Análise macroscópica e radiográfica de dentes decíduos com hiperbilirrubinemia de crianças com doenças hepáticas crônicas e transplante hepático / Macroscopic and radiographic analysis of primary teeth with hyperbilirubinemiain children with chronic liver disease and liver transplantation

Objetivo: identificar mediante análise macroscópica e ra-diográfica as alterações estruturais em tecidos dentários afetados pela hiperbilirrubinemia, normalmente constatada a partir do sinal clínico de icterícia e provoca o desenvolvi-mento de pigmentos intrínsecos esverdeados nas estruturas dentárias. Materiais e Métodos: a amostra foi composta por 31 dentes decíduos dividida em grupo controle (n= 7) e grupo experimental (n= 24). As análises macroscópicas foram efetuadas por meio de fotografias individuais padroniza-das e as radiográficas obtidas com aquisições de imagem a 9 mA, 70 kVp, distância de 8cm, exposição 0,4 segundos e com XDR Sensor®. As imagens foram convertidas pelo software XDR Brasil 3.1.6 e padronizadas pelo programa GIMP 2.10.22. Os dados da média simples do histograma foram analisados pelo teste T-Student e Mann-Whitney (p<0,05). Resultados: demonstraram a maior intensidade de pigmentação em região cervical da raiz, com diferença de densidade radiográfica estaticamente significante na porção radicular entre os grupos experimental e controle (p=0,043). Na análise da densidade radiográfica da estrutura radicular do grupo experimental houve diferença estatica-mente significante (p=0,016) entre os terços cervical e apical. Discussão: Os dados evidenciaram que dentes pigmentados pela hiperbilirrubinemia não possuem alterações na densidade mineral nos terços coronários. Conclusão: Dentes com pigmentação esverdeada bilirrubina possuem diferenças na densidade radiográfica so-mente na região radicular.

Aim: is to identify, through macroscopic and radio-graphic analysis, structural changes in dental tissues affected by hyperbilirubinemia, usually seen from the clinical sign of icterus and causes the development of intrinsic greenish pigments in dental structure. Materials and Methods: The sample consisted of 31 primary teeth divided into a control group (n=7) and an experimental group (n=24). Macroscopic analyzes were performed using standardized individual photographs and radiographic ones obtained by image acquisition at 9 mA, 70 kVp, 8cm distance, 0.4 seconds exposure and with XDR Sensor®. The images were converted by XDR Brasil 3.1.6 software and standardized by GIMP 2.10.22 software. The Histogram's simple mean data were analyzed by T-Student and Mann-Whitney tests (p<0.05). Results: showed intensity of pigmentation in the cervical region of the root, with a statistically significant difference in the root portion between the experimental and control groups (p=0.043. In the analysis of radiographic density of the root structure of the experimental group, there was a statistically significant difference (p= 0.016) between the cervical and apical thirds. Discussion: The data showed that teeth pigmented by hyperbilirubinemia do not have changes in mineral density in the coronary thirds. Conclusion: Greenish pigments teeth have differences in radiographic density only in the root structure.

Validación de un método analítico para cuantificación de ferritina en líquido cefalorraquídeo / Validation of an analytical method for the quantification of ferritin in cerebrospinal fluid

Resumen La ferritina es una proteína de gran tamaño que se encuentra fisiológicamente en el líquido cefalorraquídeo (LCR) en concentraciones de 2-10 ng/mL. Su elevación puede utilizarse como biomarcador en distintas condiciones patológicas. El procedimiento de validación tradicional para la medición en LCR no puede ser utilizado debido a la ausencia de controles y calibradores comerciales para esta matriz. El objetivo de este trabajo fue llevar a cabo una validación analítica de ferritina en LCR. Se realizaron ensayos de estimación de precisión y veracidad mediante el protocolo EP15-A3, linealidad por el protocolo EP6-A (ambos de la guía de la CLSI), recuperación, estabilidad, contaminación por arrastre, interferencia por hemólisis y bilirrubina y límite de detección (LoD). La ferritina en LCR en el autoanalizador DxI 800 de Beckman Coulter tuvo una performance intra e interensayo <3,7%, el ensayo denota linealidad en el intervalo de 2,1-547 ng/mL; se estableció estabilidad por un período de 5 días y la recuperación resultó ser aceptable. No se evidenció efecto de contaminación por arrastre ni interferencia por hemólisis hasta un rango entre 300-500 mg/dL de hemoglobina, ni interferencia por bilirrubina hasta una concentración de 16,0 mg/dL de bilirrubina total. El LoD fue de 0,4 ng/mL. Por medio de los ensayos realizados se logró validar la ferritina en LCR a partir de la utilización de pools de muestras, lo que pudo garantizar la confiabilidad y exactitud del método analítico.

Abstract Ferritin is a large protein physiologically present in the cerebrospinal fluid (CSF) in concentrations of 2-10 ng/mL. Its elevation can be used as a biomarker in several pathological conditions. The traditional validation procedure for measurement in CSF cannot be used due to the absence of commercial controls and calibrators for this matrix. The objective of the present study was to perform CSF ferritin analytical validation. Assays such as precision and accuracy estimation through the EP15-A3 protocol, linearity according to the EP6-A protocol (both from the CLSI guidelines), recovery, stability, carry-over, hemolysis and bilirubin interference and limit of detection (LoD) were conducted. Serum samples with different concentrations of ferritin were added to aliquots of a normal CSF pool. CSF ferritin in the Beckman Coulter DxI 800 had a <3.7% intra and inter-assay performance, the assay shows linearity in the 2.1 -547 ng/mL interval, stability was established for a 5-day period and the recovery was acceptable. There was neither carry-over effect or hemolysis interference up to a range of 300-500 mg/dL of hemoglobin, nor interference by bilirubin up to 16.0 mg/dL of total bilirubin. The LoD was 0.4 ng/mL. By means of the performed assays, CSF ferritin was validated by using sample pools, thereby ensuring the reliability and accuracy of the analytical method.

