Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil.

BACKGROUND: Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals. METHODS: This cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography. RESULTS: The prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication. CONCLUSIONS: The prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis. TRIAL REGISTRATION: Research Ethics Committee of the Faculty of Health Sciences of the University of Brasília - UNB (CAAE number 77818317.2.0000.0030) and by the Ethics Committee of the Health Science Teaching and Research Foundation - FEPECS/SES/DF (CAAE number 77818317.2.3001.5553).

Transient Elastography and Controlled Attenuation Parameter (CAP) in the Assessment of Liver Steatosis in Severe Adult Growth Hormone Deficiency.

Non-alcoholic fatty liver disease (NAFLD) is common in patients with growth hormone deficiency (GHD). Some noninvasive techniques have been used to quantify liver fat, such as the controlled attenuation parameter (CAP). Objective: To evaluate CAP as a tool to identify liver steatosis and its relationship with different clinical and biochemical metabolic parameters in a group of patients with severe adult growth hormone deficiency (AGHD), and to compare the evolution of metabolic profiles after 6 months of human growth hormone (rhGH) replacement therapy in a subgroup of patients. Methods: Cross-sectional observational study at baseline of naive rhGH multiple pituitary hormonal deficiency (MPHD) hypopituitarism patients. A 6-month intervention clinical trial in a selected group of a non-randomized, non-controlled cohort was also applied. Results: Liver stiffness measurement (LSM) was normal in severe AGHD patients. CAP evaluation showed steatosis in 36.3% of baseline patients (8/22), associated with higher BMI, waist circumference, insulin, and alanine aminotransferase (ALT) levels. According to steatosis degree by CAP, child-onset growth hormone deficiency (CO-GHD) was graded as 68.75% (11/16) S0, 12.5% (2/16) S1, and 18.75% (3/16) S3, whereas AO-GHD was graded as 50% (3/6) S0, 16.66% (1/6) S2, and 33.33% S3. After 6 months of hrGH replacement, CAP measurements did not change significantly, neither on group without hepatic steatosis at baseline (194.4 ± 24.3 vs. 215.4 ± 51.3; p = 0.267) nor on the group with hepatic steatosis (297.2 ± 32.3 vs. 276.4 ± 27.8; p = 0.082). A significant improvement of body composition was observed only in the first group. Conclusions: We have demonstrated the importance of CAP as a non-invasive tool in the liver steatosis identification on hypopituitary patients. This method may be an important indicator of the severity of metabolic disorders in MPHD patients. In our study, no liver health modification in LSM at baseline or after 6 months of rhGH replacement was found. Longer studies can help to establish the potential repercussions of growth hormone replacement therapy on liver steatosis.

[Clinical predictors of growth response in the first year of treatment with a fixed dose of growth hormone in children born small for gestational age]. / Preditores clínicos do ganho estatural do primeiro ano de tratamento com dose fixa de hormônio de crescimento em crianças nascidas pequenas para idade gestacional.

OBJECTIVE: To identify clinical predictors associated with catch-up growth in the first year of treatment with somatropin (rhGH) in a group of children born small for gestational age (SGA). SUBJECTS AND METHODS: Thirty nine children who have been on rhGH therapy for at least one year (0.33 mg/kg/week) were evaluated. The clinical parameters analyzed were chronological age (CA), bone age (BA), target height and standard deviations scores (SDS) of birth weight and length, height, weight and growth rate. RESULTS: rhGH therapy was associated with a first year height increment of 0.67 SDS (p < 0.01). BA and birth weight SDS were predictive of growth response, with statistical difference in height SDS variation between prepubertal and pubertal subgroups (p = 0.016). CONCLUSION: These data show a significant growth response with a fixed rhGH dose, those children who started rhGH in prepubertal ages presented the best outcomes.

Preditores clínicos do ganho estatural do primeiro ano de tratamento com dose fixa de hormônio de crescimento em crianças nascidas pequenas para idade gestacional / Clinical predictors of growth response in the first year of treatment with a fixed dose of growth hormone in children born small for gestational age

OBJETIVO: Identificar preditores clínicos associados à recuperação do crescimento no primeiro ano de tratamento com somatropina (rhGH) em um grupo de crianças nascidas pequenas para a idade gestacional (PIG). SUJEITOS E MÉTODOS: Foram avaliadas 39 crianças que estavam em terapia com rhGH por pelo menos um ano (0,33 mg/kg/semana). As variáveis analisadas foram idade cronológica (IC), idade óssea (IO), altura-alvo e escores de desvios-padrão (Z-escore) do peso e comprimento ao nascer, altura, peso e velocidade de crescimento pré e pós-rhGH. RESULTADOS: A terapia com rhGH foi associada a incremento significativo de 0,67 Z-escore (p < 0,01) na estatura nesse primeiro ano. IO e Z-escore de peso ao nascimento foram reconhecidos como preditores dessa resposta, com diferença significativa na variação do Z-escore de estatura entre pré-púberes e púberes (p = 0,016). CONCLUSÃO: Esses dados mostram ganho estatural significativo com dose fixa de rhGH, observando-se melhores resultados quando a terapia foi iniciada na fase pré-puberal.

