Avaliação de pacientes com hepatite autoimune atendidos em ambulatório de referência do sul do Brasil / Evaluation of patients with autoimmune hepatitis in a specialized outpatient clinic in southern brazil

ABSTRACT BACKGROUND: Autoimmune hepatitis (AIH) is a chronic liver disease, characterized by necroinflammation and autoimmune etiology. Studies evaluating the characteristics of patients with AIH are scarce in Brazil. OBJECTIVE: Our objective was to evaluate the profile of patients with AIH in a specialized center in Southern Brazil and to verify factors related to treatment response. METHODS: this was a retrospective cohort study, which analyzed demographic, epidemiological, clinical, laboratory, and histologic data. Patients with AIH diagnosed according to the criteria of the International Autoimmune Hepatitis Group (IAIHG) were included. In liver biopsies, the degree of fibrosis, histological activity, presence of hepatocyte rosettes, plasma cell infiltrates, and confluent necrosis were evaluated. In the statistical analysis, the significance level was 5%. RESULTS: Forty adults patients diagnosed with AIH were included. The evaluated population predominantly consisted of women (75.0%) and the average age at diagnosis was 44.2 years. The association with extrahepatic autoimmune diseases occurred in 20.0% of cases. Clinically, 35.0% of patients presented with acute onset hepatitis, 37.5% with cirrhosis, and 27.5% with other forms of presentation. The most common clinical manifestation was jaundice (47.5%). Thirty-five patients were treated, and of these, 97.1% used prednisone combined with azathioprine. The average treatment time was 2.7 years. Response to treatment was complete or partial in 30 (85.7%) and absent in 5 (14.3%) patients. There was no statistically significant difference when evaluating response to treatment in relation to forms of presentation, histological findings, and the presence of autoantibodies. Regarding fibrosis, regression was observed in 18.75% of the cases. CONCLUSION: Most patients with AIH were young at presentation and of female sex. The association with extrahepatic autoimmune diseases and cirrhosis at presentation was seen in a considerable proportion of patients. Treatment was effective, but there were no clinical, histological or serological parameters capable of predicting treatment response.

RESUMO CONTEXTO: A hepatite autoimune (HAI) é uma doença hepática crônica, de caráter necroinflamatório e etiologia autoimune. Os estudos que avaliam as características de pacientes com HAI são escassos no Brasil. OBJETIVO: Nosso objetivo foi avaliar o perfil dos pacientes com HAI atendidos em um centro de referência do sul do Brasil e verificar fatores relacionados à resposta ao tratamento. MÉTODOS: Este foi um estudo de coorte retrospectivo, que analisou dados demográficos, epidemiológicos e clínicos. Nas biópsias hepáticas, foram avaliados o grau de fibrose, a atividade histológica, a presença de rosetas, de infiltrado plasmocitário e de necrose confluente. Na análise estatística, o nível de significância foi de 5%. RESULTADOS: Foram incluídos 40 pacientes adultos com diagnóstico de HAI. Houve predomínio do sexo feminino (75,0%), e a média de idade no diagnóstico foi de 44,2 anos. A associação com doenças autoimunes extra-hepáticas ocorreu em 20,0% dos casos. Clinicamente, 35,0% dos pacientes se apresentaram sob forma de hepatite aguda, 37,5% com cirrose e 27,5% com outras formas de apresentação. A manifestação clínica mais comum na apresentação foi a icterícia (47,5%). Trinta e cinco pacientes foram tratados, sendo que destes, 97,1% utilizaram prednisona associada com azatioprina. A média do tempo de tratamento foi 2,7 anos. A resposta ao tratamento foi completa ou parcial em 30 (85,7%) e ausente em 5 (14,3%) pacientes. Não houve diferença estatisticamente significativa quando avaliada a resposta ao tratamento em relação à forma de apresentação, aos achados histológicos e à presença de autoanticorpos. Em relação à fibrose, foi observada regressão em 18,75% dos casos. CONCLUSÃO: A maioria dos pacientes era jovem no momento do diagnóstico e do sexo feminino. A associação com doenças autoimunes extra-hepáticas e com cirrose na apresentação foi vista em uma parcela considerável dos casos. O tratamento foi eficaz, mas não houve parâmetros clínicos, histológicos ou sorológicos capazes de prever a resposta ao tratamento.