Resumo A ferritina é uma grande proteína fisiologicamente encontrada no líquido cefalorraquidiano (LCR) em concentrações de 2 a 10 ng/mL. Sua elevação pode ser usada como biomarcador em diferentes condições patológicas. O procedimento de validação tradicional para medição no LCR não pode ser usado devido à ausência de controles e calibradores comerciais para esta matriz. O objetivo deste estudo foi realizar uma validação analítica da ferritina no LCR. Foram realizados estudos de precisão e veracidade utilizando o protocolo EP15-A3, linearidade pelo protocolo EP6-A (ambos das diretrizes do CLSI), recuperação, estabilidade, contaminação transportada, interferência de hemólise e bilirrubina e limite de detecção (LoD). A ferritina no LCR no DxI 800 da Beckman Coulter teve um desempenho intra e inter-ensaio <3,7%, o ensaio denota linearidade na faixa de 2,1-547 ng/mL, a estabilidade foi estabelecida em um período de 5 dias e a recuperação foi considerado aceitável. Nenhum efeito de transporte ou interferência por hemólise foi evidenciado até um intervalo entre 300-500 mg/dL de hemoglobina, nem interferência pela bilirrubina até uma concentração de 16,0 mg/dL de bilirrubina total. O LoD foi de 0,4 ng/mL. Através dos testes realizados, a ferritina no LCR foi validada, com base no uso de pool de amostras, o que poderia garantir a confiabilidade e a acurácia do método analítico.

Comparación clínica y laboratorial de la fiebre amarilla severa versus dengue grave en Perú / Clinical and laboratory differences between severe yellow fever and severe dengue in emergency patients

En los centros de Emergencia con poco apoyo de laboratorio, es difícil diferenciar a los pacientes con dengue grave y fiebre amarilla severa. El objetivo fue comparar el perfil clínico y de laboratorio de los pacientes con dengue grave y fiebre amarilla severa en Urgencias. Se realizó un estudio observacional retrospectivo de pacientes con diagnóstico confirmado de dengue y fiebre amarilla en el período 2018 a 2020 atendidos en la Unidad de Emergencia del Hospital Carrión, Huancayo-Perú. Se evaluaron un total de 35 pacientes, 11 pacientes (31,4%) fueron diagnosticados con fiebre amarilla severa y 24 pacientes (68,5%) con dengue grave. La media de los resultados de laboratorio con fiebre amarilla severa fueron bilirrubina indirecta 4,7 ml/dL, aspartato transaminasa 4463 UI/L, transaminasa aminotransferasa 4329 UI/L, creatinina 4,9 mg/dl. En pacientes con dengue grave el hematocrito promedio fue 51,8, hemoglobina 17,6 g/dl, plaquetas 24 × 103/mm. En pacientes con síndrome ictérico-febril la presencia de bradicardia, bilirrubina indirecta elevada y transaminasas muy elevadas debe hacer sospechar de fiebre amarilla; mientras que los pacientes que acuden por ascitis, derrame pleural, aumento de hematocrito y deficiencia de plaquetas, se debe tratar como dengue grave sobre todo en Unidades de Emergencia con poco apoyo de laboratorio(AU)

In Emergency centers with little laboratory support, differentiating patients with dengue and yellow fever is difficult. The Aim was to compare the clinical and laboratory profile of patients with severe dengue and severe yellow fever in the Emergency unit. We conducted a retrospective observational study of patients with a confirmed diagnosis of dengue and yellow fever in the period 2018 to 2020 treated in the Emergency Unit of the Carrión hospital, Huancayo-Peru. A total of 35 patients were evaluated, 11 patients (31.4%) were diagnosed with severe yellow fever and 24 patients (68.5%) with severe dengue. The mean laboratory results in patients with severe yellow fever were indirect bilirubin 4.7 ml/dL, aspartate transaminase 4463 IU/L, transaminase aminotransferase 4329 IU/L, creatinine 4.9 mg / dl. In patients with severe dengue were hematocrit 51.8, hemoglobin 17.6 g / dl, platelets 24 × 103 / mm. In patients with syndrome jaundice and fever the presence of bradycardia, elevated indirect bilirubin, and very elevated transaminases should be suspicious for yellow fever; while in patients who come for ascites, pleural effusion, increased hematocrit and platelet deficiency, it should be treated as severe dengue especially in Emergency Units with little laboratory support(AU)

Hiperbilirrubinemia: visión del patólogo / Hyperbilirubinemia: pathologist's view

Los niveles de bilirrubina sérica normal en el adulto varían entre 0,3 mg/dL y 1,2 mg/dL, y su valor está determinado por la tasa de captación hepática, conjugación y excreción. La ictericia se hace evidente cuando los niveles de bilirrubina sérica se elevan por encima de 2,5 mg/dL a 3 mg/dL, siendo un indicador de enfermedad subyacente. La bilis es producida por los hepatocitos y fluye desde los canalículos, canales de Hering, conductos biliares intrahepáticos, conductos hepáticos derechos e izquierdos hasta llegar al duodeno. A nivel histopatológico, cualquier entidad que lleve a la acumulación intrahepática de bilis por disfunción hepatocelular u obstrucción biliar genera colestasis, que se observa en la biopsia hepática como la acumulación de tapones de color marrón verdoso de pigmento biliar en los hepatocitos, y secundariamente se observan los canalículos dilatados. Las causas de colestasis intrahepática son diversas e incluyen enfermedades como colangitis biliar primaria, colangitis esclerosante primaria, hepatitis autoinmune, hepatitis virales y toxicidad medicamentosa. Esta revisión tiene como objetivo analizar algunos tipos de hiperbilirrubinemia, resaltando sus características histopatológicas.

Normal serum bilirubin levels in adults range from 0.3 mg/dL to 1.2 mg/dL, and its value is determined by the rate of hepatic uptake, conjugation, and excretion. Jaundice becomes apparent when serum bilirubin levels rise above 2.5 mg/dL to 3.5 mg/dL and is an indicator of underlying disease. Bile is produced by hepatocytes and flows from the canaliculi, Hering's canals, intrahepatic bile ducts, and right and left hepatic ducts to the duodenum. Pathologically, any condition that leadsto intrahepatic accumulation of bile due to hepatocellular dysfunction or biliary obstruction, generates cholestasis, which is observed in liver biopsy as the accumulation of greenish-brown deposits of bile pigment in hepatocytes, with dilated canaliculi. The causes of intrahepatic cholestasis are diverse and include diseases such as primary biliary cholangitis and primary sclerosing cholangitis, autoimmune hepatitis, viral hepatitis, and drug toxicity. This review aims to analyze some types of hyperbilirubinemia, highlighting their histopathological characteristics.

