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Ferraz MLG, Piccoli LDZ, Rezende R, Borba LA, Junior AP, Cheinquer H, Silva GF, Ferreira PRA, Villela-Nogueira CA, Mazo DF, Souza FF, Codes L, Ivantes CAP, Gomide GPM, Pereira GHS, Pessôa MG, França AVC, Pinto ADS, Teixeira R, Bittencourt PL. National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents. Braz J Infect Dis 2022; 26:102388. [PMID: 35905930 PMCID: PMC9459029 DOI: 10.1016/j.bjid.2022.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 10/27/2022] Open
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Franco KGS, de Amorim FJR, Santos MA, Rollemberg CVV, de Oliveira FA, França AVC, Santos CNO, Magalhães LS, Cazzaniga RA, de Lima FS, Benevides L, Carregaro V, Silva JS, Brito HLDF, Fernandes DA, da Silva ÂM, de Almeida RP, Bezerra-Santos M, de Jesus AR. Association of IL-9, IL-10, and IL-17 Cytokines With Hepatic Fibrosis in Human Schistosoma mansoni Infection. Front Immunol 2021. [PMID: 34970264 DOI: 10.3389/fimmu.2021.779534]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is a case series study to evaluate immunological markers associated with schistosomiasis advanced fibrosis, including 69 patients from an endemic area from the State of Sergipe and from the Hepatology Service of the University Hospital in Sergipe, Brazil. Hepatic fibrosis was classified based on Niamey protocol for ultrasonography (US). Immune response to Schistosoma mansoni antigens was evaluated by stimulating peripheral blood mononuclear cells (PBMCs) from these patients with either adult worm (SWAP-10 μg/ml) or egg (SEA-10 μg/ml) antigens or purified protein derivative of turberculin (PPD-10 μg/ml) or phytohemagglutinin (PHA-1 μg/ml) for 72 h. The levels of IFN-γ, TNF-α, IL-5, IL-10, and IL-17 were measured in these supernatants by ELISA and IL-9 by Luminex. Single nucleotide polymorphisms in IL-17, IL10, and CD209 genes were genotyped using TaqMan probe by qPCR. Higher levels of IL-9, IL-10, and IL-17 were found in PBMC supernatants of patients with advanced hepatic fibrosis. Direct correlations were detected between IL-9 and IL-17 levels with US spleen sizes, portal vein diameters, and periportal thickening. The CD209 rs2287886 AG polymorphism patients produce higher IL-17 levels. Together, these data suggest a role of these cytokines in the immunopathogenesis of advanced fibrosis in human schistosomiasis.
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Affiliation(s)
- Karine Garcez Schuster Franco
- Image and Graphic Methods Unit, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Fabio Jorge Ramalho de Amorim
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Mário Adriano Santos
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
| | - Carla Virgínia Vieira Rollemberg
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Fabricia Alvisi de Oliveira
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Alex Vianey Callado França
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Hepatology Service, University Hospital, Federal University of Sergipe, Aracaju, Brazil
| | - Camilla Natália Oliveira Santos
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Lucas Sousa Magalhães
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Rodrigo Anselmo Cazzaniga
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | | | - Luciana Benevides
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Vanessa Carregaro
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Santana Silva
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Ângela Maria da Silva
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Infectology Service, University Hospital, Federal University of Sergipe, Sergipe, Brazil
| | - Roque Pacheco de Almeida
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Immunology Institute of Investigation (III), National Institute of Science and Technology (INCT), Brazilian Research and Technology Council (CNPq), São Paulo, Brazil
| | - Márcio Bezerra-Santos
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Department of Morphology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Amélia Ribeiro de Jesus
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Immunology Institute of Investigation (III), National Institute of Science and Technology (INCT), Brazilian Research and Technology Council (CNPq), São Paulo, Brazil
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Franco KGS, de Amorim FJR, Santos MA, Rollemberg CVV, de Oliveira FA, França AVC, Santos CNO, Magalhães LS, Cazzaniga RA, de Lima FS, Benevides L, Carregaro V, Silva JS, Brito HLDF, Fernandes DA, da Silva ÂM, de Almeida RP, Bezerra-Santos M, de Jesus AR. Association of IL-9, IL-10, and IL-17 Cytokines With Hepatic Fibrosis in Human Schistosoma mansoni Infection. Front Immunol 2021; 12:779534. [PMID: 34970264 PMCID: PMC8712476 DOI: 10.3389/fimmu.2021.779534] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
This is a case series study to evaluate immunological markers associated with schistosomiasis advanced fibrosis, including 69 patients from an endemic area from the State of Sergipe and from the Hepatology Service of the University Hospital in Sergipe, Brazil. Hepatic fibrosis was classified based on Niamey protocol for ultrasonography (US). Immune response to Schistosoma mansoni antigens was evaluated by stimulating peripheral blood mononuclear cells (PBMCs) from these patients with either adult worm (SWAP-10 μg/ml) or egg (SEA-10 μg/ml) antigens or purified protein derivative of turberculin (PPD-10 μg/ml) or phytohemagglutinin (PHA-1 μg/ml) for 72 h. The levels of IFN-γ, TNF-α, IL-5, IL-10, and IL-17 were measured in these supernatants by ELISA and IL-9 by Luminex. Single nucleotide polymorphisms in IL-17, IL10, and CD209 genes were genotyped using TaqMan probe by qPCR. Higher levels of IL-9, IL-10, and IL-17 were found in PBMC supernatants of patients with advanced hepatic fibrosis. Direct correlations were detected between IL-9 and IL-17 levels with US spleen sizes, portal vein diameters, and periportal thickening. The CD209 rs2287886 AG polymorphism patients produce higher IL-17 levels. Together, these data suggest a role of these cytokines in the immunopathogenesis of advanced fibrosis in human schistosomiasis.
