Hígado graso agudo del embarazo en una adulta joven / Acute fatty liver of pregnancy in a young adult woman i: en

Se presenta el caso clínico de una gestante de 20 años de edad, quien acudió al Cuerpo de Guardia del bloque materno del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba por presentar decaimiento, náuseas y malestar general. Durante la exploración física se encontró piel sudorosa y fría, taquicardia e ictericia. Se realizaron diversos exámenes complementarios y se constató alteración hepática, así como cifras bajas de glucemia. Se diagnosticó hígado graso agudo del embarazo. Luego de varios días de hospitalizada con una evolución desfavorable, hasta llegar al estado crítico, la paciente falleció por síndrome de disfunción multiorgánica.

The case report of a 20 years pregnant woman is presented, who went to the maternal block emergency room of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba due to run-down, nausea and diffuse discomfort. During the physical exploration sweaty and cold skin, tachycardia and jaundice were found. Diverse complementary exams were carried out and a hepatic disorder was verified, as well as low figures of glycemia. Acute fatty liver of pregnancy was diagnosed. After several days hospitalized with an unfavorable clinical course until getting to the critical state, the patient died due to multiple organ dysfunction syndrome.

Características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico: Serie de casos / Clinical-epidemiologic characteristics of patients with non-alcoholic fatty liver disease: Case series

Fundamento: El hígado graso no alcohólico es la enfermedad hepática por depósito de grasa en ausencia de un consumo significativo de alcohol. La mayoría de los pacientes tienen un nexo epidemiológico común asociado a factores de riesgo metabólico. Objetivo: Describir características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico. Metodología: Se realizó un estudio descriptivo de una serie de casos en la consulta de Gastroenterología del Hospital General Provincial "Camilo Cienfuegos" de Sancti Spíritus, durante el período 6 de mayo de 2019 al 6 de mayo de 2020. Se consideró un total de 1167 pacientes pertenecientes a la provincia Sancti Spíritus; a 346 pacientes se le diagnosticó esteatosis hepática por ultrasonido; la muestra se conformó por 114 pacientes que cumplieron con los criterios de inclusión. Resultados: La mayoría de los pacientes con la enfermedad eran sintomáticos, hombres y tenían comorbilidad como la hipertensión arterial y obesidad, el índice de masa corporal y el índice de cintura abdominal/cadera estaban elevados en el sexo femenino, las alteraciones en la química sanguínea fueron colesterol y triacilglicéridos. Conclusiones: Predominó en el sexo masculino y la comorbilidad con la HTA y la obesidad, y la dislipidemia, además los hábitos alimenticios inadecuados y el sedentarismo; las medidas antropométricas resultaron elevadas en el sexo femenino.

Background: Nonalcoholic fatty liver disease is a resulting from fat accumulation in the absence of significant alcohol consumption. Most patients have a common epidemiologic link associated with metabolic risk factors. Objective: To describe the clinical and epidemiologic characteristics of patients with nonalcoholic fatty liver disease. Methodology: A descriptive study of a series of cases was carried out in the Gastroenterology consultation of the "Camilo Cienfuegos" Provincial General Hospital of Sancti Spíritus, during the period from May 6, 2019 through May 6, 2020. A total of 1167 patients belonging to the province of Sancti Spiritus were included in the study; 346 patients were diagnosed with hepatic steatosis by means of ultrasound; the sample consisted of 114 patients who fulfilled the inclusion criteria. Results: Most patients with the disease were symptomatic, men, and had comorbidities including hypertension and obesity, the body mass index and the waist-to-hip ratio of the abdomen were increased in women., the blood chemistry changes were cholesterol and triacylglycerides. Conclusions: It predominated in the male sex and comorbidity with HBP and obesity and dyslipidemia, in addition to inadequate dietary habits and sedentary lifestyle; in women, the anthropometric measurements were high.