Cord blood bilirubin and prediction of neonatal hyperbilirubinemia and perinatal infection in newborns at risk of hemolysis

Abstract Objective To assess the accuracy of umbilical cord bilirubin values to predict jaundice in the first 48 h of life and neonatal infection. Method Newborn infants treated at a regional well-baby nursery born at ≥36 weeks of gestation were included in this retrospective cohort study. All infants born in a 3-year period from mothers with O blood type and/or Rh-negative were included and had the umbilical cord bilirubin levels measured. Hyperbilirubinemia in the first 48 h was defined as bilirubin levels above the phototherapy threshold. Neonatal infection was defined as any antibiotic treatment before discharge. Results A total of 1360 newborn infants were included. Two hundred and three (14.9%) newborn infants developed hyperbilirubinemia in the first 48 h of life. Hyperbilirubinemic infants had smaller birth weight, higher levels of umbilical cord bilirubin, a higher rate of infection and were more often direct antiglobulin test positive. Umbilical cord bilirubin had a sensitivity of 76.85% and a specificity of 69.58% in detecting hyperbilirubinemia in the first 48 h, with the cut-off value at 34 µmol/L. The area under the receiver operating characteristic curve was 0.80 (95% CI: 0.78-0.82). Umbilical cord bilirubin had a sensitivity of 27.03% and specificity of 91.31% in detecting perinatal infection. The area under the receiver operating characteristic (ROC) curve was 0.59 (95% CI: 0.57-0.63). Conclusions A positive correlation was found between umbilical cord bilirubin and hyperbilirubinemia in the first 48 h of life. Umbilical cord bilirubin is a poor marker for predicting neonatal infection.

Associations between Gilbert's syndrome and personality characteristics

Abstract Objective Gilbert's syndrome (GS) is a benign genetic disorder that is characterized by intermittent mild jaundice in which the liver doesn't process bilirubin properly. The aim of this study was to determine whether GS patients have a different personality structure and if there are associations between properties of temperament and character and total bilirubin levels. Methods A total of 1665 young male individuals aged from 19 to 30 who were admitted for occupational examinations were included in this study. Careful patient history was taken, a detailed physical examination was conducted, and hematologic and biochemical tests and abdominal ultrasonography were performed. The Turkish version of the Temperament and Character Inventory (TCI) was administered to all participants. 81 patients diagnosed with GS and 150 randomly chosen healthy individuals (control group) were investigated with comparison and correlation analyses. Results GS patients had higher scores than healthy controls for disorderliness (NS4) (p = 0.018), sentimentality (RD1) (p = 0.042), and fatigability (HA4) (p = 0.03). Moreover, Gilbert syndrome patients scored lower than controls for empathy (C2) (p = 0.041) and transpersonal identification (ST2) (p = 0.044). Bilirubin levels were positively associated with disorderliness (NS4) (r = 0.141, p = 0.032) and fatigability (HA4) (r = 0.14, p = 0.033). Conclusions GS patients may have some different personality characteristics from healthy individuals. This study is an initial exploration of the personality structure of GS patients and the findings should be interpreted with caution. Further prospective studies are needed to identify the relationship between Gilbert disease and personality characteristics.

Accuracy of transcutaneous bilirubin measurement in full-term newborns at 3400 meters above sea level / Precisión de la bilirrubinometría transcutánea en recién nacidos a término a 3400 metros sobre el nivel del mar

Abstract Background: Neonatal jaundice is a frequent benign condition in newborns. However, a rapid diagnosis must be established for its most appropriate treatment. The objective of this study was to measure the correlation between total serum bilirubin (TSB) and transcutaneous bilirubin (in forehead and sternum) in full-term newborns at 3400 m above sea level. Methods: We conducted a prospective and cross-sectional study in full-term newborns with clinical jaundice from the Hospital Regional in Cusco-Peru. General characteristics and measurement of TSB, transcutaneous forehead bilirubin (TcBF), and transcutaneous bilirubin in the sternum (TcBS) were explored. Correlation, sensitivity, and specificity were calculated. Receiver operating characteristic (ROC) curves were constructed using the SPSS statistical package, version 22.0. Results: A total of 123 newborns were evaluated. The mean bilirubin values were 13.7 ± 3.5 for TcBF, 14.1 ± 3.1 for TcBS, and 13.8 ± 3.9 for TSB. In addition, Pearson correlation coefficients between TSB/TcBF and TSB/TcBS were 0.90 and 0.91, respectively (p < 0.001). For the percentile 95 cut-off point, a sensitivity of 93% and 100% and a specificity of 89% and 80% were obtained for TcBF and TcBS, respectively, with an area under the curve of 0.813 for TcBF and 0.815 for TcBS (p < 0.001) Conclusions: Measurement of transcutaneous bilirubin is a fast and painless method that can be considered a reliable tool for screening and monitoring neonatal jaundice, but not for a definitive diagnosis to decide the use of phototherapy in full-term newborns at 3400 m above sea level.

Resumen Introducción: La ictericia neonatal es una condición benigna y frecuente en los recién nacidos, en quienes es preciso hacer un diagnóstico rápido para el tratamiento más adecuado. El objetivo de este estudio fue determinar la correlación entre la bilirrubina sérica total (BST) y la bilirrubina transcutánea (frente y esternón) en recién nacidos a término a 3400 metros sobre el nivel del mar. Método: Estudio prospectivo y transversal en recién nacidos con ictericia clínica en el Hospital Regional de la Ciudad de Cusco, Perú. Se exploraron las características generales y se midieron la BST, la bilirrubina transcutánea en la frente (BTcF) y la bilirrubina transcutánea en el esternón (BTcE). Se calcularon la correlación, la sensibilidad y la especificidad, y se elaboraron las curvas de características operativas del receptor (ROC) con el paquete estadístico SPSS 22.0. Resultados: Se evaluaron 123 recién nacidos. El promedio de la BST fue de 13.8 ± 3.9, el de la BTcF fue de 13.7 ± 3.5 y el de la BTcE fue de 14.1 ± 3.1. La correlación entre BST/BTcF y BST/BTcE fue de 0.90 y 0.91, respectivamente (p < 0.001). Para el punto de corte del percentil 95 según el nomograma Bhutani se obtuvo una sensibilidad del 93% y el 100%, y una especificidad del 89% y el 80%, para la BTcF y la BTcE, respectivamente, con un área bajo la curva ROC de 0.813 para la BTcF y de 0.815 para la BTcE (p < 0.001). Conclusiones: La medición de la bilirrubina transcutánea es un método rápido e indoloro, y podría ser considerado confiable para el despistaje y el seguimiento de la ictericia neonatal, mas no para un diagnóstico definitivo con el fin de decidir el uso de fototerapia en recién nacidos a término a 3400 metros sobre el nivel del mar.