Déficit de glucosa-6-fosfato deshidrogenasa / Glucose-6-Phosphate Dehydrogenase Deficiency

Introducción: La presencia de ictericia en la práctica clínica generalmente hace sospechar problemas hepáticos o de vías biliares, siendo el íctero de causa hemolítica menos frecuente. Objetivo: Presentar un caso de íctero hemolítico infrecuente. Caso clínico: Paciente femenina de 47 años que presenta episodio de íctero hemolítico después de la ingestión de medicamentos. Los estudios de función hepáticos fueron normales. Se sospecha y diagnostica déficit de glucosa 6 fosfato deshidrogenasa variante electroforética A-. Conclusiones: Ante la presencia de íctero deben sospecharse posibles causas no hepáticas, como el déficit de glucosa 6 fosfato deshidrogenasa(AU)

Introduction: The presence of jaundice in clinical practice usually causes suspicion of liver or bile duct problems, but hemolytic icterus is a less frequent cause. Objective: To present a case of infrequent hemolytic icterus. Clinical case: A 47-year-old female patient who presented an episode of hemolytic icterus after medication ingestion. Liver function studies were normal. Suspected and diagnosed glucose 6-phosphate dehydrogenase deficiency, electrophoretic variant A-. Conclusions: In the presence of icterus, possible non-hepatic causes should be suspected, such as glucose 6-phosphate dehydrogenase deficiency(AU)

Amoxycillin Clavulanic Acid Induced Hepatotoxicity.

Drug-related hepatotoxicity is a serious health problem, with broad implications for patients, healthcare providers, the pharmaceutical industry and governmental regulatory agencies. Herein we report a rare case of amoxycillinclavulanic acid combination induced liver injury of cholestatic pattern in 40 years old, well educated male patient. Patient gave history that though other drugs were given to him by his physician for fever with chills & rigors, malaise, bodyache, except amoxycillin-clavulanic acid combination all other drugs were well tolerated previously by the patient, without appearance of jaundice. So jaundice in this patient was most probably due to amoxycillinclavulanic acid combination. Though severe liver injury is rare, proper history should be taken while prescribing amoxycillin-clavulanic acid combination. Attention must be paid to potential side-effects of the drugs and close follow-up with patients is a medical necessity to evaluate adverse reactions, especially in case of amoxycillinclavulanic acid combination.

Das hepatopatias e icterícias às hepatites virais: configuração de um caleidoscópio / From hepatic diseases and jaundice to viral hepatitis: the configuration of a kaleidoscope / De las hepatopatías e ictericias a las hepatitis virales: configuración de un caleidoscopio

As hepatites virais A, B, C, D e E - viroses sistêmicas hepatotrópicas - produzem quadros de hepatite aguda. Dependendo do agente etiológico, da carga viral e de condições do hospedeiro, podem evoluir para hepatite crônica, cirrose, câncer de fígado e formas agudas fulminantes. A versatilidade ecológica desses vírus configura uma natureza espectral e cambiante de transmissão no tempo e no espaço; potencializada pelo curso subclínico por vezes prolongado de grande parte das infecções, constitui-se em desafio epidemiológico. Com base no curso histórico dessas infecções foram descritos cenários e tendências relativas ao seu comportamento socioepidemiológico, apontando para a necessidade de superar modelos, padrões, protocolos e retornar à investigação de cada situação de saúde/doença. Ou seja, assinala para a imprescindível exploração das singularidades no sentido de desenvolver ações gerais modeladas pelas especificidades locais.

Viral hepatitis A, B, C, D and E - systemic hepatotropic viral infections - present as acute hepatitis that, depending on the etiological agent, viral load and host conditions, may evolve into chronic hepatitis, cirrhosis, liver cancer and acute fulminant disease. The ecological versatility of these viruses, their spectrum of transmission in time and space, potentialized by the sub-clinical course of a large proportion of infections, comprise an epidemiological challenge. This essay describes scenarios and tendencies in the socioepidemiologic profile, based on the history of these infections, and indicates the need to overcome patterns, models, and protocols and instead investigate each particular situation. In other words, it highlights the need to explore singularities in order to be able to develop new proposals for general actions tailored to local specificities.

Las hepatitis virales A, B, C, D y E - virosis sistémicas hepatotrópicas - producen cuadros de hepatitis aguda. Dependiendo del agente etiológico, de la carga viral y de las condiciones del hospedador, pueden evolucionar hacia hepatitis crónica, cirrosis, cáncer del hígado y formas agudas fulminantes. La versatilidad ecológica de estos virus, configura una naturaleza espectral y cambiante de transmisión en el tiempo y espacio; potencializada por el curso subclínico, a veces prolongado, constituye un desafío epidemiológico en gran parte de las infecciones. Con base en el curso histórico de estas infecciones se han descrito escenarios y tendencias relativas a su comportamiento socioepidemiológico, apuntando hacia la necesidad de superar modelos, patrones, protocolos, y retornar a la investigación de cada situación de salud/enfermedad. Es decir, señala la imprescindible exploración de las singularidades en el sentido de desarrollar acciones generales modeladas por las especificidades locales.

