only partially understood and recent translational studies have identified novel therapeutic targets. Early forms of ALD are often missed and most clinical attention is focused on AH, which is defined as an abrupt onset of jaundice and liver-related complications. In patients with potential confounding factors, a transjugular biopsy is recommended. The standard therapy for AH (i.e. prednisolone) has not evolved in the last decades yet promising new therapies (i.e. G-CSF, N-acetylcysteine) have been recently proposed. In both patients with early and severe ALD, prolonged abstinence is the most efficient therapeutic measure to decrease long-term morbidity and mortality. A multidisciplinary team including alcohol addiction specialists is recommended to manage patients with ALD. Liver transplantation should be considered in the management of patients with end-stage ALD that do not recover despite abstinence. In selected cases, increasing number of centers are proposing early transplantation for patients with severe AH not responding to medical therapy.

Autorregulação na aprendizagem: um estudo exploratório no ensino superior português / Self-regulated learning: an exploratory study in portuguese higher education / La autorregulación en el aprendizaje: un estudio exploratorio en la educación superior portuguesa

Este estudo avalia as qualidades psicométricas do Questionário de Autorregulação da Aprendizagem (QARA; Williams & Deci, 1996)e analisa diferenças em estudantes do ensino superior português. Participaram 171 adultos (147, 86,0% mulheres), com uma idade média de 24,70 anos (Min-Max:17-53; DP= 8,56), aos quais foi administrado o QARA, constituído por 12 itens que avaliam o grau de participação no curso de ensino superior, e as possíveis razões para esse envolvimento, de acordo com uma regulação controlada versus autónoma. A análise fatorial exploratória indica a existência de dois fatores que explicam 50% da variância total dos itens. Registram-se diferenças estatisticamente significativas em função do sexo na regulação controlada, e em função da idade na regulação autónoma e na regulação controlada. Não se verificam diferenças em função da média académica, da satisfação académica, ou da satisfação com a vida em geral. Retiram-se implicações para o aprofundamento desta linha de investigação.

This study assesses psychometric properties of the Self-Regulation Learning Questionnaire (SRLQ; Williams & Deci, 1996), and analyzes differences in Portuguese higher education students. 171 adults (147, 86.0 % women) participated, with a mean age of 24.70 years (Min-Max: 17-53, SD = 8.56), to which the SRLQ was administered, consisting of 12 items that assess the degree of participation in the higher education course, and the possible reasons for this involvement, according to autonomous vs controlled regulation. The exploratory factor analysis suggests the influence of two factors, which explain 50% of the items total variance. There were statistically significant differences by sex in the controlled regulation, and by age in the autonomous regulation and controlled regulation. There were no differences considering academic average, academic satisfaction or satisfaction with life in general. Implications are drawn for the advancement of this research area.

Este estudio evalúa las calidades psicométricas del Cuestionario de Autorregulación del Aprendizaje (CARA; Williams & Deci, 1996), y analiza las diferencias en los estudiantes de la educación superior portuguesa. Los participantes son 171 adultos (147, 86% mujeres), con edad promedio de 24 años (mín-máx: 17-53; SD = 8,56), a quién se administró el CARA, que consta de 12 ítems que evalúan el grado de participación en el curso de educación superior y las posibles razones para esta participación, de acuerdo con una regulación controlada vs. autónoma. El análisis factorial exploratorio indica que hay dos factores que explican 50% de la varianza total de los ítems. Se registran diferencias estadísticamente significativas por sexo en la regulación controlada, y por la edad en la regulación autónoma y regulación controlada. No hay ninguna diferencia en función de la media académica, la satisfacción académica o la satisfacción con la vida en general. Retiran se implicaciones para el futuro desarrollo de esta línea de investigación.

Identificação de necessidades de intervenção psicológica: um estudo-piloto no ensino superior português / Identification des besoins d’intervention psychologique: une étude pilote dans le cadre de l’enseignement supérieur portugais / Identificación de necesidades de intervención psicológica: estudio piloto en la educación superior portuguesa / Identification of psychological intervention needs: a pilot study in portuguese higher education

Este estudo analisa as necessidades de intervenção psicológica dos estudantes da Faculdade de Ciências Humanas da Universidade Católica Portuguesa. Participaram 157 alunos, avaliados nas suas preocupações e necessidades pessoais, de carreira e de aprendizagem, bem como nas preferências relativas ao apoio, por meio do questionário de identificação de necessidades de intervenção psicológica. Os resultados indicam necessidade de apoio nas áreas: (i) controlo de ansiedade e nervosismo, (ii) medo de falhar, (iii) estratégias de procura de emprego, (iv) escolha de uma carreira e (v) competências de gestão do tempo. Verifica-se uma preferência, no apoio pretendido, pelas modalidades de aconselhamento individual e cursos breves. Registram-se diferenças em função do sexo, da média no curso, da regularidade de contato com a família e dos níveis de satisfação acadêmica e satisfação global com a vida. Retiram-se implicações para a disponibilização de sistemas, estratégias e atividades de apoio psicológico que possam responder às preocupações dos estudantes.