Impacto do consumo excessivo de frutose e dieta hiperlipídica no metabolismo lipídico, inflamação e desenvolvimento de esteatose hepática / Impact of excessive fructose consumption and high-fat diet on lipid metabolism, inflammation and development of hepatic steatosis

Introdução: A doença hepática gordurosa não alcoólica (DHGNA) caracteriza-se pelo acúmulo de triglicerídeos (TG) nos hepatócitos, destacando-se a elevada prevalência de esteatose hepática (NAFL). A NAFL é uma condição clínica definida pelo acúmulo de ácidos graxos (AG) no fígado, obtidos pela ingestão direta de gorduras e carboidratos e/ou pela síntese de AG via ativação da lipogênese. A NAFL é desencadeada por um conjunto de fatores, como o padrão dietético, o estilo de vida e a genética. Dietas hipercalóricas, caracterizadas pela presença de gorduras saturadas e carboidratos simples exercem importante papel no desenvolvimento da NAFL. Além disso, uma dieta rica em carboidratos simples, destacando-se a frutose, também é importante no NAFL, visto que a frutose, ao ser ingerida, é, majoritariamente, metabolizada pelo fígado, sendo assim, um componente mais sensível à lipogênese. Objetivo: Avaliar o impacto do consumo excessivo de frutose e lipídeos na modulação da inflamação e no metabolismo lipídico hepático. Metodologia: O estudo foi baseado em modelo experimental com 100 dias de seguimento. Dezoito ratos da espécie Wistar, machos e adultos jovens (7 semanas) foram distribuídos em 3 grupos: Dieta Controle (DC) (n=6) - ração comercial e água filtrada; Dieta Frutose (DF) (n=6) - ração comercial e água filtrada com 30% de frutose; e Dieta Hiperlipídica (DH) (n=6) - ração hiperlipídica e água filtrada. Ração e água foram administradas ad libitum. Após a eutanásia, o sangue e o fígado foram coletados. Resultados: Os animais do grupo DH tiveram um consumo de ração menor, assim como os animais do grupo DF, porém esses apresentaram um consumo calórico maior comparado ao grupo DC. Por outro lado, o aumento do comprimento foi significativo para todos, tendo o grupo DH apresentado maior crescimento. Conforme esperado, a cetose plasmática foi maior no grupo DH, assim como as enzimas hepáticas aspartato aminotransferase (AST), alanina aminotransferase (ALT) e fosfatase alcalina (FA). Glicose e frutose plasmáticas foram similares entre os grupos. O peso relativo do fígado foi maior no grupo DF comparado ao grupo DH. O conteúdo de colesterol total (CT), TG e ácidos graxos não esterificados (AGNE) foi superior no grupo que recebeu DH. Inesperadamente, as substâncias reativas ao ácido tiobarbitúrico (TBARS) foram superiores no grupo DC. Em relação a fosfolipase 3 associada à patatina (PNPLA3) observamos aumento expressivo no grupo DF comparado aos animais alimentados com DH, porém, os grupos foram semelhantes em relação ao fator de crescimento de fibroblasto 21 (FGF21) e ao membro 2 da superfamília da proteína trnasmembrana 6 (TM6SF2). As citocinas - interleucinas I-beta (IL-1ß), 6 (IL-6), 10 (IL-10) e fator de necrose tumoral (TNF-α) foram maiores no grupo DF. Na análise da histologia do tecido hepático observou-se a presença de infiltrado inflamatório acentuado e de esteatose hepática no grupo DH. Conclusão: Frutose (30%) e lipídios (90%), quando consumidos de forma crônica (100 dias) promovem inflamação e acúmulo de lipídios hepático compatíveis com a DHGNA.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is characterized by the triglycerides (TG) accumulation in hepatocytes, highlighting the high prevalence of hepatic steatosis (NAFL). NAFL is a clinical condition defined by liver fatty acids (FA) accumulation, obtained by direct ingestion of fats and carbohydrates and/or by FA synthesis via lipogenesis activation. NAFL is triggered by a number of factors, such as dietary pattern, lifestyle and genetics. Hypercaloric diets, characterized by the presence of saturated fats and simple carbohydrates, play an important role in the development of NAFL. In addition, a diet rich in simple carbohydrates, especially fructose, is also important in NAFL, since fructose, when ingested, is mostly metabolized by liver, thus being a component that is more sensitive to lipogenesis. Objective: To evaluate the impact of excessive consumption of fructose and lipids on the inflammation modulation and hepatic lipid metabolism. Methodology: The study was based on a 100 days follow-up experimental model. Eighteen Wistar rats, male and young adults (7 weeks old) were distributed into 3 groups: Control Diet (CD) (n=6) - commercial chow and filtered water; Fructose Diet (FD) (n=6) - commercial feed and filtered water with 30% fructose; and High-fat Diet (HFD) (n=6) - high-fat diet and filtered water. Chow and water were administered ad libitum. After euthanasia, blood and liver were collected. Results: HFD animals group had a lower feed intake, as well as the FD animals group, but these ones had a higher caloric intake compared to the CD group. On the other hand, the length increase was significant for all and the HFD group showed greater growth. As expected, plasma ketosis was higher in the DH group, as were liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (AP). Plasma glucose and fructose were similar between groups. Liver relative weight was higher in the DF group compared to the HFD group. Total cholesterol (TC), TG and non-esterified fatty acids (NEFA) content was higher in HFD group. Unexpectedly, thiobarbituric acid reactive substances (TBARS) were higher in CD group. Regarding patatin-associated phospholipase 3 (PNPLA3), we observed a significant increase in FD group compared to animals fed with HD, however, the groups were similar in relation to fibroblast growth factor 21 (FGF21) and member 2 of the protein superfamily transmembrane 6 (TM6SF2). Cytokines - interleukins I-beta (IL-1ß), 6 (IL-6), 10 (IL-10) and tumor necrosis factor (TNF-α) were higher in FD group. In the analysis of the hepatic tissue histology, the presence of accentuated inflammatory infiltrate and hepatic steatosis was observed in DH group. Conclusion: Fructose (30%) and lipids (90%), when consumed chronically (100 days) promote inflammation and hepatic lipids accumulation compatible with NAFLD.