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Affiliation(s)
- Karine Garcez Schuster Franco
- Image and Graphic Methods Unit, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Fabio Jorge Ramalho de Amorim
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Mário Adriano Santos
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
| | - Carla Virgínia Vieira Rollemberg
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Fabricia Alvisi de Oliveira
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Alex Vianey Callado França
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Hepatology Service, University Hospital, Federal University of Sergipe, Aracaju, Brazil
| | - Camilla Natália Oliveira Santos
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Lucas Sousa Magalhães
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | - Rodrigo Anselmo Cazzaniga
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
| | | | - Luciana Benevides
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Vanessa Carregaro
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Santana Silva
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Ângela Maria da Silva
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Infectology Service, University Hospital, Federal University of Sergipe, Sergipe, Brazil
| | - Roque Pacheco de Almeida
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Immunology Institute of Investigation (III), National Institute of Science and Technology (INCT), Brazilian Research and Technology Council (CNPq), São Paulo, Brazil
| | - Márcio Bezerra-Santos
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Department of Morphology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Amélia Ribeiro de Jesus
- Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Laboratory of Molecular Biology, University Hospital, Federal Sergipe University, Aracaju, Brazil
- Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Immunology Institute of Investigation (III), National Institute of Science and Technology (INCT), Brazilian Research and Technology Council (CNPq), São Paulo, Brazil
- *Correspondence: Amélia Ribeiro de Jesus,
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Santos MB, Santos ADD, Silva PPD, Barreto AS, Santos EOD, França AVC, Barbosa CS, Araújo KCGMD. Spatial analysis of viral hepatitis and schistosomiasis coinfection in an endemic area in Northeastern Brazil. Rev Soc Bras Med Trop 2017; 50:383-387. [PMID: 28700058 DOI: 10.1590/0037-8682-0411-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/01/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: This cross-sectional study analyzed the spatial distribution of hepatitis B or C virus (HBV/HBC) and schistosomiasis coinfection. METHODS: Serum samples were collected from patients with Schistosoma mansoni infection. These were tested for serological markers of HBV/HCV infection. The spatial distribution of coinfection was analyzed using intensity kernel estimation. RESULTS: Overall, 9.4% of individuals had contact with HBV and 1.7% of samples tested positive for anti-HCV antibodies. We identified clusters of risk located in the central region. CONCLUSIONS: Spatial analysis allowed visualization of high-risk areas, leading to a definition of priority areas to be targeted for intensification of control interventions.