Cette étude vise à explorer le besoin d’intervention psychologique des élèves qui fréquentent la Faculté des Sciences Humaines de l’Université Catholique Portugaise. Ont participé 157 étudiants lesquels ont été évalués sur leurs besoins et préoccupations personnelles, de carrière et d’apprentissage, ainsi que sur leur préférences concernant le support désiré et déjà reçu, à travers The Survey of Student Needs. Les résultats indiquent que les participants ont besoin de plus d’information et d’un appui dans les domaines suivants: (i) gérer l’anxiété et la nervosité, (ii) la peur de l’échec, (iii) les stratégies de recherche d’emploi, (iv) le choix d’une carrière, et (v) des compétences pour la gestion du temps. On remarque une préférence pour le conseil individuel et les cours de courte durée . On remarque des différences selon le sexe, le grade universitaire, la régularité du contact avec la famille et la satisfaction avec la vie universitaire et la vie en général. Les résultats évoquent la création des systèmes, stratégies et activités de soutien psychologique, qui puissent répondre à les différentes préoccupations des étudiants.

Este estudio tiene como objetivo explorar las necesidades de intervención psicológica de los estudiantes de la Facultad de Ciencias Humanas de la Universidad Católica Portuguesa. Participaron 157 estudiantes, se les evaluaron sus necesidades y preocupaciones, así como las preferencias relacionadas con el apoyo deseado y previamente recibido de la carrera y del aprendizaje, a través del cuestionario de identificación de las necesidades de intervención psicológica. Los resultados indican que los participantes necesitan más información o ayuda en las siguientes áreas: (i) manejo de la ansiedad y del nerviosismo, (ii) miedo al fracaso, (iii) estrategias de búsqueda de empleo, (iv) elección de una carrera y (v) habilidades de gestión del tiempo. Hay una preferencia por asesoramiento individual y cursos cortos. Existen diferencias en función del sexo, grado académico, regularidad de contacto con la familia y satisfacción con la vida académica y global. De los resultados provienen implicaciones para la disponibilidad de sistemas, estrategias y actividades de apoyo psicológico para que los estudiantes puedan contestar adecuadamente a sus diferentes intereses.

This study aims to explore the psychological intervention needs of the students attending the Faculty of Human Sciences of the Portuguese Catholic University. 157 students were evaluated on their personal, career and learning needs and concerns, as well as on their possible support preferences, through the questionnaire of identification of psychological intervention needs. The results indicate that participants need more information or support in the following areas: (i) management of anxiety and nervousness, (ii) fear of failure, (iii) job search, (iv) career choice and (v) time management skills. There is a preference for individual counseling and workshops. There are differences according to sex, academic grades, regularity of family contact and academic and global life satisfaction. Implications are drawn for the availability of systems, strategies and activities of psychological support for students that can respond appropriately to their different needs.

Projetos de vida em situações de vulnerabilidade social: uma formação para técnicos / Life projects in situations of social vulnerability: training for technicians / Proyectos de vida en situación de vulnerabilidad social: formación para técnicos

Apresenta-se um estudo de investigação-ação com técnicos da Santa Casa da Misericórdia de Lisboa-Portugal, que desenvolvem a sua atividade no âmbito da construção de projetos de vida com pessoas em situação de vulnerabilidade social. Descrevem-se as três etapas do estudo: 1. identificação de necessidades, expectativas e problemas dos formandos no exercício das suas funções, 2. desenvolvimento e implementação de uma ação formativa fundamentada, e 3. avaliação de fatores de (in)satisfação associados à sua implementação. Os resultados prévios indicam necessidades de atualização de conhecimentos, e os resultados finais indicam elevada satisfação com a formação recebida. Este estudo traz importantes contributos para o desenvolvimento de diretivas para formação destes técnicos face à especificidade dos destinatários da sua intervenção social e educativa.

