Metabolic disease and the liver: A review.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, with an estimated prevalence of 31% in Latin America. The presence of metabolic comorbidities coexisting with liver disease varies substantially among populations. It is acknowledged that obesity is boosting the type 2 diabetes mellitus "epidemic," and both conditions are significant contributors to the increasing number of patients with MASLD. Non-alcoholic steatohepatitis represents a condition of chronic liver inflammation and is considered the most severe form of MASLD. MASLD diagnosis is based on the presence of steatosis, noninvasive scores and altered liver tests. Noninvasive scores of liver fibrosis, such as serum biomarkers, which should be used in primary care to rule out advanced fibrosis, are simple, inexpensive, and widely available. Currently, guidelines from international hepatology societies recommend using noninvasive strategies to simplify case finding and management of high-risk patients with MASLD in clinical practice. Unfortunately, there is no definite pharmacological treatment for the condition. Creating public health policies to treat patients with risk factors for MASLD prevention is essential.

High red meat consumption among PNPLA3 polymorphism carriers is associated with NAFLD in a multi-center cross-sectional study.

BACKGROUND & AIM: Patatin-like phospholipase domain-containing 3 gene (PNPLA3) polymorphism has been implicated in susceptibility to non-alcoholic fatty liver disease (NAFLD), with evidence for potential interaction with nutrition. However, the combination of meat consumption with genetic polymorphism has not been tested. Therefore, this study aims to test the association between the joint presence of PNPLA3 rs738409 G-allele with high meat consumption and NAFLD in populations with diverse meat consumption. METHODS: A cross-sectional study among Israeli screening and Brazilian primary healthcare populations. Food consumption was assessed by a food-frequency questionnaire. PNPLA3 polymorphism was defined as homozygous (GG) or heterozygous (GC). Inconclusive/probable NAFLD was defined as a fatty liver index (FLI) ≥ 30 and probable NAFLD as FLI ≥ 60. RESULTS: The sample included 511 subjects from the screening and primary healthcare populations (n = 213 and n = 298, respectively). Genetic polymorphism (homozygous GG or heterozygous GC) combined with high consumption of total meat, red and/or processed meat, unprocessed red meat, and processed meat was associated with the highest odds for inconclusive/probable NAFLD (OR = 2.75, 95%CI 1.27-5.97, p = 0.011; OR = 3.24, 1.43-7.34, p = 0.005; OR = 2.92, 1.32-6.47, p = 0.008; OR = 3.16, 1.46-6.83, p = 0.003, respectively), adjusting for age, gender, BMI, alcohol consumption, carbohydrate, and saturated fat intake. In addition, genetic polymorphism combined with high processed meat consumption was associated with the highest odds for probable NAFLD (OR = 2.40, 95%CI 1.04-5.56, p = 0.040). CONCLUSIONS: High red meat intake may confer a greater risk for NAFLD among PNPLA3 polymorphism carriers. Prospective studies are needed to confirm these findings and consider minimizing red and processed meat consumption among PNPLA3 polymorphism carriers.

MINIMAL LIVER ENZYMES ABNORMALITIES AT ADMISSION ARE RELATED TO SEVERE COVID-19 CLINICAL COURSE IN A LARGE BRAZILIAN COHORT.

BACKGROUND: COVID-19 is a multisystemic disease, primarily affecting the respiratory system. Liver involvement is frequent, but the impact on the clinical course and outcomes are controversial. OBJECTIVE: The aim was to assess liver function at the admission and evaluate its effects on severity and mortality in hospitalized patients with COVID-19. METHODS: This is a retrospective study of hospitalized patients in a tertiary hospital in Brazil, with a PCR-confirmed SARS-CoV-2 infection between April and October 2020. 1080 out of 1229 patients had liver enzymes on admission and were divided in two cohorts, based on the presence or absence of abnormal liver enzymes (ALE). Demographic, clinical, laboratory, imaging, clinical severity, and mortality were evaluated. Patients were followed until discharge, death or transfer to another institution. RESULTS: Median age was 60 years and 51.5% were male. The more frequent comorbidities were hypertension (51.2%), and diabetes (31.6%). Chronic liver disease and cirrhosis were present in 8.6% and 2.3%, respectively. ALE (aminotransferases higher than 40 IU/L) were present in 56.9% of patients [mild (1-2 times): 63.9%; moderate (2-5 times): 29.8%; severe (>5 times): 6.3%]. Male gender [RR 1.49, P=0.007], increased total bilirubin [RR 1.18, P<0.001] and chronic liver disease [RR 1.47, P=0.015] were predictors of abnormal aminotransferases on admission. Patients with ALE had a higher risk of disease severity [RR 1.19; P=0.004]. There was no association among ALE and mortality. CONCLUSION: ALE is common in COVID-19 hospitalized patients and were independently correlated with severe COVID-19. Even mild ALE at admission may be a severity prognostic marker.