OBJECTIVE: To identify clinical predictors associated with catch-up growth in the first year of treatment with somatropin (rhGH) in a group of children born small for gestational age (SGA). SUBJECTS AND METHODS: Thirty nine children who have been on rhGH therapy for at least one year (0.33 mg/kg/week) were evaluated. The clinical parameters analyzed were chronological age (CA), bone age (BA), target height and standard deviations scores (SDS) of birth weight and length, height, weight and growth rate. RESULTS: rhGH therapy was associated with a first year height increment of 0.67 SDS (p < 0.01). BA and birth weight SDS were predictive of growth response, with statistical difference in height SDS variation between prepubertal and pubertal subgroups (p = 0.016). CONCLUSION: These data show a significant growth response with a fixed rhGH dose, those children who started rhGH in prepubertal ages presented the best outcomes.

Síndrome de Marine-Lenhart: seguimento de caso por 23 anos / Marine-Lenhart syndrome: follow-up of case along 23 years

Introdução. A síndrome em estudo, descrita em 1911 por Marine e Lenhart, consiste em doença de Graves com nódulo funcionante (nódulo morno cintilográfico). Corresponde a 2,7 por cento dos casos de bócio difuso tóxico, é aceita como subdivisão desse hipertireoidismo em 1969. Relato do Caso. Paciente, 25 anos, feminina, foi atendida em 1983 com bócio difuso tóxico, exoftalmia à esquerda e nódulo no lobo tireiodiano esquerdo. Dosagens hormonais por radioimunoensaio mostraram T3 e T4 elevados, com TSH suprimido; cintilografia com I131 revelou aumento difuso com nódulo hipocaptante no lobo esquerdo; captação de 58 por cento em 24 horas. Foi tratada com propiltiouracil até 1986, quando foi reavaliada. Realizou-se teste de supressão com triiodotironina, que mostrou o mesmo aspecto cintilográfico, mas com captação de 22% em 24 horas. Em maio de 1987, optou-se por administrar 203,5 MBq (5,5 mCi) de I131 pela adesão irregular da paciente ao uso do antitireoidiano. Em maio de 1988, submeteu-se à craniotomia frontal bilateral para descomprimir a exoftalmia, que afetou ambos os olhos, realizou cintilografia com I131 com nódulo funcionante no lobo esquerdo com supressão total do tecido paranodular. Permaneceu eutireóidea até 1992, e o exame do material obtido por punção aspirativa por agulha fina revelou bócio adenomatoso. Nesse ano, engravidou e desenvolveu hipotireoidismo. Na reposição hormonal, empregou-se levotiroxina, usada irregularmente até 1995. A revisão à época mostrou ainda hipotireoidismo. Foi aumentada a dose de levotiroxina; nova avaliação com uso de punção por agulha fina levou ao diagnóstico de celularidade indicativa de tratamento com radioiodo. O acompanhamento subseqüente com dosagens hormonais, exames de material colhido em punção por agulha fina e avaliação clínica, constatou quadro de normalidade até 2006. Conclusões. O seguimento desse caso por 23 anos, com avaliação citológica de material obtido de punção aspirativa por agulha fina e outros exames...

Introduction. The reported syndrome refers to that described in 1911 by Marine and Lenhart and consists in the coexistence of Graves disease with a functional (hot) nodule. It occurs in 2,7 per cent of toxic diffuse goiter and was accepted as a subdivision of Graves disease in 1969. Case Report. A 25 year old woman developed toxic diffuse goiter with left exophtalm and a left lobe thyroidal nodule in 1983. Hormonal levels by radioimmuneassay showed increased T3 and T4 with suppressed TSH; 131I scintilography revealed diffuse growth with hypocaptating left lobe nodule, 58 per cent 24h uptake. Propiltiouracil was used until 1986 when a triiodotironin suppression test showed similar scintilographic aspect and decreased 24h uptake (22 per cent). In May 1987, because of irregular adherence to antithyroidal drug, application of 203,5 MBq (5,5 mCi) I131 was performed. In May 1988 the patient was submitted to bilateral frontal craniotomy to bilateral exophtalm decompression and another I131 scintilography showed a left lobe functional nodule with total suppression of paranodular tissues. She remained euthyroidal until 1992 and fine needle aspiration exam revealed adenomatous goiter. The patient got pregnant at that year and then developed hypothyroidism. Initiated irregular levothyroxin use until 1995, when mild hypothyroidism was still found. Levothyroxin dose was increased and a new fine needle aspiration exam showed radioiodine-treatment-compatible cellularity. Follow-up with fine needle aspiration, hormonal dosages and clinical evaluation was normal up to 2006. Conclusions. The 23 years follow-up with histopathological fine needle aspiration and other serial exams was adequate at this case. The remnant functional nodule showed neither autonomy nor malignization. The radioiodine-131 constitutes an adequate option for treatment.