A research-action study is presented with technicians from Santa Casa da Misericórdia in Lisbon-Portugal, who develop their activity in the construction of life projects with people in situations of social vulnerability. The three stages of the process are described: 1. identification of participants' needs, expectations and problems in the exercise of their functions, 2. development and implementation of reasoned formative action, and 3. evaluation factors of (in)satisfaction associated with its application. Previous results indicate knowledge updating needs and final results indicate high satisfaction with training. This study provides important contributions to the development of policies for the training of these technicians, given the specificity of the recipients of their social and educational intervention.

Se presenta un estudio de investigación-acción con técnicos de la Santa Casa da Misericórdia de Lisboa-Portugal, que desarrollan su actividad en el campo de la construcción de proyectos de vida con personas en situación de vulnerabilidad social. Se describen las tres etapas del estudio: 1. identificación de las necesidades, expectativas y problemas de los participantes en el ejercicio de sus funciones, 2. el desarrollo e implementación de una acción formativa fundamentada, y 3. evaluación de factores de (in)satisfacción asociada a su implementación. Los resultados previos indican necesidades de actualización de conocimientos y los resultados finales indican una alta satisfacción con la formación. Este estudio proporciona importantes contribuciones al desarrollo de políticas para la formación de estos técnicos, ante la especificidad de los destinatarios y de su intervención social y educativa.

Identificação de necessidades de intervenção psicológica: um estudo-piloto no ensino superior português / Identification des besoins d’intervention psychologique: une étude pilote dans le cadre de l’enseignement supérieur portugais / Identificación de necesidades de intervención psicológica: estudio piloto en la educación superior portuguesa

Este estudo analisa as necessidades de intervenção psicológica dos estudantes da Faculdade de Ciências Humanas da Universidade Católica Portuguesa. Participaram 157 alunos, avaliados nas suas preocupações e necessidades pessoais, de carreira e de aprendizagem, bem como nas preferências relativas ao apoio, por meio do questionário de identificação de necessidades de intervenção psicológica. Os resultados indicam necessidade de apoio nas áreas: (i) controlo de ansiedade e nervosismo, (ii) medo de falhar, (iii) estratégias de procura de emprego, (iv) escolha de uma carreira e (v) competências de gestão do tempo. Verifica-se uma preferência, no apoio pretendido, pelas modalidades de aconselhamento individual e cursos breves. Registram-se diferenças em função do sexo, da média no curso, da regularidade de contato com a família e dos níveis de satisfação acadêmica e satisfação global com a vida. Retiram-se implicações para a disponibilização de sistemas, estratégias e atividades de apoio psicológico que possam responder às preocupações dos estudantes. (AU)

Cette étude vise à explorer le besoin d’intervention psychologique des élèves qui fréquentent la Faculté des Sciences Humaines de l’Université Catholique Portugaise. Ont participé 157 étudiants lesquels ont été évalués sur leurs besoins et préoccupations personnelles, de carrière et d’apprentissage, ainsi que sur leur préférences concernant le support désiré et déjà reçu, à travers The Survey of Student Needs. Les résultats indiquent que les participants ont besoin de plus d’information et d’un appui dans les domaines suivants: (i) gérer l’anxiété et la nervosité, (ii) la peur de l’échec, (iii) les stratégies de recherche d’emploi, (iv) le choix d’une carrière, et (v) des compétences pour la gestion du temps. On remarque une préférence pour le conseil individuel et les cours de courte durée . On remarque des différences selon le sexe, le grade universitaire, la régularité du contact avec la famille et la satisfaction avec la vie universitaire et la vie en général. Les résultats évoquent la création des systèmes, stratégies et activités de soutien psychologique, qui puissent répondre à les différentes préoccupations des étudiants. (AU)

Este estudio tiene como objetivo explorar las necesidades de intervención psicológica de los estudiantes de la Facultad de Ciencias Humanas de la Universidad Católica Portuguesa. Participaron 157 estudiantes, se les evaluaron sus necesidades y preocupaciones, así como las preferencias relacionadas con el apoyo deseado y previamente recibido de la carrera y del aprendizaje, a través del cuestionario de identificación de las necesidades de intervención psicológica. Los resultados indican que los participantes necesitan más información o ayuda en las siguientes áreas: (i) manejo de la ansiedad y del nerviosismo, (ii) miedo al fracaso, (iii) estrategias de búsqueda de empleo, (iv) elección de una carrera y (v) habilidades de gestión del tiempo. Hay una preferencia por asesoramiento individual y cursos cortos. Existen diferencias en función del sexo, grado académico, regularidad de contacto con la familia y satisfacción con la vida académica y global. De los resultados provienen implicaciones para la disponibilidad de sistemas, estrategias y actividades de apoyo psicológico para que los estudiantes puedan contestar adecuadamente a sus diferentes intereses. (AU)

Genetic ancestry analysis in non-alcoholic fatty liver disease patients from Brazil and Portugal.