Changes in the gut microbiota of rats after exposure to the fungicide Mancozeb.

Mancozeb is a fungicide commonly used in pest control programs, especially to protect vineyards. Its toxicity has already been evidenced in several studies. However, its influence on the composition and diversity of the gut microbiota remains unknown. In this work, the adverse impact of Mancozeb on the intestinal microbiota was investigated using a rodent model. Adult male Sprague Dawley rats were randomized into three groups: Control (standard diet), MZ1 (Mancozeb dose: 250 mg/kg bw/day), and MZ2 (Mancozeb dose: 500 mg/kg bw/day). After 12 weeks of experiment, animals were euthanized, and feces present in the intestine were collected. After fecal DNA extraction, the V4 region of the 16S rRNA gene was amplified followed by sequencing in an Ion S5™ System. Alpha and beta diversity analysis showed significant differences between Control and Mancozeb groups (MZ1 e MZ2), but no difference between MZ1 and MZ2 was observed. Seven genera significantly increased in abundance following Mancozeb exposure, while five genera decreased. Co-occurrence analyses revealed that the topological properties of the microbial networks, which can be used to infer co-occurrence interaction patterns among microorganisms, were significantly lower in both groups exposed to Mancozeb when compared to Control. In addition, 23 differentially abundant microbial metabolic pathways were identified in Mancozeb-treated groups mainly related to a change in energy metabolism, LPS biosynthesis, and nucleotide biosynthesis. In conclusion, the exposure to Mancozeb presented side effects by changing the composition of the microbiota in rats, increasing bacterial diversity regardless of the dose used, reducing the interaction patterns of the microbial communities, and changing microbial metabolic pathways.

Alterações mínimas em enzimas hepáticas à admissão hospitalar correlacionam-se à gravidade da COVID-19 em uma grande coorte no Brasil / Minimal liver enzymes abnormalities at admission are related to severe covid-19 clinical course in a large brazilian cohort

ABSTRACT Background: COVID-19 is a multisystemic disease, primarily affecting the respiratory system. Liver involvement is frequent, but the impact on the clinical course and outcomes are controversial. Objective: The aim was to assess liver function at the admission and evaluate its effects on severity and mortality in hospitalized patients with COVID-19. Methods: This is a retrospective study of hospitalized patients in a tertiary hospital in Brazil, with a PCR-confirmed SARS-CoV-2 infection between April and October 2020. 1080 out of 1229 patients had liver enzymes on admission and were divided in two cohorts, based on the presence or absence of abnormal liver enzymes (ALE). Demographic, clinical, laboratory, imaging, clinical severity, and mortality were evaluated. Patients were followed until discharge, death or transfer to another institution. Results: Median age was 60 years and 51.5% were male. The more frequent comorbidities were hypertension (51.2%), and diabetes (31.6%). Chronic liver disease and cirrhosis were present in 8.6% and 2.3%, respectively. ALE (aminotransferases higher than 40 IU/L) were present in 56.9% of patients [mild (1-2 times): 63.9%; moderate (2-5 times): 29.8%; severe (>5 times): 6.3%]. Male gender [RR 1.49, P=0.007], increased total bilirubin [RR 1.18, P<0.001] and chronic liver disease [RR 1.47, P=0.015] were predictors of abnormal aminotransferases on admission. Patients with ALE had a higher risk of disease severity [RR 1.19; P=0.004]. There was no association among ALE and mortality. Conclusion: ALE is common in COVID-19 hospitalized patients and were independently correlated with severe COVID-19. Even mild ALE at admission may be a severity prognostic marker.