Dépistage de la stéatose hépatique par le Fibroscan/CAP chez les sujets noirs africains porteurs d'une Hépatite Virale B chronique en Côte d'Ivoire / Fibroscan/CAP screening for hepatic steatosis in black African subjects with chronic Viral Hepatitis B in Ivory Coast

Context and objectives As the global epidemic of obesity and metabolic syndrome progresses, the coexistence of fatty liver disease in patients with chronic viral hepatitis B (VHB) becomes significant. The objective of this work was to determine the frequency of hepatic steatosis assessed by Fibroscan/CAP (Controlled Attenuation Parameter) in patients with chronic VHB in Côte d'Ivoire. Methods. The study included 83 patients with chronic VHB. These were black patients who had performed a Fibroscan/CAP during the recruitment period and were willing to participate in the study. Patients with significant alcohol consumption, a secondary cause of hepatic steatosis, another liver disease regardless of the etiology associated with VHB were not included. Results. The frequency of hepatic steatosis in chronic HBV carriers assessed by CAP in our study population was 48.19 %, including 24.10 % of severe steatosis. Obesity was statistically correlated with the presence of steatosis in our patients. Patients who had steatosis on ultrasound were 5 times more likely to have steatosis on CAP. Significant fibrosis was insignificantly associated with steatosis. Conclusion. The frequency of fatty liver disease detected by fibroscan/CAP is high in patients with chronic VHB.

