Recurrent anaemia in a patient with lymphocytic gastritis and vitamin B12 deficiency.

Lymphocytic gastritis is an idiopathic disease, characterized by intraepithelial infiltration of large numbers of T lymphocytes and often described in association with coeliac disease and Helicobacter pylori infection. Although usually associated with iron deficiency anaemia, there is no description on the association between lymphocytic gastritis and secondary vitamin B12 deficiency anaemia. We describe a rare case of recurrent anaemia in a patient with lymphocytic gastritis reversed with vitamin B12 replacement.

¿Cuál es el perfil de los pacientes en espera de nuevos tratamientos para la hepatitis C? / What is the Profile of Patients Waiting for New Hepatitis C Treatments?

Introducción: hasta hace poco, el tratamiento estándar de oro para la hepatitis C eran los interferones pegilados (Peg-IFN) en combinación con la ribavirina (RBV). Con la llegada de nuevos fármacos, se propuso evaluar los resultados del tratamiento y a los pacientes en espera de la nueva terapia. Materiales y métodos: este estudio analítico transversal evaluó el resultado del tratamiento en individuos con hepatitis C crónica, y luego comparó a individuos que tienen experiencia en no responder al tratamiento basado en interferón (IFN) con individuos sin experiencia de tratamiento previo. Resultados: el estudio incluyó 192 individuos. Entre 87 pacientes sometidos a tratamiento, se observaron bajas tasas de respuesta viral sostenida (RVS). La comparación de los 105 pacientes no tratados previamente y los 87 que habían recibido tratamiento con IFN previamente evidenció que entre los pacientes en espera de nuevas terapias, los individuos sin tratamiento previo presentaron mayor proporción de genotipo 1 (68% frente a 49%; p = 0,028), menores niveles de ALT (91,1 ± 73,0 frente a 126,0 ± 73,40 U/L; p = 017), de AST (70,1 ± 51,3 frente a 89,7 ± 47,40 U/L; p = 050), de GGT (85,3 ± 85,1 frente a 148,4 ± 123,9 U/L; p = 0,007) y menor proporción de fibrosis significativa (24,3 frente a 83,3; p <0,001). Conclusiones: las tasas de RVS fueron bajas. La mayoría de posibles candidatos para el tratamiento por VHC no lo han tenido y son de genótipo-1 con histología leve.

Introduction: Until recently, treatment with a combination of pegylated interferons (Peg-IFN) and ribavirin (RBV) was the gold standard treatment for hepatitis C. In anticipation of the arrival of new drugs, we evaluate current treatment outcomes and patients waiting for the new therapy. Materials and Methods: This cross-sectional analytical study evaluated treatment outcomes among chronic hepatitis C patients, and then compared chronic non-responders and treatment naïve patients who were given interferon based-treatment. Results: The study included 192 individuals among whom were 87 patients who received treatment. Among treated patients, we observed low rates of sustained viral response. A comparison of 105 treatment-naïve patients and 87 who had previously received IFN treatment showed that among patients waiting for new therapies, naïve individuals presented a higher proportion of genotype 1 (68% vs. 49%; p = 0.028) than did previously treated patients, lower ALT (91.1 ± 73.0 vs. 126.0 ± 73.40 U/L; p =017), lower AST (70.1 ± 51.3 vs. 89.7 ± 47.40 U/L; p = 050), lower GGT (85.3 ± 85.1 vs. 148.4 ± 123.9 U/L; p = 0.007) levels and a lower proportion of significant fibrosis (24.3% vs. 83.3%; p < 0.001). Conclusions: SVR rates were low. Among potential candidates for HCV treatment, the majority are naïve, genotype-1 with mild histology.

Factors associated with steatosis in liver biopsies of individuals with chronic hepatitis C infection in southern Brazil.