AIM: To study the association between genetic ancestry, non-alcoholic fatty liver disease (NAFLD) metabolic characteristics in two cohorts of patients, from Brazil and Portugal. METHODS: We included 131 subjects from Brazil [(n = 45 with simple steatosis (S. Steatosis) and n = 86 with nonalcoholic steatohepatitis (NASH)] and 90 patients from Portugal (n = 66, S. Steatosis; n = 24, NASH). All patients had biopsy-proven NAFLD. In histologic evaluation NAFLD activity score was used to assess histology and more than 5 points defined NASH in this study. Patients were divided into two groups according to histology diagnosis: simple steatosis or non-alcoholic statohepatitis. Genetic ancestry was assessed using real-time polymerase chain reaction. Seven ancestry informative markers (AT3-I/D, LPL, Sb19.3, APO, FY-Null, PV92, and CKMM) with the greatest ethnic-geographical differential frequencies (≥ 48%) were used to define genetic ancestry. Data were analyzed using R PROJECTS software. Ancestry allele frequencies between groups were analyzed by GENEPOP online and the estimation of genetic ancestry contribution was evaluated by ADMIX-95 software. The 5% alpha-error was considered as significant (P < 0.05). RESULTS: In the Brazilian sample, NASH was significantly more frequent among the elderly patients with diabetes (NASH 56 ± 1.1 years old vs S. Steatosis 51 ± 1.5 years old, P = 3.7 x 10(-9)), dyslipidemia (NASH 63% vs S. Steatosis 37%, P = 0.009), higher fasting glucose levels (NASH 124 ± 5.2 vs S. Steatosis 106 ± 5.3, P = 0.001) and Homeostatic Model of Assessment index > 2.5 [NASH 5.3 (70.8%) vs S. Steatosis 4.6 (29.2%) P = 0.04]. In the Portuguese study population, dyslipidemia was present in all patients with NASH (P = 0.03) and hypertension was present in a larger percentage of subjects in the S. Steatosis group (P = 0.003, respectively). The genetic ancestry contribution among Brazilian and Portuguese individuals with NASH was similar to those with S. Steatosis from each cohort (Brazilian cohort: P = 0.75; Portuguese cohort: P = 0.97). Nonetheless, the genetic ancestry contribution of the Brazilian and Portuguese population were different, and a greater European and Amerindian ancestry contribution was detected in the Portuguese population while a higher African genetic ancestry contribution was observed in Brazilian population of both NASH and S. Steatosis groups. CONCLUSION: There was no difference between the genetic ancestry contribution among Brazilian and Portuguese individuals with NASH and S. Steatosis from each cohort.

Increased frequency of CD4 and CD8 regulatory T cells in individuals under 15 years with multibacillary leprosy.

BACKGROUND: Leprosy is a chronic disease, caused by Mycobacterium leprae, which poses a serious public health problem worldwide. Its high incidence in people under 15 years old in Ceará state, Brazil, reflects the difficulty of its control. The spectrum of clinical manifestations is associated with the immune response developed, with the Th1 and Th2 responses being related to the paucibacillary and multibacillary forms, respectively. Regulatory T cells (Treg), which can suppress Th1 and Th2 response, have received special attention in the literature and have been associated with development of chronic infections. However, their role in leprosy in individuals under 15 years old has not yet been elucidated. We evaluated the frequency of CD4(+)/CD8(+)CD25(high)FOXP3(+) and CD4(+)/CD8(+)CD25(high)FOXP3(high) cells in leprosy patients and household contacts, in both cases under 15 years old. METHODOLOGY/PRINCIPAL FINDINGS: PBMC from 12 patients and 17 contacts were cultured for 72 hours with anti-CD3 and anti-CD28 (activators) or with activators associated with total sonicated fraction of M. leprae. After culture, the frequency of CD4(+)/CD8(+) Treg was identified by flow cytometry. Cells stimulated by activators and antigen from multibacillary patients showed Treg frequencies almost two times that of the contacts: CD4(+)FOXP3(+) (21.93±8.43 vs. 13.79±8.19%, p = 0.0500), CD4(+)FOXP3(high) (10.33±5.69 vs. 5.57±4.03%, p = 0.0362), CD8(+)FOXP3(+) (13.88±9.19 vs. 6.18±5.56%, p = 0.0230) and CD8(+)FOXP3(high) (5.36±4.17 vs. 2.23±2.68%, p = 0.0461). Furthermore, the mean fluorescence intensity of FOXP3 in Treg was higher in multibacillary patients than in the contacts. Interestingly, there was a positive correlation of the bacillary index and number of lesions with the frequency of all Treg evaluated in patients. CONCLUSIONS/SIGNIFICANCE: We have demonstrated for the first time that multibacillary leprosy patients under 15 years old have greater CD4(+) and CD8(+) Treg frequencies and these correlate with clinical and laboratorial aspects of disease. These findings suggest the involvement of these cells in the perpetuation of M. leprae infection.