Predictores de Coledocolitiasis en pacientes con litiasis vesicular sintomática tratados en la Segunda Cátedra de Clínica Quirúrgica, Hospital de Clínicas, San Lorenzo año 2017-2019 / Predictors of Choledocholithiasis in patients with symptomatic gallstones treated in the II General Surgery Service of Clinica´s Hospital, San Lorenzo, year 2017-2019

La litiasis vesicular sintomática puede presentarse asociada a litiasis de la vía biliar principal, siendo necesaria la utilización de medios diagnósticos adecuados para su posterior tratamiento. En este trabajo, se sugiere la evaluación mediante las guías de la Sociedad Americana para Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy ASGE), usando factores como la edad, pruebas hepáticas y hallazgos ecográficos, categorizando a los pacientes en baja, intermedia y alta probabilidad de coledocolitiasis. Estudio de diseño retrospectivo, observacional, descriptivo, de corte transversal, con un muestreo no probabilístico de casos consecutivos, sobre pacientes con diagnóstico de litiasis vesicular sintomática y sospecha de litiasis de la via biliar principal internados en la II Cátedra de Clínica Quirúrgica, del Hospital de Clínicas de San Lorenzo, entre los años 2017 a 2019. Con los siguientes resultados, de un total de 339 pacientes con diagnóstico de litiasis vesicular sintomática, el 6,64% tuvo el diagnóstico de coledocolitiasis asociada. En cuanto a los predictores muy fuertes de coledocolitiasis el más frecuentemente (68,6%,) encontrado fue el nivel de la bilirrubina total ≥ 4mg/dl; de los predictores fuertes el 70,6% presentaba la vía biliar principal dilatada; de los predictores moderados, el 84,3% presentó las enzimas hepáticas alteradas. En conclusión, se pudo identificar que la mayoría de los pacientes presentó alta probabilidad de coledocolitiasis y la conducta tomada fue realizar en primer lugar una colangiografía retrógrada endoscópica, con fines terapéuticos y luego colecistectomía, correspondiente al manejo correcto establecido por las guías actuales internacionales.

Symptomatic gallstones can occur associated with lithiasis of the main bile duct, requiring the use of adequate diagnostic tools for subsequent treatment. In this paper, we suggest using the guidelines of the American Society for Gastrointestinal Endoscopy (ASGE), that uses factors such as age, liver tests, and ultrasound findings, categorizing patients as those with low, intermediate, and high probability. of choledocholithiasis. A Retrospective, observational, descriptive, cross-sectional design study, with a non-probabilistic sampling of consecutive cases, on patients with a diagnosis of symptomatic gallstones and suspected stones of the main bile duct admitted to the the 2nd Surgical Department and Service of Clinica´s Hospital of San Lorenzo, between the years 2017 to 2019. With the following results; of a total of 339 patients with the diagnosis of symptomatic gallstones, 6.64% had associated choledocholithiasis. Regarding the very strong predictors of choledocholithiasis, the most frequent (68.6%) was the total bilirubin level ≥ 4mg / dl; 70.6% had a dilated main bile duct as a strong predictor; as a moderate predictor, 84.3% had altered liver enzymes. In conclusion, it was possible to identify that most of the patients presented a high probability of choledocholithiasis and the action taken was to first perform an endoscopic retrograde cholangiography, for therapeutic purposes, and then cholecystectomy, corresponding to the correct management established by current international guidelines.

Bilirrubina: mecanismos tóxicos de una molécula antioxidante / Bilirubin: The toxic mechanisms of an antioxidant molecule

La hiperbilirrubinemia es el motivo más frecuente de consulta e internación en el período neonatal. Requiere la instauración oportuna de un tratamiento eficiente, ya que los recién nacidos son especialmente vulnerables a los daños que la bilirrubina puede causar en el sistema nervioso central, debido a características propias de esta etapa de la vida.La bilirrubina en altas concentraciones produce neurotoxicidad y estrés oxidativo. Sin embargo, estudios de biología molecular demuestran que la misma molécula se comporta como un potente antioxidante.El objetivo de esta actualización es revisar cuáles son los procesos por los que la bilirrubina genera daño celular y cuáles son sus efectos antioxidantes beneficiosos. Conocer estos mecanismos facilitaría una indicación más precisa de luminoterapia individualizada, eficaz y oportuna. Hasta nuevos avances científicos, la prescripción de este tratamiento debe ser orientada por consenso de expertos

Hyperbilirubinemia is the most common reason for consultation and hospitalization in the neonatal period. It requires a timely initiation of an effective treatment because newborn infants are especially vulnerable to damage caused by bilirubin in the central nervous system due to the characteristics typical of this stage of life.High bilirubin levels result in neurotoxicity and oxidative stress. However, molecular biology studies have demonstrated that bilirubin itself acts as a potent antioxidant.The objective of this update is to review the processes whereby bilirubin causes cell damage and determine its beneficial antioxidant effects. Knowing these mechanisms may facilitate a more accurate indication of a customized, effective, and timely phototherapy. Until new scientific advances are made, phototherapy should be prescribed based on expert consensus.

Uso de corticosteroides no tratamento da lesão hepática aguda grave decorrente de anabolizante estanazolol / Use of corticosteroids in the treatment of stanazolol-induce severe acute liver injury

A busca pelo corpo perfeito pode gerar graves consequências para a população que faz uso indiscriminado de substâncias visando a resultados rápidos. O caso relatado se refere a um pa- ciente de 21 anos, do sexo masculino, na cidade de São Paulo (SP), que apresentou quadro de síndrome colestática 15 dias após uso do anabolizante estanazolol para fins estéticos na ativi- dade física, evoluindo com hepatite medicamentosa grave, com aumento de transaminases, hiperrubilinemia às custas de bilirrubina direta e fatores de coagulação, sem resposta satis- fatória ao tratamento de suporte convencional, com melhora significativa após introdução de corticoterapia.

Searching for the perfect body image can cause severe conse- quences to the population using substances indiscriminately to reach results fast. The case reported refers to a male patient, 21 years old, from the city of São Paulo (SP), who developed choles- tatic syndrome 15 days after the use of the steroid Stanazol for aesthetic purposes during physical activity, progressing with se- vere drug-induced hepatitis, transaminases, bilirubin, and coagu- lation factors increase with no satisfactory response to the con- ventional support treatment, and significant improvement after the introduction of corticotherapy.