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Affiliation(s)
- Márcio Bezerra Santos
- Departamento de Educação em Saúde, Universidade Federal de Sergipe, Campus Prof. Antônio Garcia Filho, Lagarto, SE, Brasil.,Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Universidade Federal de Sergipe, Campus Prof. João Cardoso Nascimento, Aracaju, SE, Brasil
| | - Allan Dantas Dos Santos
- Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Universidade Federal de Sergipe, Campus Prof. João Cardoso Nascimento, Aracaju, SE, Brasil.,Departamento de Enfermagem, Universidade Federal de Sergipe, Campus Prof. Antônio Garcia Filho, Lagarto, SE, Brasil
| | - Patrícia Pereira da Silva
- Programa de Pós-graduação Stricto Sensu em Biologia Parasitária, Universidade Federal de Sergipe, Cidade Universitária Prof. José Aloísio de Campos, São Cristóvão, SE, Brasil
| | - Aline Silva Barreto
- Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Universidade Federal de Sergipe, Campus Prof. João Cardoso Nascimento, Aracaju, SE, Brasil
| | | | - Alex Vianey Callado França
- Departamento de Medicina, Universidade Federal de Sergipe, Campus Prof. João Cardoso Nascimento, Aracaju, SE, Brasil
| | - Constança Simões Barbosa
- Laboratório de Referência em Esquistossomose, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Karina Conceição Gomes Machado de Araújo
- Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Universidade Federal de Sergipe, Campus Prof. João Cardoso Nascimento, Aracaju, SE, Brasil.,Departamento de Morfologia, Universidade Federal de Sergipe, Cidade Universitária Prof. José Aloísio de Campos, São Cristóvão, SE, Brasil
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Strauss E, Ferreira ADSP, França AVC, Lyra AC, Barros FMDR, Silva I, Garcia JHP, Parise ER. Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations. Arq Gastroenterol 2016; 52 Suppl 1:47-54. [PMID: 26959805 DOI: 10.1590/s0004-28032015000500003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Space-occupying lesions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenomas and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenomas are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenomas may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenomas growth, particularly of the hepatocyte nuclear factor-1alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of the liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the absence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agents are indicated.
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Affiliation(s)
- Edna Strauss
- Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Fernandes DA, Chagas ACP, Jesus ARD, França AVC, Lima FSD, Silva ÂMD, Godinho AS, Franco KGS. Aspectos ultrassonográficos associados à morbidade de formas clínicas crônicas de esquistossomose mansônica, utilizando-se protocolo proposto pela Organização Mundial da Saúde. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000100006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJETIVO: Avaliar aspectos ultrassonográficos associados à morbidade em pacientes com formas clínicas crônicas de esquistossomose mansônica, utilizando-se protocolo proposto pela Organização Mundial da Saúde (OMS). MATERIAIS E MÉTODOS: Foram avaliadas duas populações distintas: a) área endêmica e b) institucional terciária, com histopatológico confirmando fibrose. Critérios de inclusão: diagnóstico confirmado por parasitológico de fezes para Schistosoma mansoni (método Kato-Katz). Critérios de exclusão: sorologia positiva para HIV, HTLV-1, VHB ou VHC. Foi utilizado protocolo ultrassonográfico de Niamey, proposto pela OMS. RESULTADOS: Avaliando-se isoladamente as medidas dos espaços periportais, estas se mostraram sem alterações em 21% dos indivíduos com doença avançada da instituição terciária. Utilizando-se todos os parâmetros do protocolo, 100% dos indivíduos da instituição terciária, com forma grave da doença, apresentaram fibrose periportal avançada. Em pacientes hepatoesplênicos da área endêmica não se identificou fibrose à ultrassonografia. CONCLUSÃO: O protocolo ultrassonográfico proposto pela OMS detecta fibrose periportal avançada nos pacientes com forma grave da doença, com maior sensibilidade do que a medida do espaço periportal isoladamente. A complexidade de identificação das fases iniciais da fibrose periportal, em áreas endêmicas, pela ultrassonografia, pode suscitar o campo da complementação diagnóstica e a continuidade do aprimoramento dos protocolos ultrassonográficos nestas áreas.
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Affiliation(s)
| | | | | | | | | | | | - Atilano Salvador Godinho
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Universidade Federal de Sergipe, Brasil
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Nogueira JBC, Sena LCS, Quintans JDSS, Almeida JRGDS, França AVC, Júnior LJQ. Side effects of the therapy with peginterferon and ribavirin in chronic hepatitis C: a small audit. J Pharm Pract 2011; 25:85-8. [PMID: 21940604 DOI: 10.1177/0897190011415687] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study sought to decribe, quantify, and classify any adverse reactions occurring in patients with chronic hepatitis C treated with peginterferon and ribavirin, as well as verify the occurrence of potential medication interactions. The most prevalent reactions were fatigue (84.8%), fever (83%), weight loss (80%), irritability (74%), and body pain (72%). Most of the reactions were classified as mild (95%), whereas 4.5% were classified as moderate and 0.4% as severe. Adverse reactions led to the rearrangement of therapy for 9 patients (20%), where there was a reduction in dose for 7 (15%), temporary interruption of treatment for 5 (11%), and permanent discontinuation for 3 patients (7%). A total of 11 potential medication interactions were identified in 9 patients (20%), with the most frequent between peginterferon-α2a and captopril (45%). Given the above, it is observed that the treatment of chronic hepatitis C is marked by several adverse reactions of varying severity, which can interfere with the patient's quality of life or in treatment compliance, and that can be aggravated by potential drug-drug interactions.