Febre amarela: Rio Grande do Sul e o risco da reurbanização / Yellow fever: rio grande do sul and the risk of reurbanização

A Febre Amarela e uma doença infecciosa aguda não - contagiosa de curta duração e de gravidade variável. É causada por um flavivírus, para o qual está disponível uma vacina altamente eficaz. A transmissão é feita por intermédio de mosquitos. O surgimento de novos casos de febre amarela, no Brasil é uma ameaça constante. A possível expansão desta doença infecciosa para o Rio Grande do Sul é a preocupação de muitos sanitaristas, uma vez que o vetor está presente nas cidades gaúchas. Em 2001, a vacinação contra a febre amarela em 43 municípios da Região das Missões foi realizada após comprovação de quea febre amarela fora a causa de morte de bugius em muitos municípios, sendo estes classificados como áreas de risco para endemias. Neste contexto, torna-se essencial aos médicos o conhecimento da Febre Amarela: fisiopatologia, áreas de risco, manejo da doença e, sobretudo, mecanismos de prevenção. Cabe lembrar que a Febre Amarela é uma doença de notificação compulsória aos órgãos públicos.

A status survey of common water-borne diseases in desert city Bikaner (NW Rajasthan, India).

Water is scarce and, in general, a low quality resource in desert areas and the Indian desert is no exception. With this in view, the present study was taken up to survey the status of common water-borne diseases epidemiological trends in the desert city Bikaner (NW Rajasthan). In the city, 15.5 per cent population and 44.5 per cent families were found to suffer from one or more common water-borne diseases including amoebiasis, diarrhoea, dysentery, jaundice and typhoid. No case of fluorosis was recorded. The highest incidence was that of diarrhoea (5.4 per cent population). The worst affected and safe zones in the city were identified and the trends of different diseases in different zones of the city are discussed. The highest incidence of diseases was noted during summer (58.8 per cent) followed by winter (34.1 per cent) and monsoon (7.0 per cent). Relationship of diseases with population attributes like age, education, economy and family size are also discussed. Attributes for contamination of drinking water have been tried to identify and safety measures suggested.

Hepatitis in falciparum malaria.

BACKGROUND: Hepatocellular jaundice occurring in patients with falciparum malaria has been called as malarial hepatitis. METHODS: We studied 95 consecutive patients admitted with falciparum malaria. Of these 20 had evidence of malarial hepatitis. Their clinical presentation, complications and response to treatment was compared with that of patients without evidence of malarial hepatitis. RESULTS: The clinical presentation of these patients was not different from those without hepatitis. However, the incidence of complications such as renal failure (60% vs 25%; X2 = 8.47, p < 0.01), Adult Respiratory Distress Syndrome (35% vs 3%; X2 = 18.13, p < 0.001) and septicemia (20% vs 6%; X2 = 4.01, p < 0.05) was significantly higher. The mortality also was higher in the group of patients with malarial hepatitis (40% vs 17%; X2 = 4.85, p < 0.05). CONCLUSIONS: We conclude that the presence of hepatitis in patients with falciparum malaria indicates a more severe illness with a higher incidence of complications and a poor prognosis.

Les icteres chirurgicaux au Centre Hospitalier National Yalgado Ouedraogo (CHNYO) Ouagadougou (BF)

Les auteurs rapportent dans une etude retrospective; 29 cas d'ictere par obstruction de la voie biliaire principale colliges en 6 ans. Ils notent l'importance de l'affection chez le sujet age de sexe masculin : 72 pour cent des patients ont plus de 50 ans avec un sex-ratio de 3 hommes pour 1 femme. Les obstructions de la voie biliaire principale par tumeurs sont les plus observees (83 pour cent) contre 17 pour cent pour la lithiase de la voie biliaire principale (LVBP). Une derivation bilio digestive chirurgicale palliative type anastomose choledocojejunale termino-laterale sur une anse en Y est pratiquee dans 24 cas (83 pour cent). La lithiase de la voie biliaire principale est traitee par une anastomose choledo-duodenale latero-laterale (17 pour cent). La mortalite globale hospitaliere est de 6 cas sur 29 (21 pour cent). Le carcinome excretobiliaire panparietal reste l'affection dont le taux de mortalite est le plus eleve. (3 deces sur 3)

An investigation of an outbreak of viral hepatitis in a residential area of Delhi.

Epidemiological investigation of a focal outbreak of jaundice in the KD block of Pitampura, Delhi during February-March 1992 revealed that 7.0 per cent of the population of the block suffered from viral hepatitis. There was no age or sex predilection. Epidemiological findings and Serological studies suggest that the epidemic was due to Hepatitis E (Enterically transmitted Non A and Non B) virus.

Etiología y frecuencia del síndrome ictérico en lactantes / Etiology and frequency of jaundice syndrome in infants

Con el propósito de conocer la frecuencia y las causas del síndrome ictérico en lactantes, se estudiaron 70 casos de manera retrospectiva y 3 en forma prospectiva; las edades oscilaron de 3 semanas a 2 años en ambos grupos. No hubo una diferencia notable entre las causas susceptibles de manejo médico y las que requerían tratamiento quirúrgico (46.2 y 45.2%, respectivamente); en 8 casos no se determinó la causa del síndrome. En el grupo de causas que ameritan tratamiento médico predominaron las infecciones (86%), y entre las que requerían cirugía se encontró atresia de vías biliares (54.7%) y otros padecimientos (45.3%)