Contexte et objectifs Avec la progression de l'épidémie mondiale d'obésité et du syndrome métabolique, la coexistence d'une stéatose hépatique chez les patients porteurs d'une hépatite virale B chronique devient non négligeable. L'objectif de ce travail était de déterminer la fréquence de la stéatose hépatique chez les patients porteurs d'une hépatite virale B (HVB) chronique. Méthodes. Il s'agissait d'une série des cas de HVB de race noire, ayant réalisé un Fibroscan/CAP pendant la période du recrutement et consentants à participer à l'étude. Les patients ayant une consommation d'alcool significative, une cause secondaire de stéatose hépatique, une autre hépatopathie quelle que soit l'étiologie associée à l'hépatite B n'ont pas été inclus. Résultats. Quatre-vingt-trois patients porteurs d'une HVB ont été inclus. La fréquence de la stéatose hépatique chez les porteurs du VHB chronique était de 48,19 % dont 24,10 % de stéatose sévère. L'obésité était statistiquement corrélée à la présence d'une stéatose chez nos patients. Les patients qui avaient une stéatose à l'échographie étaient 5 fois plus à risque d'avoir une stéatose au CAP. La fibrose significative était associée de façon non significative à la stéatose. Conclusion : Près de la moitié des patients porteurs d'une hépatite virale B chronique présente une stéatose hépatique.

The role of purslane in modulating diverse effects of high fat diet on biochemical, histological, and molecular parameters of rats' liver / O papel da beldroega na modulação de diversos efeitos da dieta rica em gordura nos parâmetros bioquímicos, histológicos e moleculares do fígado de ratos

Consuming a high-fat diet causes a harmful accumulation of fat in the liver, which may not reverse even after switching to a healthier diet. Different reports dealt with the role of purslane as an extract against high-fat diet; meanwhile, it was necessary to study the potential role of fresh purslane as a hypolipidemic agent. This study is supposed to investigate further the potential mechanism in the hypolipidemic effect of fresh purslane, by measuring cholesterol 7a-hydroxylase (CYP7A1) and low-density lipoprotein receptor (Ldlr). Rats were divided into two main groups: the first one is the normal control group (n=7 rats) and the second group (n=28 rats) received a high fat diet for 28 weeks to induce obesity. Then the high fat diet group was divided into equal four subgroups. As, the positive control group still fed on a high fat diet only. Meanwhile, the other three groups were received high-fat diet supplemented with a different percent of fresh purslane (25, 50 and 75%) respectively. At the end of the experiment, rats were sacrificed and samples were collected for molecular, biochemical, and histological studies. Current study reported that, supplementation of fresh purslane especially at a concentration of 75% play an important role against harmful effects of high-fat diet at both cellular and organ level, by increasing CYP7A1 as well as Ldlr mRNA expression. Also, there were an improvement on the tested liver functions, thyroid hormones, and lipid profile. Fresh purslane plays the potential role as a hypolipidemic agent via modulation of both Ldlr and Cyp7A, which will point to use fresh purslane against harmful effects of obesity.

O consumo de uma dieta rica em gordura causa um acúmulo prejudicial de gordura no fígado, que pode não reverter mesmo após a mudança para uma dieta mais saudável. Diferentes relatórios trataram do papel da beldroega como um extrato contra uma dieta rica em gordura; entretanto, foi necessário estudar o papel potencial da beldroega fresca como agente hipolipemiante. Este estudo pretende investigar mais profundamente o mecanismo potencial no efeito hipolipidêmico da beldroega fresca, medindo o colesterol 7a-hidroxilase (CYP7A1) e o receptor de lipoproteína de baixa densidade (Ldlr). Os ratos foram divididos em dois grupos principais: o primeiro é o grupo controle normal (n = 7 ratos) e o segundo grupo (n = 28 ratos) recebeu dieta rica em gorduras por 28 semanas para induzir a obesidade. Em seguida, o grupo de dieta rica em gordura foi dividido em quatro subgrupos iguais. Como, o grupo de controle positivo ainda se alimentava apenas com dieta rica em gordura. Enquanto isso, os outros três grupos receberam dieta rica em gordura suplementada com diferentes porcentagens de beldroegas frescas (25%, 50% e 75%), respectivamente. Ao final do experimento, os ratos foram sacrificados e amostras coletadas para estudos moleculares, bioquímica e histológicos. O estudo atual relatou que a suplementação de beldroegas frescas, especialmente a uma concentração de 75%, desempenha papel importante contra os efeitos prejudiciais da dieta rica em gordura em nível celular e orgânico, aumentando a expressão de CYP7A1 e Ldlr mRNA. Além disso, houve melhora nas funções hepáticas testadas, nos hormônios tireoidianos e no perfil lipídico. Beldroegas frescas desempenham papel potencial como agente hipolipemiante por meio da modulação de Ldlr e Cyp7A, o que apontará para o uso de beldroegas frescas contra os efeitos nocivos da obesidade.