RESUMO Contexto: COVID-19 é uma doença sistêmica que afeta primariamente o sistema respiratório. O comprometimento hepático é frequente, mas seu impacto no curso clínico da doença ainda é controverso. Objetivo: Avaliar na admissão hospitalar a função hepática de pacientes com COVID-19 e correlacioná-la à gravidade e mortalidade da doença. Métodos: Estudo retrospectivo de pacientes admitidos a um hospital terciário no Brasil, com infecção confirmada por SARS-CoV-2 entre abril e outubro de 2020. A coorte foi dividida em pacientes com enzimas normais ou alterada, e avaliados dados demográficos, clínicos, laboratoriais e de imagem, bem como a gravidade clínica e a mortalidade. Os pacientes foram seguidos até a alta ou óbito. Resultados: 1080 de 1229 pacientes tiveram enzimas hepáticas na admissão. A mediana de idade foi de 60 anos e 51,5% eram homens. As comorbidades mais comuns foram hipertensão (51,2%) e diabetes mellitus (31,6%). Doença hepática crônica ou cirrose estiveram presentes em 8,6% e 2,3%, respectivamente. Enzimas normais ou alterada (aminotransferases >40 IU/L) esteve presente em 56,9% [leve (1-2 vezes o normal): 63,9%; moderada (2-5 vezes): 29,8%; acentuada (>5 vezes): 6,3%]. Homens [RR 1,49; P=0,007], bilirubina total elevada [RR 1,18; P<0,001] e doença hepática crônica [RR 1,47, P=0,015] foram preditores de enzimas normais ou alterada na admissão. Pacientes com enzimas normais ou alterada tiveram maior risco de COVID-19 grave [RR 1,19; P=0,004]. Não houve associação entre enzimas normais ou alterada e mortalidade. Conclusão: Enzimas normais ou alterada é comum em pacientes hospitalizados com COVID-19. Mesmo alterações mínimas correlacionam-se de forma independente com a gravidade da doença e podem ser úteis como marcador prognóstico.

Elevada taxa de insegurança alimentar em unidades de triagem de resíduos no sul do Brasil: insegurança alimentar em recicladores / High food insecurity in recyclers from waste sorting units in southern Brazil: high food insecurity in recyclers

Introdução: No Brasil, existem poucos estudos com recicladores de Unidades de Triagem de Resíduos (UTRs). Vários fenômenos sociais têm sido associados ao aumento da Insegurança Alimentar (IA) em países menos desenvolvidos. O estudo tem como objetivo descrever a prevalência de insegurança alimentar em recicladores.Métodos: Estudo transversal realizado com adultos associados de duas UTRs na cidade de Porto Alegre, sul do Brasil, entre 2017 a 2018. Todas as coletas ocorreram nas UTRs. Os indivíduos tiveram seu estado nutricional avaliado por medidas antropométricas através da aferição de peso, altura e circunferência da cintura. A taxa de Insegurança Alimentar foi avaliada pela Escala Brasileira de Insegurança Alimentar (EBIA) e o risco para uso de substâncias foi avaliado pelo Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).Resultados: Foram avaliados 123 sujeitos, com idade média de 35 ± 13,4 anos, sendo 66% do sexo feminino. Foi identificada uma taxa de IA de 74%, sendo que destes, 16% apresentaram Insegurança Alimentar Grave. Cerca de 57% dos participantes apresentaram sobrepeso ou obesidade e 48% circunferência da cintura aumentada. Em relação ao uso de substâncias, 60,5% relataram abuso de tabaco e 14% de álcool.Conclusão: São necessárias intervenções multidisciplinares para prevenir as situações encontradas e a implementação de políticas públicas voltadas para os atos de promoção da saúde na população de recicladores. É fundamental que tanto a sociedade, quanto o governo reconheçam a existência destes problemas para que medidas efetivas possam ser instituídas.

Introduction: In Brazil, there are few studies with recyclers of Waste Sorting Units (WSUs). Several social phenomena have been associated with increased food insecurity (FI) in less developed countries. The study aims to describe food insecurity prevalence in recyclers.Methods: Cross-sectional study conducted with adults from two WSUs in the city of Porto Alegre, southern Brazil, between 2017 and 2018. All data assessment occurred in WSUs. Anthropometric measurements were assessed by weight, height and waist circumference. Food insecurity was assessed with the Brazilian Food Insecurity Scale (EBIA) and substance use was evaluated by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).Results: 123 subjects were evaluated, with a mean age of 35 ± 13.4 years, 66% of which were female. A FI rate of 74% was identified, and of these, 16% had Severe Food Insecurity. About 57% of participants were overweight or obese and 48% presented high waist circumference. Regarding substance use, 60.5% were classified for tobacco abuse and 14% for alcohol abuse.Conclusion: Multidisciplinary interventions are needed to prevent all health issues encountered as well as implementation of public policies for the recyclers' health promotion. It is essential that both society and the government recognize the existence of these problems so that measures can be carried out by health institutions.

Heart failure secondary to myocarditis after SARS-CoV-2 reinfection: a case report.