Dientes primarios verdes por hiperbilirubinemia / Dentes decíduos verdes por hiperbilirubinemia / Green deciduous teeth due to hyperbilirubinemia

Definida como una concentración sérica de bilirrubina, la hiperbilirrubinemia es una condición rara y puede ser causada por cualquier factor que eleve la carga de bilirrubina a ser metabolizada por el hígado. Así, la bilirrubina se distribuye por los tejidos corporales y se acumula en los tejidos duros, incluso, en los dientes primarios. El objetivo de este trabajo es relatar un caso clínico sobre la repercusión severa de la hiperbilirrubinemia en dientes primarios y sus manifestaciones bucales en la primera infancia, como dientes verdosos. Paciente del sexo masculino, 3 años y 8 meses, estuvo en clínica odontológica para evaluación de "manchas verdes en los dientes". En su historia médica se observó que nació prematuro y tuvo complicaciones posparto que evolucionaron para sepsis Dientes primarios verdes por hiperbilirrubinemiaIvana Aguiar Raposo,1..... Ronilza Matos,2.....• Marta Verônica Souto de Araujo,3..... •Tamara Kerber Tedesko,4.....José Carlos Pettorossi Imparato,5..... Revista de Odontopediatría Latinoamericana¹ São Leopoldo Mandic Campinas, Sao Paulo, Brasil.2 Universidade Paulista. 3 Universidade Federal de Pernambuco.4 Universidade Federal de Santa Maria.5 Universidade São Paulo - USP.Casos ClínicosDOI: 10.47990/alop.v11i2.304y, como consecuencia del uso de varios medicamentos, desarrolló un cuadro de hiperbilirrubinemia. El examen clínico dental constató la presencia de manchas verdes en los 20 dientes primarios, ausencia de lesión de caries, encías sanas y buena condición de higiene bucal. Se concluye que los altos niveles de bilirrubina desarrollados por el niño prematuro asociados a septicemia pueden llevar a la pigmentación verde (coloración intrínseca) en los dientes primarios durante el periodo de calcificación de los mismos (odontogénesis), incluso a la afectación de los dientes permanentes. Por eso, es relevante el conocimiento de la historia médica del niño desde el nacimiento para el establecimiento del diagnóstico y pronóstico de las alteraciones dentales

Defined as a serum bilirubin concentration, hyperbilirubinemia is a rare condition and can be caused by any factor that raises the bilirubin load to be metabolized by the liver. Thus, bilirubin is distributed throughout the body's tissues and accumulates in hard tissues, including primary teeth. The aim of this work is to report a clinical case about the severe repercussion of hyperbilirubinemia in primary teeth, and its early childhood manifestations, such as greenish teeth. A male patient, 3 years and 8 months old, attended the dental clinic for evaluation of "green spots on teeth". Medical history revealed that the child had premature birth and postpartum complications that evolved into sepsis, and due to the use of several drugs, developed hyperbilirubinemia. The dental clinical examination showed the presence of green spots on all 20 deciduous teeth, absence of carious lesions, healthy gums and good oral hygiene conditions. We conclude

Niveles de proteína C reactiva, bilirrubina y leucocitos como predictores de evolución anatomopatológica apendicular / Levels of C-reactive Protein, Bilirubin and Leucocytes as Predictors of Anotomopathological Appendicular Evolution

RESUMEN Introducción: La apendicitis aguda es la urgencia quirúrgica más frecuente en cualquier hospital del mundo. Aunque la mayoría de las veces se trata de un proceso intrabdominal banal, en ocasiones presenta una no desdeñable morbilidad y todavía en la época actual. Esta morbimortalidad se asocia, en la mayoría de los casos, a estados avanzados de afección apendicular. Objetivo: Predecir, con la cifra de bilirrubina, la proteína C reactiva y el recuento leucocitario, el estado del proceso apendicular agudo que presentaban los pacientes. Métodos: Se realizó un estudio observacional descriptivo en el que se han incluido aquellos pacientes intervenidos por sospecha de apendicitis aguda durante un periodo de 3 años (2017-2019) que cumplían los criterios de inclusión. Se analizó, como datos de laboratorio, la cifra de leucocitos, proteína C reactiva y bilirrubina. Resultados: Se observó un aumento de las cifras de proteína C reactiva y bilirrubina en los casos apendiculares avanzados, al igual que otros autores han evidenciado en la literatura. Así mismo, estos dos valores han resultado ser un factor de riesgo para presentar formas graves. El nivel de leucocitos sin embargo no ha demostrado relacionarse con la gravedad del proceso. Conclusiones: Vemos relevante el uso de los biomarcadores estudiados para predecir la gravedad apendicular con el objetivo de mejorar la asistencia en estos enfermos y disminuir las complicaciones derivadas del retraso terapéutico(AU)

ABSTRACT Introduction: Acute appendicitis is the most frequent surgical emergency in any hospital worldwide. Although most of the time it is a trivial intraabdominal process, sometimes it presents an unneglectable morbidity. This morbidity and the subsequent mortality are associated, in most cases, with advanced stages of an appendicular disease. Objective: To predict, using the value corresponding to bilirubin, C-reactive protein and leukocyte count, the state of acute appendicular process presented by patients. Methods: A descriptive observational study was carried out, including patients operated on for suspected acute appendicitis during a period of three years (2017-2019) and who met the inclusion criteria. The values for leukocyte count, C-reactive protein, and bilirubin were analyzed as laboratory data. Results: An increase in the values of C-reactive protein and bilirubin levels was observed in advanced appendicular cases, as other authors have shown in the medical literature. Likewise, these two values ​​have turned out to be a risk factor for presenting severe forms. However, the level of leukocytes has not been shown to be related to the severity of the process. Conclusions: We consider the use of the biomarkers studied as relevant to predict appendicular severity in view of improving care of these patients and reducing complications derived from therapeutic delay(AU)

¿Son los criterios de la ASGE suficientes para la estratificación del riesgo de coledocolitiasis? / ¿Are the ASGE criteria sufficient to stratify the risk of choledocholithiasis?

Resumen Introducción: la patología biliar litiásica es una de las entidades más frecuentes en el área de cirugía general y en gastroenterología. El tratamiento varía según el lugar donde se alojen los cálculos. Para esto, se han definido diversas escalas de estratificación del riesgo de presentar coledocolitiasis, pero son los criterios planteados por la Sociedad Americana de Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy, ASGE) los más usados a nivel mundial, ya que tienen una precisión diagnóstica definida del 70 %. Los procedimientos o ayudas diagnósticas establecidas por estos criterios, en ocasiones, prolongan el tiempo de hospitalización, aumentan los costos y pueden tener complicaciones. Metodología: se realizó un estudio observacional analítico, de tipo transversal retrospectivo, con datos obtenidos a partir de las historias clínicas de pacientes sometidos a colecistectomía laparoscópica, en la Clínica CES de Medellín, entre julio y diciembre de 2017. Resultados y conclusiones: se analizaron 424 historias clínicas de pacientes sometidos a colecistectomia laparoscópica. De ellos, 254 (56,76 %) se categorizaron como de riesgo bajo, mientras que 94 (22,11 %) fueron de riesgo intermedio y 76 (17,88 %) de riesgo alto. Se encontró una frecuencia de coledocolitiasis del 90,8 % en aquellos categorizados como de riesgo alto y del 26,6 % en los pacientes de riesgo intermedio. En la categoría de riesgo intermedio se hallaron diferencias estadísticamente significativas entre ambos grupos para los valores de bilirrubina total, bilirrubina directa y aspartato aminotransferasa (AST) (p = 0,001; p = 0,014; p = 0,007, respectivamente). La baja frecuencia de coledocolitiasis en la categoría de riesgo intermedio puede ser explicada por cálculos menores a 5 mm no visibles en la colangiorresonancia. A partir de este estudio, se propone ajustar los rangos de valores de los criterios de la ASGE para la categoría de riesgo intermedio, permitiendo tener una mayor precisión a la hora de clasificar los pacientes con patología litiásica y disminuir costos y estancia hospitalaria.