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Bourbon Filho LDA, Ferrão TDO, França AVC, Rocha RD, Dantas LD, Carvalho LFDP, Moreira MDDAB, Cipolotti R. Sobrecarga de ferro transfusional em portadores de anemia falciforme: comparação entre ressonância magnética e ferritina sérica. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000300006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Identificar variáveis preditoras de sobrecarga de ferro em portadores de anemia falciforme e correlacionar indicadores bioquímicos e imaginológicos. MATERIAiS E MÉTODOS: Foi realizado estudo transversal envolvendo 32 portadores de anemia falciforme, que foram submetidos a dosagem sérica de ferro, ferritina e a ressonância magnética do fígado. Foram realizadas cinco sequências gradiente-eco e uma spin-eco. A intensidade de sinal foi obtida em cada sequência pelas médias das regiões de interesse no fígado e musculatura paravertebral para obter a razão da intensidade de sinal (RIS) fígado/músculo. A partir da RIS foi obtida a concentração hepática estimada de ferro (CHEF) pela fórmula: e[5,808 - (0,877 × T2*) - (1,518 × PI)], onde T2* é a RIS na sequência com TE de 13 ms e PI é a RIS da sequência com ponderação intermediária. Os pacientes foram agrupados segundo o regime de transfusão de hemácias (regulares mensais versus esporádicas). RESULTADOS: Os grupos transfusionais foram comparados pelas variáveis clínico-laboratoriais, sendo significativas as diferenças entre RIS, CHEF e ferritina sérica: o grupo que recebeu transfusões regulares apresentou sobrecarga de ferro hepático mais intensa. CONCLUSÃO: A ressonância magnética foi ferramenta eficiente para avaliação de sobrecarga hepática de ferro em portadores de anemia falciforme.
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Abstract
This study aims to describe the learning results of the implementation of teaching strategies involving patients who will be submitted to liver transplantation. One of these strategies is to give the patients a manual with orientations and the subsequent application of a questionnaire related to the content of the manual. Authors analyzed 13 patients who were waiting for liver transplantation. With respect to the answers regarding the questionnaire, an average of 83.8% of correct responses was given and only one patient got all the questions right. During the correction and the time to clarify their doubts, authors concluded that the opportunity of reading the manual and applying the questionnaire allowed patients and families to get a better understanding about the surgery's most important aspects.
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Affiliation(s)
- Karina Dal Sasso
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo.
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Abstract
AIM We report the case of a patient with hepatocellular carcinoma submitted to liver transplantation, who subsequently manifested tumor recurrence initially as brain metastasis. CASE DESCRIPTION A 48-year-old male cirrhotic patient with hepatitis C infection, and two focal hepatic lesions, had a cytologic and histologic diagnosis of hepatocellular carcinoma. Before transplant, he was submitted to adjuvant treatment with a combination of arterial embolization and intratumoral ethanol injection. In the 3rd month post-liver transplantation, the patient developed headache, nausea and vomiting, without any neurological impairment. Brain computed tomography and magnetic resonance imaging identified an expansive hypervascular lesion with internal bleeding. Evaluation of the surgical explant revealed macroscopic invasion of portal vessels. CONCLUSION Brain metastasis of a hepatocellular carcinoma after liver transplantation may occur. This metastasis may have occurred before or soon after the transplant. Patients with hepatocellular carcinoma, awaiting liver transplant, should be screened for cerebral metastasis. Vascular invasion may indicate hematogenic dissemination of the tumor.
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Affiliation(s)
- Alex Vianey Callado França
- Liver Transplant Group, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, SP, Brazil.
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Abstract
The objective of the present study was to report on three distinct forms of presentation of Cryptococcus neoformans infection in three cirrhotic patients. One patient had disseminated cryptococcosis with detection of the fungus in ascitic fluid, cerebrospinal fluid and blood; the second patient had pleural involvement and the third had cutaneous infection caused by C. neoformans.
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Affiliation(s)
- Alex Vianey Callado França
- Hepatology Unit, Division of Gastroenterology, Medical School of Ribeirão Preto, São Paulo University, São Paulo, Brazil.