Methyl ferulic acid ameliorates ethanol-induced L02 cell steatosis through microRNA-378b-mediated CaMKK2-AMPK pathway / 中国中药杂志

Alcoholic liver disease(ALD), with its increasing morbidity and mortality, has seriously and extensively affected the health of people worldwide. Methyl ferulic acid(MFA) has been proven to significantly inhibit alcohol-induced lipid production in L02 cells through the AMP-activated protein kinase(AMPK) pathway, but its in-depth mechanism remains unclear. This study aimed to further clarify the mechanism of MFA in improving lipid accumulation in L02 cells through the microRNA-378b(miR-378b)-mediated calcium/calmodulin-dependent protein kinase kinase 2(CaMKK2)-AMPK signaling pathway based on existing researches. L02 cells were induced by 100 mmol·L~(-1) ethanol for 48 h to establish the model of ALD in vitro, and 100, 50, and 25 μmol·L~(-1) concentration of MFA was treated. MiR-378b plasmids(containing the overexpression plasmid-miR-378b mimics, silence plasmid-miR-378b inhibitor, and their respective negative control-miR-378b NCs) were transfected into L02 cells by electroporation to up-regulate or down-regulate the levels of miR-378b in L02 cells. The levels of total cholesterol(TC) and triglyceride(TG) in cells were detected by commercial diagnostic kits and automatic biochemical analyzers. The expression levels of miR-378b in L02 cells were detected by real-time quantitative polymerase chain reaction(qRT-PCR). CaMKK2 mRNA levels were detected by PCR, and protein expressions of related factors involved in lipid synthesis, decomposition, and transport in lipid metabolism were detected by Western blot. The results displayed that ethanol significantly increased TG and TC levels in L02 cells, while MFA decreased TG and TC levels. Ethanol up-regulated the miR-378b level, while MFA effectively inhibited the miR-378b level. The overexpression of miR-378b led to lipid accumulation in ethanol-induced L02 cells, while the silence of miR-378b improved the lipid deposition induced by ethanol. MFA activated the CaMKK2-AMPK signaling pathway by lowering miR-378b, thus improving lipid synthesis, decomposition, and transport, which improved lipid deposition in L02 cells. This study shows that MFA improves lipid deposition in L02 cells by regulating the CaMKK2-AMPK pathway through miR-378b.

Homozygous familial hypobetalipoproteinemia caused by APOB gene variations: a case report and review of literature / 中华儿科杂志

Objective: To summarize the genotypes and clinical characteristics of homozygous family hypobetalipoproteinemia (Ho-FHBL) caused by apolipoprotein B (APOB) gene variations. Methods: The clinical, laboratory, genetic, and liver histology data of a boy with Ho-FHBL managed in the hepatology ward of the Children's Hospital of Fudan University in May 2021 were retrospectively analyzed. The literature was searched from China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China VIP database, China Biology Medicine disc and PubMed database (up to May 2022) with "familial hypobetalipoproteinemia" or "hypobetalipoproteinemias" or "hypo beta lipoproteinemia" or "hypolipoproteinemias" as the search terms. All relevant literatures were reviewed to summarize the clinical and genetic features of Ho-FHBL caused by APOB gene variations. Results: The male patient was admitted to the hospital due to abnormal liver function tests for 8 months at the age of 4 years and 6 months. Blood biochemistry showed transaminitis and abnormally low serum levels of lipids. Liver biopsy revealed fatty liver with inflammation and early cirrhosis (Brunt score was F3G2S4). Whole exome sequencing revealed two novel variants of APOB gene (c.3745C>T, p.Q1249 * from the father and c.4589_4592delinsAGGTAGGAGGTTTAACTCCTCCTACCT, p.T1530Kfs * 12 from the mother). He was diagnosed as Ho-FHBL caused by APOB gene compound heterozygous variations. Literature search retrieved 36 English literatures and 0 Chinese literature. A total of 55 (23 males and 32 females) Ho-FHBL cases, including this one, were caused by 54 APOB gene pathogenic variants (23 frameshift, 15 nonsense, 7 missense, 8 splice and 1 gross deletions). The age of the last follow-up was between 1 month and 75 years. Among them, 28 cases had lipid malabsorption, 19 cases had early dysplasia, 12 cases had no symptoms. Twenty-one patients had symptoms related to fat soluble vitamin deficiency, including 14 cases of acanthocytosis, 10 cases of neurological symptoms, and 6 cases of ocular lesions. Thirty-four patients had liver involvement, including 25 cases of elevated transaminase, 21 cases of fatty liver, 15 cases of hepatomegaly, 9 cases of liver fibrosis, 3 cases of liver cirrhosis, 1 case of hepatic hemangioma and 1 case of liver neoplastic nodule. Conclusions: The variants of APOB gene in Ho-FHBL are mainly frameshift and nonsense variations. Patients may have lipid malabsorption and (or) early dysplasia, or symptom-free. Liver involvement is common.