Abstract Introduction: Biliary lithiasis is one of the most frequent diseases in the area of general surgery and gastroenterology. Treatment varies depending on the location of the gallstones. Several stratification scales of the risk of choledocholithiasis have been defined, being the criteria proposed by the American Society of Gastrointestinal Endoscopy (ASGE) the most used worldwide, with a diagnostic accuracy of 70%. However, the procedures or diagnostic aids defined by these criteria, sometimes, increase hospital stay, costs, and may lead to the development of complications. Methodology: An observational, analytical, retrospective, cross-sectional study was conducted with data obtained from the clinical records of patients undergoing laparoscopic cholecystectomy at the CES Clinic in Medellín, Colombia, between July and December of 2017. Results and conclusions: 424 medical records were analyzed, of which 254 (56.76%) were classified as low-risk, 94 (22.11%) as intermediate-risk and 76 (17.88%) as high-risk. The frequency of choledocholithiasis was 90.8% in high-risk patients and 26.6% in intermediate-risk patients. For the intermediate-risk category, statistically significant differences were found between the two groups for the total bilirubin, direct bilirubin, and AST values (p: 0.001, p: 0.014, p:0.007, respectively). The low frequency of choledocholithiasis in the intermediate-risk category can be explained by less than 5mm gallstones not identified by the cholangioresonance. Based on this study, we propose to adjust the ranges of the ASGE criteria variables for the intermediate-risk category for better accuracy when classifying patients with biliary lithiasis and, thus, reduce costs and hospital stay.

Hemorragia suprarrenal neonatal en el contexto de ictericia neonatal isoinmune. Reporte de caso / Neonatal adrenal hemorrhage in the context of isoimmune neonatal jaundice. Case report

La hemorragia de las glándulas suprarrenales en el período neonatal se produce secundariamente a traumatismos del parto y a modificaciones de la presión venosa. La ictericia neonatal tiene como causa infrecuente la presencia de un hematoma suprarrenal. Los casos sintomáticos son poco frecuentes y, si se manifiestan, suele ser como ictericia prolongada.Se presenta el caso de un neonato que ingresó a las 20 horas de vida por ictericia isoinmune anti-A. Por aumento de bilirrubina directa, se solicitó una ecografía abdominal a los 10 días de vida, que mostró una masa suprarrenal derecha no vascularizada, de 50 x 21 mm, con imágenes quísticas en su interior, compatible con hemorragia de glándula suprarrenal derecha. La ecografía seriada mostró una resolución progresiva hasta desaparecer, y el paciente se mantuvo asintomático y sin ictericia. Cuando persiste una ictericia en el período neonatal, hay que evaluar la posibilidad de una hemorragia suprarrenal significativ

Hemorrhage of the adrenal glands in the neonatal period happens secondarily to birth trauma and to changes in venous pressure. Neonatal jaundice has as an infrequent etiology the presence of an adrenal gland hematoma. Symptomatic cases are rare, and if they manifest, it is usually as prolonged jaundice.We present the case of a neonate who was admitted at 20 hours of life due to isoimmune jaundice. Due to an increase in conjugated bilirubin, an abdominal ultrasound was requested at 10 days of life, which showed a non-vascularized right adrenal mass, 50 x 21 mm, with cystic images inside, compatible with bleeding of the right adrenal gland. Serial ultrasound showed a progressive resolution until its disappearance, keeping the baby asymptomatic and without jaundice. In cases of prolonged jaundice in the neonatal period, the possibility of significant adrenal hemorrhage must be assessed.

Is serum bilirubin level a predictor factor in parotid gland carcinoma? / O nível sérico de bilirrubina é um fator preditivo no carcinoma da glândula parótida?

Abstract Introduction: Bilirubin levels have been associated with risk of several malignancies. The association between pretreatment serum bilirubin levels and overall survival of patients with parotid gland carcinoma is unclear. Objectives: In this study, we assessed the effect of serum bilirubin levels to overall survival in malignant parotid tumors. Methods: This study included a total of 35 patients, 15 female and 20 male. The mean age of these patients was 60.7 ± 14.5 years. All patients who were diagnosed with parotid gland carcinoma and underwent total parotidectomy between 2008 and 2018, were retrospectively assessed. The relationship between the overall survival of patients and total bilirubin, direct bilirubin, and indirect bilirubin levels was estimated. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off points. Results: Patients with low direct bilirubin, total bilirubin and indirect bilirubin had significantly longer overall survival than those with high levels. Cut-off values for total bilirubin, direct bilirubin and indirect bilirubin were detected as 0.545 mg/dL, 0.175 mg/dL and 0.435 mg/dL, respectively. Conclusion: In our study, we observed that increased preoperative bilirubin levels are associated with reduced survival time in the postoperative period of patients with parotid gland carcinoma.

Resumo Introdução: Os níveis de bilirrubina têm sido associados ao risco de várias lesões malignas. A associação entre os níveis séricos de bilirrubina pré-tratamento e a sobrevida global dos pacientes com carcinoma da glândula parótida ainda não é clara. Objetivos: Neste estudo, avaliamos o efeito dos níveis séricos de bilirrubina na sobrevida global em tumores malignos de parótida. Método: Este estudo avaliou 35 pacientes, 15 do sexo feminino e 20 do masculino. A média de idade foi de 60,7 ± 14,5 anos. Pacientes diagnosticados com carcinoma da glândula parótida e submetidos a parotidectomia total entre 2008 e 2018 foram avaliados retrospectivamente. A relação entre a sobrevida global dos pacientes e os níveis de bilirrubina total, bilirrubina direta e bilirrubina indireta foi estimada. A análise da curva Receiver Operating Characteristic foi realizada para determinar os pontos de corte ideais. Resultados: Pacientes com níveis mais baixos de bilirrubina direta, bilirrubina indireta e bilirrubina total tiveram sobrevida global significantemente maior do que aqueles com valores mais altos. Valores de corte para bilirrubina total, bilirrubina direta e bilirrubina indireta foram estabelecidos como 0,545 mg/dL, 0,175 mg/dL e 0,435 mg/dL, respectivamente. Conclusão: Em nosso estudo, verificamos que níveis de bilirrubina aumentados no pré-operatório estão associados à redução do tempo de sobrevida no período pós-operatório em pacientes com carcinoma da glândula parótida.