INTRODUCTION: Cardiac involvement in COVID-19 can range from mild damage to severe myocarditis. The precise mechanism by which COVID-19 causes myocardial injury is still unknown. Myocarditis following administration of COVID-19 vaccines, especially those based on mRNA, has also been described. However, no reports of heart failure following reinfection with SARS-CoV-2 in patients immunized with an inactivated vaccine have been identified. CASE DESCRIPTION: The patient was a 47-year-old male construction worker of African descent, with type II diabetes and a history of infection by SARS-CoV-2 in December 2020 and May 2021, confirmed by RT-PCR. He received two doses of an inactivated vaccine against COVID-19. Between the two COVID-19 episodes with positive RT-PCR, he had two episodes of bacterial lung infection. After the second episode of SARS-CoV-2 infection, he was diagnosed with severe heart failure as a sequela of myocarditis. CONCLUSION: It is essential to perform a thorough follow-up after infection with SARS-CoV-2 since, even with proper immunization, it is possible that the patient was reinfected and suffered severe cardiac sequelae as a consequence. The hypothesis of an etiology associated with the use of an inactivated vaccine against COVID-19, with a potential immune enhancement mechanism following reinfection with SARS-CoV-2, cannot be rejected.

Reduction in COVID-19 prevalence in healthcare workers in a university hospital in southern Brazil after the start of vaccination.

INTRODUCTION: The quick spread of SARS-CoV-2 led to the development of vaccines that are capable of reducing infection and the number of more severe COVID-19 cases. AIM: To assess COVID-19 prevalence among healthcare workers (HCWs) after vaccination against SARS-CoV-2. METHODS: This was a cross-sectional study on the prevalence of COVID-19 diagnosis among 7523 HCWs vaccinated against SARS-CoV-2 with CoronaVac and ChAdOx1 nCoV-19 in a university hospital, in southern Brazil, between January 18 and March 18, 2021.The variables evaluated were: sex, age, work area, role, source of infection, previous diagnosis of COVID-19, date of vaccine administration, type of vaccine, and need for hospitalization. The statistical analysis used Poisson regression and Fisher's exact test with SPSS software version 25, and a level of significance set at 5%. RESULTS: 813 vaccinated HCWs showed symptoms suggestive of COVID-19, of whom 35.4% (288) had a detectable result after undergoing RT-PCR for SARS-CoV-2. There was a reduction of 62% in new cases of COVID-19 among HCWs in the institution 7 weeks after the start of vaccine rollout. CONCLUSION: Our data suggest that the vaccines used by the institution reduced the number of COVID-19 cases among healthcare workers, demonstrating the effectiveness of the vaccines.

Exposure to organic solvents and hepatotoxicity.

The purpose of this study was to identify the long-term effect of chemical exposure on the liver. Laboratory tests included alanine aminotransferase (ALT) dosage and oxidative stress tests, such as thiobarbituric acid reactive substances in plasma and superoxide dismutase (SOD) and glutathione S-transferase analysis in erythrocytes. The cross-sectional study comprised 70 workers, 30 of them exposed to organic solvents and 40 not exposed. All those exposed presented at least 5 years of exposure to solvents. Hepatitis B and C, known hepatic disease, comorbidities, use of alcohol, illicit drugs or hepatotoxic medications, smoking, body mass index >30, female sex and age (<18 or >65) were excluded from the sample. Results indicated that elevated ALT was more frequent in the exposed group compared to controls: 33% vs. 10.5%, with a statistical significance (p < 0.05). Thiobarbituric acid reactive substances were significantly elevated (p < 0.01) in the exposed group in comparison to controls. Antioxidant enzymes were more elevated in the exposed group compared to controls: SOD 7.29 (4.30-8.91) USOD/mg of protein vs. 3.48 (2.98-5.28) USOD/mg of protein and GST 2.57 µmol/min/mg of protein (1.80-4.78) vs. 1.81 µmol/min/mg of protein (1.45- 2.30) µM/min/mg of protein. The results suggest an association between exposure to organic solvents and hepatotoxicity.

