Sarcopenia in chronic viral hepatitis: From concept to clinical relevance.

Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma (HCC) is increasing, chronic hepatitis B (CHB) and chronic hepatitis C (CHC) remain the most relevant risk factors for advanced liver disease worldwide. In addition to liver damage, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia, lymphoproliferative disorders, renal disease, insulin resistance, type 2 diabetes, sicca syndrome, rheumatoid arthritis-like polyarthritis, and autoantibody production. Recently, the list has grown to include sarcopenia. Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0% of patients with advanced liver disease. Nonetheless, among published studies, there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia. In particular, the interaction between sarcopenia, CHB and CHC has not been completely clarified in a real-world setting. Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV. Thus, in the present review, we provide an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis, with an emphasis on clinical outcomes, which have been associated with skeletal muscle loss in these patients. A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV, independent of the stage of the liver disease, will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.

Prevalence and epidemiological aspects of Chikungunya fever in states of the Northeast region of Brazil: A systematic review.

Chikungunya fever is a disease caused by the Chikungunya virus (CHIKV), which is transmitted through the bite of infected female hematophagous mosquitoes of the genus Aedes (Diptera: Culicidae). In the Americas, the first autochthonous cases of the disease were recorded in 2013. A year later, in 2014, the first records of the disease were acquired locally in Brazil, in the states of Bahia and Amapá. The present study aimed to carry out a systematic review of the literature on the prevalence and epidemiological aspects of Chikungunya fever in states of the Northeast region of Brazil, between the years 2018 to 2022. This study was registered in the Open Science Framework (OSF) and in the International Prospective Register of Systemactic Reviews (PROSPERO) and followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The searches were carried out in the scientific electronic databases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), U. S. National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO), using descriptors cataloged in Descritores em Ciências da Saúde (DeCS) and Medical Subject Headings (MeSH) in Portuguese, English and Spanish. Gray literature was also searched by accessing Google Scholar to search for additional publications not captured in the selected electronic databases. Of the 19 studies included in the present systematic review, seven referred to the state of Ceará. Most cases of Chikungunya fever corresponded to the female gender (ranging from 7.5% to 100.0%), to the age group younger than 60 years (84.2%), to literate individuals (93.3%), belonging to the non-white race/color (95.21%) and blacks (100.0%), and residents of the urban area (range from 51.95% to 100.0%). As for laboratory characteristics, most notifications were diagnosed using clinical-epidemiological criteria (ranging from 71.21% to 90.35%). The epidemiological information about Chikungunya fever in the Northeast region of Brazil presented in this systematic review is useful to better understand the characteristics of the disease introduction process in the country. To this end, prevention and control strategies must be adopted, especially in the Northeast, as this region is most responsible for the number of cases of the disease in the country.

Novel Biomarkers for Posterior Urethral Valve.

The posterior urethral valve (PUV) is one of the main causes of congenital obstruction of the lower urinary tract in pediatrics. Its occurrence, although rare, can cause chronic kidney disease (CKD), with frequent progression to end stage kidney disease. Therefore, the development of new diagnostic strategies, such as biomarkers, is crucial to better assess the prognosis of patients with PUV. We aimed to review the literature on traditional and new biomarkers in PUV. For that, searches were performed in PubMed/MEDLINE, Scopus and SciELO databases. To systematize the search, terms such as "Posterior Urethral Valve", "Prognosis", "Biomarkers" and variations described in the Medical Subject Headings (MeSH) database were used. The literature showed new biomarkers of disease prognosis, with emphasis on inflammatory cytokines, proteomics and genomics techniques, as well as classic biomarkers, focusing on serum creatinine and urine osmolality. As for biomarkers recently described in the literature, the 12PUV, a set of 12 fetal urinary peptides that accurately predicted postnatal kidney function in fetuses with PUV, stands out. Similarly, oxidative stress markers, inflammatory cytokines and components of the renin-angiotensin system (RAS), when increased, were indicative of severe kidney outcomes. Genetic alterations also correlated to worse prognosis among patients with PUV, with emphasis on RAS polymorphisms and, specifically, those affecting the angiotensin-converting enzyme (ACE) and the angiotensin II receptors types 1 and 2 (AGTR1 and AGTR2) genes. Considering the severity of the PUV condition, the identification of sensitive and cost-effective biomarkers, beyond improving diagnosis, may favor the investigation of new therapeutic strategies.

Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B.

BACKGROUND: Although the prognostic relevance of sarcopenia has been increasingly recognised in the context of liver disease, there is a paucity of data evaluating body composition in patients with chronic hepatitis B (CHB). Beyond virus-related factors, nutritional and metabolic aspects can be associated with skeletal muscle abnormalities in these patients and should not be disregarded. AIM: To evaluate the association between components of sarcopenia and demographic, clinical, lifestyle, nutritional, and biochemical variables in CHB patients. METHODS: Dual-energy X-ray absorptiometry (DXA) was used to assess muscle mass by quantifying appendicular lean mass (ALM) adjusted for body mass index (ALMBMI). Muscle function was evaluated by hand grip strength (HGS) and the timed up and go test. Metabolic-associated fatty liver disease (MAFLD) was defined according to the criteria proposed by an international expert panel. A body shape index and the International Physical Activity Questionnaire were used to assess central obesity and physical activity level, respectively. RESULTS: This cross-sectional study included 105 CHB outpatients followed at the tertiary care ambulatory centre (mean age, 48.5 ± 12.0 years; 58.1% males; 76.2% without cirrhosis; 23.8% with compensated cirrhosis). The DXA-derived fat mass percentage was inversely correlated with the ALMBMI (r = - 0.87) and HGS (r = - 0.63). In the multivariable analysis, MAFLD, sedentarism and central obesity were positively and independently associated with low ALMBMI. MAFLD and central obesity were independently associated with low HGS. CONCLUSION: MAFLD and central obesity were associated with low muscle mass and strength in patients with chronic hepatitis B, independent of the liver disease stage.