Protective effect of Echinochrome against intrahepatic cholestasis induced by alpha-naphthylisothiocyanate in rats / Efeito protetor de Echinochrome contra colestase intra-hepática induzida por isotiocianato de alfa-naftilo em ratos

Abstract The present study was designed to evaluate the protective effects of echinochrome (Ech) on intrahepatic cholestasis in rats induced by a single (i.p.) injection of alpha-naphthylisothiocyanate (ANIT) (75 mg/kg body weight). The rats were pre-treated orally for 48hr (one dose / 24hr) with Ech (1, 5 and 10 mg/kg body weight) or ursodeoxycholic acid (UDCA) 80 mg/kg body weight drug then, injected with ANIT. ANIT markedly increased serum activities of alanine amino transaminase (ALT), aspartate amino transaminase (AST) and alkaline phosphatase (ALP), which was accompanied by a massive inflammation of epithelial cells on bile duct at 24h after ANIT injection. ANIT also increased the levels of total protein (TP), total bilirubin (TB), direct bilirubin (DB), indirect bilirubin (IB), however decrease albumin content (ALB). In addition ANIT increased hepatic MDA and NO level and decreased GSH level and GST activity. The Ech exerted hepatoprotective and anticholestatic effects as assessed by a significant decrease in the activities of serum AST, ALT and ALP, and the levels of TP, TB, DB and IB as well as liver MDA level and NO level. In conclusion, Ech was found to possess hepatoprotective effect against intrahepatic cholestasis induced by hepatotoxin such as ANIT.

Resumo O presente estudo destinou-se a avaliar os efeitos protetores do Ech na colestase intra-hepática em ratos induzidos por uma única injeção (i.p.) de alfa-naftilisotiocianato (ANIT) (75 mg / kg de peso corporal). Os ratos foram pré-tratados oralmente durante 48 horas (uma dose / 24 horas) com cada (1, 5 e 10 mg / kg de peso corporal) e ácido ursodeoxicólico (UDCA) 80 mg / kg de peso corporal, em seguida, injetado com ANIT. ANIT atividades de soro marcadamente aumentadas de alanina amino transaminasa (ALT), aspartato de amino transaminases (AST) e fosfatase alcalina (ALP), que foi acompanhada por uma inflamação maciça de células epiteliais no ducto biliar às 24h após a injeção de ANIT. A ANIT também aumentou os níveis de proteína total (TP), bilirrubina total (TB), bilirrubina direta (DB), bilirrubina indireta (IB), no entanto, diminuem o teor de albumina (ALB). Além disso, a ANIT aumentou o nível de MDA hepático e NO e diminuiu o nível de GSH e a atividade de GST. O Ech exerceu efeitos hepatoprotectores e anticolestáticos como avaliado por uma diminuição significativa nas atividades de AST sérica, ALT e ALP e os níveis de TP, TB, DB e IB, bem como o nível de MDA no fígado e o nível de NO. Ech foi encontrado para possuir efeito protetor no fígado contra a colestase intra-hepática induzida por hepatotoxina, como a ANIT.

Hyperbilirubinemia impact on newborn hearing: a literature review

SUMMARY The increase in bilirubin levels in newborns can cause toxic effects on the auditory system, which can lead to hearing loss. This review aimed to verify the impact of hyperbilirubinemia in the hearing of newborns, relating audiological findings to serum levels of bilirubin. A literature review was conducted during October 2017, using the terms "hyperbilirubinemia", "jaundice", "infant", "newborn" and "hearing loss", on databases CAPES journals, MEDLINE and BIREME (SciELO, BBO). 827 studies were identified and 59 were selected for full-text reading, resulting in the selection of seven articles that met the inclusion criteria and were considered relevant to the sample of this study. All the reviewed studies performed brainstem auditory evoked potential as the main test for audiological evaluation. Changes in the audiological findings of neonates with hyperbilirubinemia were observed in all studies. There was no consensus on the serum bilirubin levels that may cause auditory changes; however, the relationship between hearing disorders and blood levels of bilirubin was positive. We identify the need to establish reference values for bilirubin levels considered critical for the occurrence of hearing disorders as well as the audiological follow-up of neonates with hyperbilirubinemia.

RESUMO O aumento nos níveis de bilirrubina no neonato pode provocar efeitos tóxicos no sistema auditivo, podendo levar à perda auditiva. O objetivo desta revisão foi verificar o impacto da hiperbilirrubinemia na audição de recém-nascidos, relacionando os achados audiológicos aos níveis séricos de bilirrubina. Realizou-se uma revisão sistemática de literatura durante o mês de outubro de 2017, utilizando-se os termos hyperbilirubinemia, jaundice, infant, newborn e hearing loss, nas bases de dados periódicos Capes, Medline e Bireme (SciELO, BBO). Foram identificados 827 estudos, dentre os quais 59 foram selecionados para leitura do texto na íntegra, resultando na seleção de sete artigos que atendiam aos critérios de inclusão e foram considerados relevantes para a amostra deste trabalho. Em todas as pesquisas revisadas, o potencial evocado auditivo de tronco encefálico foi o principal exame audiológico realizado. Em todos os estudos foram observadas alterações nos resultados audiológicos de neonatos com hiperbilirrubinemia. Não houve consenso quanto aos níveis séricos de bilirrubina que podem causar alterações auditivas, porém, a relação entre as alterações audiológicas e os níveis sanguíneos de bilirrubina foi positiva. Percebeu-se a necessidade de estabelecer valores de referência para os níveis de bilirrubina considerados críticos para a ocorrência de alterações audiológicas, assim como de acompanhamento audiológico dos neonatos com hiperbilirrubinemia.