Difference in liver injury induced by dictamnine between males and females: based on untargeted metabolomics / 中国中药杂志

In recent years, reports of adverse reactions related to traditional Chinese medicine(TCM) have been on the rise, especially some traditionally considered "non-toxic" TCM(such as Dictamni Cortex). This has aroused the concern of scholars. This study aims to explore the metabolomic mechanism underlying the difference in liver injury induced by dictamnine between males and females through the experiment on 4-week-old mice. The results showed that the serum biochemical indexes of liver function and organ coefficients were significantly increased by dictamnine(P<0.05), and hepatic alveolar steatosis was mainly observed in female mice. However, no histopathological changes were observed in the male mice. Furthermore, a total of 48 differential metabolites(such as tryptophan, corticosterone, and indole) related to the difference in liver injury between males and females were screened out by untargeted metabolomics and multivariate statistical analysis. According to the receiver operating characteristic(ROC) curve, 14 metabolites were highly correlated with the difference. Finally, pathway enrichment analysis indicated that disorders of metabolic pathways, such as tryptophan metabolism, steroid hormone biosynthesis, and ferroptosis(linoleic acid metabolism and arachidonic acid metabolism), may be the potential mechanism of the difference. Liver injury induced by dictamnine is significantly different between males and females, which may be caused by the disorders of tryptophan metabolism, steroid hormone biosynthesis, and ferroptosis pathways.

Alteración de la microbiota intestinal y su relación con enfermedades gastrointestinales y hepatobiliares / Disruption of the intestinal microbiota and its relationship with gastrointestinal and hepatobiliary diseases

La interrupción de la simbiosis que existe entre el cuerpo humano y su microbioma puede resultar en una disbiosis, un desequilibrio en la interacción huésped-microbiota, que puede asociarse al desarrollo de diversas enfermedades como el síndrome de intestino irritable, hígado graso no alco-hólico, enfermedad hepática alcohólica y cirrosis, entre otras. En ciertas condiciones patológicas y por múltiples factores de riesgo, la capacidad de autorregulación del intestino se puede alterar, contribuyendo al incremento de la permeabilidad con inflamación intestinal crónica. El diagnóstico y el tratamiento, así como la relación entre la permeabilidad intestinal, la disbiosis y las patologías gastrointestinales y hepatobiliares, todavía no tienen estudios clínicos validados o con el soporte científico adecuado, por lo que se realiza una revisión de la literatura con la finalidad de aportar conceptos que puedan orientar con respecto a la importancia del estudio del microbioma humano en estas enfermedades.

