EncephalApp Stroop Test validation for the screening of minimal hepatic encephalopathy in Brazil.

INTRODUCTION AND OBJECTIVES: The EncephalApp Stroop Test was developed to more easily diagnose minimal hepatic encephalopathy (MHE). A cut-off of >274.9sec (ONtime+OFFtime) reached a 78% sensitivity and 90% specificity in the validation study, but it has been poorly studied in Brazil. We aim to analyze the usefulness of this diagnostic method and to describe a cut-off value to screen MHE in Brazil. METHODS: In this cross-sectional and single-center study, three positive psychometric tests defined the diagnosis of MHE as the gold standard. We evaluated gender, age, education, familiarity with smartphones, etiology of cirrhosis, Child-Pugh/MELD scores, and previous hepatic encephalopathy (HE). Healthy controls and patients without HE were compared for the task validation. The Chi-square and Mann-Whitney tests, logistic regression analysis, and ROC curves were used for statistical evaluation. RESULTS: We included 132 patients with cirrhosis (61% male) and 42 controls (62% male) around 51y. Sixty-three were diagnosed with MHE on psychometric tests and 23 had clinical HE. Viral hepatitis (38%) was the major etiology of cirrhosis. The median MELD was 10 and Child-Pugh A was more frequent (70%). There was no significant difference in test results between controls and patients without HE. There was also no influence of gender, age, education, and familiarity with smartphones in the test results. Child-Pugh A was associated with MHE (p=0.0106). A cut-off of >269.8sec (ONtime+OFFtime) had an 87% sensitivity and 77% specificity to detect MHE (p=0.002). CONCLUSION: This is a valid and reliable tool for screening MHE. However, optimal cut-off values need to be validated locally.

Changes in indications for outpatient percutaneous liver biopsy over 5 years: from hepatitis C to fatty liver disease.

INTRODUCTION: Although the use of non-invasive methods for assessment of liver fibrosis has reduced the need for biopsy, the diagnosis of liver damage still requires histological evaluation in many patients. We aim to describe the indications for percutaneous liver biopsy (PLB) and the rate of complications in an outpatient setting over 5 years. METHODS: This observational, single-center, and retrospective study included patients submitted to real-time ultrasound (US)-guided biopsies from 2015 to 2019. We collected age, gender, coagulation tests, comorbidities, and the number of needle passes. The association between the variables and complications was evaluated using the generalized estimating equations method. RESULTS: We analyzed 532 biopsies in 524 patients (55.3% male) with a median age of 49 years (range 13-74y). An average of 130.3 biopsies per year were performed in the first 3 years of the study versus 70.5 in the other 2y. The main indications were hepatitis C virus (HCV) infection (47.0%), autoimmune and cholestatic liver diseases (12.6%), and metabolic dysfunction-associated fatty liver disease (MAFLD) (12.1%). The number of HCV-related biopsies had a remarkable reduction, while MAFLD-related procedures have progressively raised over time. Around 54% of the patients reported pain, which was significantly associated with females (p=0.0143). Serious complications occurred in 11 patients (2.1%) and hospital admission was necessary in 10 cases (1.9%). No patient required surgical approach and there were no deaths. No significant association was found between the studied variables and biopsy-related complications. CONCLUSION: The indications for PLB in an outpatient setting have changed from HCV to MAFLD over the years. This procedure is safe and has a low rate of serious complications, but new strategies to prevent the pain are still needed, especially for females.

Validaçäo de um método imunoenzimático para detecçäo da infecçäo pelo Helicobacter Pylori / Validation of an immunoenzymatic method for detection of the Helicobacter pylori infection

A infecçäo pelo Heliocobacter Pylori está relacionada a várias doenças digestivas. A sorologia é um método diagnóstico näo-invasivo e de baixo custo. Contudo, os kits comerciais apresentam eficácia em geral variável. O HM-CAP, um método imunoenzimático que detecta IgG específica anti-H. pylori, foi avaliado. Foram estudados 77 pacientes com sintomatologia dispéptica e com resultados de histologia, cultura e urease compatíveis. Os soros destes pacientes foram submetidos ao ensaio e os resultados, comparados com os outros exames. Assim, a sensibilidade do HM-CAP foi de 88,1 por cento; a especificidade, de 61,1 por cento; o valor preditivo positivo, de 88,1 por cento; o valor preditivo negativo, de 61,1 por cento; a prevalência, de 76,6 por cento; e a acurácia, de 81,8 por cento. Näo houve diferença significativa quanto a sensibilidade e especificidade entre os grupos de indivíduos com idades acima e abaixo de 45 anos