Efetividade de um programa de prevenção e capacitação para redução de acidentes ocupacionais por material biológico / Effectiveness of a prevention and training program to reduce work accidents involving exposure to biological materials

Introdução: Os acidentes de trabalho com material biológico (ATMB) vêm aumentando significativamente no decorrer dos anos e suas consequências de maior importância epidemiológica são as transmissões de patógenos como os vírus da imunodeficiência humana e das hepatites B e C. Objetivo: Avaliar a efetividade de um programa de prevenção e capacitação para redução de acidentes ocupacionais por material biológico em hospital-escola a partir da incidência dos ATMB durante os oito anos de implementação do programa. Métodos: O presente estudo foi realizado de forma descritiva, retrospectiva, por coleta no banco de dados do Serviço de Tecnologia em Recursos Humanos de um hospital-escola. A população do estudo foi composta por 1.445 funcionários do hospital-escola que sofreram acidente ocupacional de exposição com material biológico do tipo perfurante ou cortante. Resultados: De um total de 1.445 acidentes de trabalho com instrumentos perfurantes ou cortantes, 47,5% foram por descarte inadequado de materiais potencialmente contaminados. Foi observada uma taxa de queda anual de 0,21% nos acidentes percutâneos e de 0,36% nos acidentes percutâneos por descarte inadequado. Conclusão: Os achados deste estudo indicam que o programa desenvolvido e implementado resultou na diminuição significativa dos acidentes ocupacionais por material biológico do tipo perfurocortante.

Background: The frequency of work accidents involving exposure to biological materials (WAEMB) is significantly increasing. The most relevant epidemiological consequences of this type of accidents are due to the transmission of pathogens including the human immunodeficiency and hepatitis B and C viruses. Objective: To assess the effectiveness of a prevention and training program to reduce the incidence of WAEMB at a teaching hospital along 8 years of implementation. Methods: Retrospective descriptive study based on data obtained from the hospital Human Resource Technology Department. We analyzed records of 1,445 hospital employees who suffered sharps injuries. Results: About 50% of the incidents were caused by inadequate sharps disposal. The overall rate of sharps injuries decreased by 0.21%/year and that of accidents due to inadequate sharps disposal by 0.36%. Conclusion: The results of the present study indicate that the implemented program was associated with significant reduction of the incidence of WAEMB.

Effectiveness of a prevention and training program to reduce work accidents involving exposure to biological materials.

BACKGROUND: The frequency of work accidents involving exposure to biological materials (WAEMB) is significantly increasing. The most relevant epidemiological consequences of this type of accidents are due to the transmission of pathogens including the human immunodeficiency and hepatitis B and C viruses. OBJECTIVE: To assess the effectiveness of a prevention and training program to reduce the incidence of WAEMB at a teaching hospital along 8 years of implementation. METHODS: Retrospective descriptive study based on data obtained from the hospital Human Resource Technology Department. We analyzed records of 1,445 hospital employees who suffered sharps injuries. RESULTS: About 50% of the incidents were caused by inadequate sharps disposal. The overall rate of sharps injuries decreased by 0.21%/year and that of accidents due to inadequate sharps disposal by 0.36%. CONCLUSION: The results of the present study indicate that the implemented program was associated with significant reduction of the incidence of WAEMB.

INTRODUÇÃO: Os acidentes de trabalho com material biológico (ATMB) vêm aumentando significativamente no decorrer dos anos e suas consequências de maior importância epidemiológica são as transmissões de patógenos como os vírus da imunodeficiência humana e das hepatites B e C. OBJETIVO: Avaliar a efetividade de um programa de prevenção e capacitação para redução de acidentes ocupacionais por material biológico em hospital-escola a partir da incidência dos ATMB durante os oito anos de implementação do programa. MÉTODOS: O presente estudo foi realizado de forma descritiva, retrospectiva, por coleta no banco de dados do Serviço de Tecnologia em Recursos Humanos de um hospital-escola. A população do estudo foi composta por 1.445 funcionários do hospital-escola que sofreram acidente ocupacional de exposição com material biológico do tipo perfurante ou cortante. RESULTADOS: De um total de 1.445 acidentes de trabalho com instrumentos perfurantes ou cortantes, 47,5% foram por descarte inadequado de materiais potencialmente contaminados. Foi observada uma taxa de queda anual de 0,21% nos acidentes percutâneos e de 0,36% nos acidentes percutâneos por descarte inadequado. CONCLUSÃO: Os achados deste estudo indicam que o programa desenvolvido e implementado resultou na diminuição significativa dos acidentes ocupacionais por material biológico do tipo perfurocortante.

Needlestick accident resulting in occupational transmission of HCV: report of two cases

Occupational transmission of hepatitis C virus (HCV) through needlestick injury is a serious problem worldwide. Occupational transmission of HCV is estimated at an average rate between 0.5% and 0.75%. There are factors associated with increased risk of transmission, such as deep injuries, procedures involving hollow-bore needle placement in the source patient’s vein or artery, and high HCV RNA titer in the source patient. We describe two cases of HCV seroconversion in nursing assistants after different risk needlestick injuries...