Disruption of the symbiosis that exists between the human body and its microbiome can result in dys-biosis, an imbalance in the host-microbiota interaction, which may be associated with the develop-ment of various diseases such as irritable bowel syndrome, non-alcoholic fatty liver disease, alcoholic liver disease and cirrhosis, among others. In certain pathological conditions and due to multiple risk factors, the self-regulating capacity of the intestine may be lost, contributing to increased permeability with chronic intestinal inflammation. Its diagnosis and treatment as well as the relationship between intestinal permeability, dysbiosis and gastrointestinal and hepatobiliary pathologies have not been validated in clinical studies or have adequate scientific support, so a review of the literature is carried out in order to provide concepts that can guide with respect to the importance of the study of the human microbiome in these diseases

Frequência de esteato-hepatite alcoólica em pacientes portadores do vírus de hepatite C / Frequency of alcoholic steatohepatitis in patients with hepatitis C virus

Introdução: o consumo de álcool é um fator de risco bem conhecido para induzir doença crônica do fígado. O álcool também é um cofator na patogênese induzida pelo vírus da hepatite C (VHC). A infecção crônica pelo VHC pode exacerbar a lesão hepática alcoólica por mecanismos que incluem aumento do estresse oxidativo. Portanto o VHC, concomitantemente com o consumo excessivo de álcool, induz diversos mecanismos fisiopatogênicos que contribuem para a diminuição da depuração viral e para a lesão hepática. Objetivos: 1 ­ avaliar a frequência de esteato-hepatite alcoólica em biópsias de pacientes portadores do vírus da hepatite C; 2 ­ estudar os estágios da fibrose hepática nesses pacientes versus pacientes com e sem ingestão de álcool; 3 ­ analisar os escores bioquímicos e antropométricos desses pacientes. Metodologia: estudo de corte transversal, com pacientes acompanhados no núcleo de hepatologia do Hospital Prof. Edgard Santos da Universidade Federal da Bahia, portadores de hepatite C, com laudos de biópsias disponíveis para avaliar presença de esteato-hepatite alcoólica comprovada pelo registro de consumo de gramas de álcool. Foram considerados etilistas homens que consumiam mais de 30 g por dia e mulheres com consumo maior do que 20 g por dia. As variáveis utilizadas basearam-se em critérios histológicos, epidemiológicos e clínicos aplicados a esses pacientes. Resultados: a amostra total de pacientes portadores de hepatite C analisados foi de 335, sendo 100 indivíduos considerados com ingestão elevada de álcool, e 28,9% dos casos da amostra. A presença de esteatose hepática sem esteato-hepatite foi em 34 indivíduos (10,15%), e os casos de esteato-hepatite aparecem em um total de 30 indivíduos (8,96%). A carga viral elevada dos pacientes, tendo como referência >800.000, esteve em n=102, com 30,4% dos casos de VHC. Conclusão: observou-se, na população de estudo, 43 % os portadores de VHC com uso excessivo de alcool, 8,9 6% tinham esteato-hepatiits e 10,15 % esteatose. Além disso, verificou-se que mais da metade desses pacientes (56,6%) apresentaram grau de fibrose moderada e 53,3%, atividade necroinflamatória leve. A comorbidade mais comum observada foi hipertensão arterial sistêmica (HAS), em 40% dos pacientes.

Introduction: alcohol consumption is a well-known risk factor for inducing chronic liver disease, alcohol is also a cofactor in the pathogenesis induced by Hepatitis C Virus (HCV). Chronic HCV infection can exacerbate alcoholic liver damage by mechanisms including increased oxidative stress. Therefore, HCV, concomitantly with excessive alcohol consumption, induces several pathophysiological mechanisms, which contribute to the decrease in viral clearance and liver damage. Objectives: 1 ­ to assess the frequency of alcoholic steatohepatitis in biopsies of patients with the hepatitis C virus, 2 ­ to study the stages of liver fibrosis in these patients versus in patients with or without alcohol intake, 3 ­ analyze biochemical and anthropometric scores of these patients. Methodology: cross-sectional study, with patients monitored at the hepatology center of Hospital Prof. Edgard Santos from the Federal University of Bahia, carriers of hepatitis C with biopsy reports available to assess the presence of alcoholic steatohepatitis proven by recording the consumption of grams of alcohol, considered an alcoholic being a man, who consumed more than 30 g per day and being woman more than 20g a day. The variables used were based on histological, epidemiological and clinical criteria applied to these patients. Results: the total sample of patients with hepatitis C analyzed was (n=335), with n=100 individuals considered to have high alcohol intake, and 28.9% of the cases in the sample. The presence of hepatic steatosis without steatohepatitis was in 34 individuals (10.15%), and cases of steatohepatitis appear in a total of n=30 individuals (8.96%).The high viral load of patients, with >800,000 as reference, was n=102, with 30.4% of cases of HCV. Conclusion: it was observed, in the study population, 43% of HCV carriers with excessive alcohol use, 8.96% had steatohepatitis and 10.15% steatosis. Furthermore, it was found that more than half of these patients (56.6%) had a moderate degree of fibrosis and 53.3% had mild necroinflammatory activity. The most common comorbidity observed was systemic arterial hypertension (SAH), in 40% of patients.