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Abstract
RACIONAL: A síndrome hepatopulmonar é caracterizada por tríade clínica que consiste em: 1) doença hepática e/ou hipertensão portal, 2) dilatações vasculares intra-pulmonares, e 3) anormalidades da oxigenação arterial (pressão parcial de oxigênio <70 mm Hg ou gradiente alvéolo-arterial de oxigênio >20 mm Hg). Sua freqüência varia de acordo com os métodos diagnósticos utilizados. OBJETIVOS: Fazer revisão da literatura sobre patogenia, diagnóstico e tratamento da síndrome hepatopulmonar. MÉTODOS: Levantamento no MEDLINE das publicações nacionais e internacionais mais relevantes sobre a síndrome hepatopulmonar. RESULTADOS: A prevalência da síndrome hepatopulmonar varia de 4% a 17,5%, a depender dos critérios diagnósticos utilizados. A doença hepática associada mais comum é a cirrose. O gradiente alvéolo-arterial de oxigênio parece ser o melhor parâmetro para avaliação das anormalidades da oxigenação arterial. Em relação à detecção das dilatações vasculares intra-pulmonares, a ecocardiografia com contraste é o método de escolha, pois é de fácil realização e pode diferenciar as comunicações intra-pulmonares das intra-cardíacas. No tratamento da síndrome hepatopulmonar, poucos relatos bem sucedidos puderam ser reproduzidos e confirmados utilizando terapia farmacológica e/ou radiologia intervencionista. Atualmente, o transplante de fígado é considerado a principal opção terapêutica desses pacientes, com resultados animadores. CONCLUSÕES: A síndrome hepatopulmonar é uma enfermidade freqüente. Exames gasométricos são necessários para o seu diagnóstico. O transplante de fígado é o tratamento de escolha para os portadores da síndrome.
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Affiliation(s)
- Beatriz Lima
- Divisão de Gastroenterologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto
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Abstract
Hepatocellular carcinomas are aggressive tumors with a high dissemination power. An early diagnosis of these tumors is of great importance in order to offer the possibility of curative treatment. For an early diagnosis, abdominal ultrasound and serum alpha-fetoprotein determinations at 6-month intervals are suggested for all patients with cirrhosis of the liver, since this disease is considered to be the main risk factor for the development of the neoplasia. Helicoidal computed tomography, magnetic resonance and/or hepatic arteriography are suggested for diagnostic confirmation and tumor staging. The need to obtain a fragment of the focal lesion for cytology and/or histology for a diagnosis of hepatocellular carcinoma depends on the inability of imaging methods to diagnose the lesion. Several classifications are currently available for tumor staging in order to determine patient prognosis. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to be the main factor related to patient survival. Classifications, however, fail to correlate treatment with prognosis and cannot suggest the ideal treatment for each tumor stage. The Barcelona Classification (BCLC) attempts to correlate tumor stage with treatment but requires prospective studies for validation. For single tumors smaller than 5 cm or up to three nodules smaller than 3 cm, surgical resection, liver transplantation and percutaneous treatment may offer good anti-tumoral results, as well as improved patient survival. Embolization or chemoembolization are therapeutic alternatives for patients who do not benefit from curative therapies.
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Affiliation(s)
- A V C França
- Divisão de Gastroenterologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Brasil
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França AVC, Valério HMG, Trevisan M, Escanhoela C, Sevá-Pereira T, Zucoloto S, Martinelli A, Soares EC. Fine needle aspiration biopsy for improving the diagnostic accuracy of cut needle biopsy of focal liver lesions. Acta Cytol 2003; 47:332-6. [PMID: 12789910 DOI: 10.1159/000326529] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the value of fine needle aspiration biopsy (FNAB) in comparison to cut needle biopsy (CNB) for the diagnosis of malignancy of focal liver lesions. STUDY DESIGN A retrospective analysis was conducted on 68 FNAB and 49 CNB procedures performed on 62 patients with focal liver lesions. RESULTS Cytology permitted a diagnosis of the lesion in 78% of cases. When punctures with insufficient material were excluded (11), the diagnostic accuracy of FNAB was 93%. For the 49 patients who underwent both procedures, FNAB and CNB had the same diagnostic accuracy, 78%, when considered separately and of 88% when considered in combination. Sensitivity, specificity and positive predictive value were similar for the 2 techniques. The negative predictive value was 64% for FNAB and CNB used separately and reached 78% when the 2 techniques were combined. There were no complications during the execution of FNAB and CNB. CONCLUSION FNAB is an effective and safe method for the diagnosis of focal hepatic lesions, with diagnostic accuracy similar to that of CNB. When the 2 techniques are combined, the accuracy of the diagnosis of malignancy of focal liver lesions increases.
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Affiliation(s)
- Alex Vianey Callado França
- Hepatology Unit, Division of Gastroenterology, Department of Medicine, Medical School of Ribeirão Preto, Sõ Paulo University, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
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