Epidemiological profile, referral routes and diagnostic accuracy of cases of acute cholangitis among individuals with obstructive jaundice admitted to a tertiary-level university hospital: a cross-sectional study

ABSTRACT BACKGROUND: Obstructive jaundice may lead to ominous complications and requires complex diagnostic evaluations and therapies that are not widely available. OBJECTIVE: To analyze the epidemiological profile, referral routes and diagnostic accuracy at admittance of cases of acute cholangitis among patients with obstructive jaundice treated at a referral unit. DESIGN AND SETTING: Cross-sectional study at a tertiary-level university hospital. METHODS: Patients with obstructive jaundice who were treated by means of endoscopic retrograde cholangiopancreatography, resection and/or surgical biliary drainage were evaluated. The main variables analyzed were epidemiological data, referral route, bilirubin levels and time elapsed between symptom onset and admittance and diagnosing of acute cholangitis at the referral unit. The accuracy of the clinical diagnosis of acute cholangitis was compared with a retrospective analysis on the medical records in accordance with the Tokyo criteria. RESULTS: Female patients predominated (58%), with an average age of 56 years. Acute cholangitis was detected in 9.9% of the individuals; application of the Tokyo criteria showed that the real prevalence was approximately 43%. The main referral route was direct contact (31.8%) and emergency care (29.7%); routing via official referral through the public healthcare system accounted for 17.6%, and internal referral from other specialties, 20%. The direct route with unofficial referral was the most important route for cases of neoplastic etiology (P < 0.01) and was the fastest route (P < 0.01). CONCLUSIONS: There is a deficiency in the official referral routes for patients with obstructive jaundice. The accuracy of the clinical diagnosis of acute cholangitis was poor. Wider dissemination of the Tokyo criteria is essential.

Utilización práctica del laboratorio en las enfermedades hepáticas / Practical use of the laboratory in hepatic diseases

RESUMEN El médico asistencial debe evaluar a diario las pruebas hepáticas en personas con afecciones del hígado, o en los llamados controles a personas supuestamente normales. El objetivo fue facilitar la reflexión práctica en la interpretación de las pruebas hepáticas. Se realizó una revisión de las publicaciones más importantes en base de datos como MEDLINE, EMBASE y Scielo en los últimos años para facilitar la interpretación de las pruebas de laboratorio en el estudio de las lesiones del hígado. En la práctica diaria la elevación de las aminotransferasas, ha sido asociada con un incremento en la mortalidad total y está relacionada con disfunción hepática. Los estudios imagenológicos al igual que la biopsia hepática pueden ser considerados cuando las pruebas hepáticas no definen el diagnóstico, para estudiar al enfermo o cuando los posibles diagnósticos sean múltiples, por lo que definir el valor de la elevación de los niveles de alanino aminotransferasas, aspartato aminotransferasas, junto a la los niveles de fosfatasa alcalina y bilirrubina en la lesión colestática, unidas al uso de pruebas que miden el metabolismo celular en la enfermedad hepatocelular o la colestasis son de vital importancia la práctica médica diaria (AU).

SUMMARY The physician providing health care should daily evaluate hepatic testes in persons with liver diseases, or in the so-called controls to persons supposedly healthy. The aim of this work was facilitating practical reflection in the interpretation of hepatic testes. The most important works published in MEDLINE, EMBASE and Scielo during the last years were reviewed for understanding laboratory tests in the study of hepatic lesions. In the regular practice the increase of aminotransferases has been associated to a growth of total mortality, and this one related to hepatic dysfunction. The imaging studies and also hepatic biopsy should be taking into consideration when hepatic testes do not define the diagnosis, to study the patient, or when there are many possible diagnoses; therefore defining the growth of the alaninotransferase and aspartate aminotransferase levels together with the levels of alkaline phosphatase and bilirubin in the cholestasis lesion and the use of testes measuring the cell metabolism in the hepatocellular disease or cholestasis are very important in the day-to-day medical practice (AU).

Eficácia hepatoprotetora do extrato metanólico de Indigofera suffruticosa (Mill) em lesão hepática induzido por paracetamol em camundongos / Hepatoprotective efficacy of methanolic extract of indigofera suffruticosa (mill) on paracetamol-induced liver damage in mice

ABSTRACT BACKGROUND: Indigofera suffruticosa Mill (Fabaceae) is abundant in northeastern Brazil and popularly used in the treatment of infectious and inflammatory processes. Several biological properties, such as anti-inflammatory, anticancer, antitumor, hepatoprotective and low toxicity, are reported for this plant. OBJECTIVE: This study investigated hepatoprotective activity and the antioxidant effect of methanolic extract of I. suffruticosa leaves (MEIS) on Swiss albino mice submitted to experimental models of acetaminophen-induced liver injury. METHODS: MEIS (50 mg/kg; p.o.) was standardized according to the LD50 and its hepatoprotective property on Swiss albino mice evaluated during a 7-day period. On the eighth day, the acetaminophen-induced hepatic injury was performed. Histomorphometric analysis of liver tissue, antioxidant activity and serum levels of alanine aminotransferase (AST), aspartate aminotransferase (ALT) and bilirubin were measured. RESULTS: MEIS (50 mg/kg; p.o.) restored serum enzyme levels and results were close to those of positive control (silymarin) when compared to the negative control. Histopathological and histomorphometric analyzes confirmed MEIS hepatoprotective activity, showing reorganization of structural units of cells, nuclei and sinusoidal capillaries of hepatocytes, reducing the damage on liver tissue and increasing organ regeneration rate. MEIS showed high antioxidant potential at concentrations of 1000 and 500 µg/mL. CONCLUSION: This study suggests that MEIS has hepatoprotective activity and high antioxidant potential.

RESUMO CONTEXTO: Indigofera suffruticosa Mill (Fabaceae) é abundante no nordeste do Brasil e popularmente utilizada no tratamento de processos infecciosos e inflamatórios. Várias propriedades biológicas, como anti-inflamatório, anticâncer, antitumoral, hepatoprotetor e baixa toxicidade, são relatadas para esta planta. OBJETIVO: Este estudo investigou a atividade hepatoprotetora e o efeito antioxidante do extrato metanólico de folhas de I. suffruticosa (MEIS) em camundongos albinos suíços submetidos a modelos experimentais de lesão hepática induzida por paracetamol. MÉTODOS: O MEIS na dose de 50 mg/kg (via oral) foi padronizado de acordo com a LD50 e sua propriedade hepatoprotetora em camundongos albinos Swiss avaliados durante um período de sete dias. No oitavo dia, a lesão hepática foi induzida por paracetamol em todos grupos pre-tratados. Foram medidos os níveis sericos enzimaticos, alanina aminotransferase, aspartato aminotransferase e bilirrubina, análise histomorfométrica do tecido hepático e atividade antioxidante. RESULTADOS: O MEIS restaurou os níveis séricos de enzimas e os resultados foram próximos aos do controle positivo (silimarina) quando comparados ao controle negativo. As análises histopatológicas e histomorfométricas confirmaram a atividade hepatoprotetora do MEIS, mostrando reorganização das unidades estruturais das células, núcleos e capilares sinusoidais dos hepatócitos, reduzindo os danos no tecido hepático e aumentando a taxa de regeneração de órgãos. O MEIS apresentou alto potencial antioxidante nas concentrações de 1000 e 500 µg/mL. CONCLUSÃO: Este estudo sugere que I. suffruticosa tem atividade hepatoprotetora e alto potencial antioxidante.