Gut microbiota and nonalcoholic fatty liver disease.

 Recent evidence has linked obesity and the metabolic syndrome with gut dysbiota. The precise mechanisms underlying that association are not entirely understood; however, microbiota can enhance the extraction of energy from diet and regulate whole-body metabolism towards increased fatty acids uptake from adipose tissue and shift lipids metabolism from oxidation to de novo production. Obesity and high fat diet relate to a specific gut microbiota, which is enriched in Firmicutes and with less Bacterioidetes. Microbiota can also play a role in the development of hepatic steatosis, necroinflammation and fibrosis. In fact, some studies have shown an association between small intestinal bacterial overgrowth, increased intestinal permeability and nonalcoholic steatohepatitis (NASH). That association is, in part, due to increased endotoxinaemia and activation of the Toll-like receptor-4 signaling cascade. Preliminary data on probiotics suggest a potential role in NASH treatment, however randomized controlled clinical trials are still lacking.

Insulin resistance and steatosis in chronic hepatitis C.

In chronic hepatitis C, insulin resistance (IR) and type 2 diabetes mellitus (DM) are more prevalent than in healthy controls or in chronic hepatitis B patients. HCV infection promotes IR mainly through increased TNF-a and cytokine suppressor (SOCS-3) production. Both events inhibit insulin receptor and IRS-1 (insulin receptor substrate) tyrosine phosphorylation. Hepatic steatosis is also 2.5 fold more frequent in hepatitis C virus (HCV) infected patients as compared to the general population. Metabolic factors play a crucial role in the etiology of hepatic steatosis genotype non-3 related, which are also the genotypes with a greater association to IR. However, genotype 3, and particularly 3a, has a greater direct steatogenic capacity, and consequently, in those patients, the association with metabolic factors is weaker. Instead, in genotype 3, steatosis associates with viral factors like viral load. Those metabolic factors influence not only the natural history of HCV infection, as well as associate to an accelerated hepatic fibrosis progression, to a worse prognosis when hepatic cirrhosis is present, namely an increased risk of hepatocellular carcinoma, and to a lower sustained viral response rate. On the other hand, in patients who achieve viral eradication, IR and hepatic steatosis may regress, and return if viral infection recurs, which once again indicates an intrinsic steatosis and IR promoter action by HCV.

Doença de Wilson: apresentaçäo com hepatite aguda

Apresentam-se dois casos de doença de Wilson que se manifestaram por hepatite aguda. No primeiro caso, o quadro clínico foi acompanhado por anemia hemolítica, hipofosfatasia com fosfatase alcalina que atingiu o mínimo de 7U/dl (normal para a idade: 57-303U/dl) e síndrome de Fanconi com hiperfosfatúria, hiperuricosúria e eliminaçäo aumentada de glicinina, glutamina, alanina e lisina. O segundo caso apresentava já quadro histológico de cirrose hepática e evoluiu para hepatite fulminante complicada por infecçäo do líquido ascítico. Nos dois casos foi iniciada terapêutica com penicilamina, imediatamente após o diagnóstico, verificando-se a regressäo das principais mainifestaçöes no primeiro caso. No segundo caso a evoluçäo foi desfavorável, verificando-se o aparecimento de sepse e insuficiência renal que näo respondeu à terapêutica com hemofiltraçäo, vindo a falecer três semanas após o início da terapêutica. Discutem-se os problemas de diagnóstico diferencial da terapêutica e prognóstico desta forma de apresentaçäo, com mençäo especial das indicaçöes atuais para transplante