BACKGROUND AND STUDY AIMS: Infection by the hepatitis C virus (HCV) is associated with various metabolic disorders that are collectively referred to as dysmetabolic syndrome associated with HCV. Hepatic steatosis is a common finding in chronic HCV infection and has been reported in 30-70% of patients. Here, we determine the prevalence of steatosis in patients with HCV, identify the characteristics associated with the presence of steatosis in liver biopsies and assess the association between steatosis and the severity of liver disease. PATIENTS AND METHODS: This analytic cross-sectional study evaluated HCV carriers (adults) at the Gastroenterology and Hepatology Outpatient Clinic of a public university hospital between July 2013 and June 2014 using retrospective data collection. The patients were divided into two groups according to the presence or absence of steatosis in their liver biopsies. The groups were compared for the presence of risk factors for steatosis and clinical, laboratory, virological and histological characteristics. RESULTS: One hundred and four patients aged 49.5±9.3 years were included in the study; 56.0% of the patients were men. Steatosis was observed in 65.4% of the liver biopsies. When comparing individuals with and without steatosis, patients with steatosis exhibited a higher proportion of non-1 genotype (43.9 vs. 20.7%; p=0.034), higher median triglyceride levels (101.0 vs. 75.0; p=0.034), ferritin levels (333.0 vs. 193.5; p=0.025) and gamma glutamyl transferase levels (2.92 xULN vs. 1.87; p=0.030). Multivariate analysis demonstrated that triglyceride levels were independently associated with the presence of steatosis (OR=1.016; 95% CI 1.002-1.031; p=0.026). CONCLUSIONS: Hepatic steatosis was observed in 65.4% of individuals with HCV. We observed that elevated triglyceride levels were associated independently with the presence of hepatic steatosis; we did not demonstrate an association between hepatic steatosis and histological severity.

Enterococcus casseliflavus and Enterococcus gallinarum as causative agents of spontaneous bacterial peritonitis.

Infection by multidrug resistant bacteria is arousing as a relevant issue among hospitalized subjects and is of particular interest in patients with cirrhosis given the frequent use of broad spectrum antibiotics and their altered immune response. We report the first case report of spontaneous bacterial peritonitis (SBP) caused by Enterococcus casseliflavus and the sixth case of SBP caused by Enterococcus gallinarum.

Morte materna por hipertensão no Estado de Santa Catarina / Maternal death rate related to hypertension in Santa Catarina State

Objetivo: Esse trabalho tem por objetivo avaliar o coeficiente de Morte Materna por hipertensão nos anos de 1996 a 2005 no estado de Santa Catarina. Métodos: Foi realizado um estudo descritivo retrospectivo. A fonte oficial relativa aos óbitos maternos estudados é o Sistema de Informações sobre Mortalidade, tendo sido utilizada as bases de óbitos de residentes em Santa Catarina no período de 1996 a 2005. O número de nascidos vivos foi obtido a partir da base de dados do Sistema de Informações sobre Nascidos Vivos. Calculou-se o Coeficiente de Mortalidade Materna geral e o relacionado a distúrbios hipertensivos e a porcentagem de óbitos relacionados aos distúrbios hipertensivos no total geral. Resultados: No período do estudo ocorreram 79 óbitos maternos relacionados à hipertensão. Esse número corresponde a 20 % do total de óbitos maternos ocorridos. O coeficiente de mortalidade materna geral no período do estudo foi de 43,3 por 100000 nascidos vivos e o de mortalidade materna relacionada à hipertensão foi de 8,6 por 100000 nascidos vivos. Conclusões: As mortes maternas por hipertensão ainda representam 20% das mortes maternas no estado. Sabe-se que as complicações da hipertensão gestacional são passíveis de prevenção com a ampliação da cobertura pré-natal, preparação do pessoal de assistência (incluindo atenção primária), diagnóstico precoce de pacientes de alto risco e um sistema de referência eficaz e rápido para centros de atenção terciária.

Objective: To evaluate the maternal death rate related to hypertension from 1996 to 2005 in Santa Catarina State. Methods: A retrospective descriptive study was made. The official source of maternal death is the Information System about Mortality. The database of deaths in Santa Catarina state from 1996 to 2005 was used. The number of born alive was gathered from the Information System about Born Alive databases. The general and hypertension maternal death rates are calculated along with the general death rate related to hypertension. Results: During the studied time 79 maternal deaths related to hypertension occurred. This number represents 20% of maternal deaths in the period. The general maternal death rate in the period was 43.3 by 100,000 born alive and the one related to hypertension was 8.6 by 100,000 born alive. Conclusions: Maternal deaths related to hypertension still represent 20% of maternal death in the state. It is known that the complications of gestational hypertension may be prevented by the broadening of prenatal coverage, training of personnel, early diagnosis of high risk patients and a quick and efficient reference system on the third health-attention level.