Preeclampsia de presentación grave asociada a hígado graso agudo del embarazo / Severe preeclampsia associated with acute fatty liver of pregnancy / Pré-eclâmpsia grave associada a fígado gorduroso agudo da gravidez

La preeclampsia se puede asociar a una patología poco frecuente como es el hígado graso agudo del embarazo. Se reporta el caso clínico de una paciente de 35 años, tercigesta, cursando embarazo gemelar que presenta preeclampsia con elementos de gravedad, asociada a hígado graso agudo del embarazo. Se realiza diagnóstico y tratamiento precoz de ambas patologías, presentando buena evolución materno-fetal.

Preeclampsia can be associated with acute fatty liver of pregnancy, a rare disease. This report describes the case of a 35-year-old patient, gravida 3, pregnant with twins, who presented with severe pre-eclampsia associated with acute fatty liver of pregnancy. Early diagnosis and treatment of both pathologies was performed, resulting in good maternal-fetal evolution.

A pré-eclâmpsia pode estar associada a uma patologia rara, como o fígado gorduroso agudo da gravidez. Neste relato, apresentamos uma paciente de 35 anos, terciária, em gestação gemelar, apresentando pré-eclâmpsia grave, associada a esteatose hepática aguda na gestação. É realizado diagnóstico e tratamento precoces de ambas as patologias, apresentando boa evolução materno-fetal.

Survival in Patients with Cirrhosis According to Etiology. Retrospective Cohort / Sobrevida en pacientes con cirrosis de acuerdo con su etiología. Cohorte retrospectiva

Abstract Introduction: Cirrhosis is the final stage of chronically progressive liver diseases of various etiologies. It is a common disease, with a variable prevalence in each country. Its peak incidence occurs between 40 and 50 years of age, predominantly in men. Aims: To compare a cohort of patients diagnosed with cirrhosis, evaluate their complications and survival according to etiology, describe clinical and laboratory aspects, and determine the role of a fatty liver. Materials and methods: A retrospective cohort study was carried out with patients who held a specialized hepatology consultation in the center of liver and digestive diseases (CEHYD) in Bogotá, Colombia, between January 2010 and June 2019. Results: We reviewed a total of 1,200 medical records (56.8 % women). There were no statistically significant differences in median survival between groups by etiology, sex, presence or absence of complications, or Child. We noted that the older the age at the diagnosis of cirrhosis, the higher the risk of death; HR 1.04 (95 % CI 1.02-1.075). For each month that follow-up increases, the risk of death decreases by 90 %; HR 0.1 (95 % CI 0.03-0.29). For each month that the follow-up of complications increases, the risk of death is reduced by 2 %; HR 0.98 (95 % CI 0.97-0.99). Conclusions: Survival by etiology was similar in the different groups. Nonalcoholic steatohepatitis (NASH) was the leading cause of cirrhosis in this cohort. Efforts should focus on its diagnosis and management in the early stages.

Resumen Introducción: la cirrosis es el estadio final de enfermedades hepáticas crónicamente progresivas de diferentes etiologías. Es una enfermedad frecuente, con una prevalencia variable en cada país. Su pico de incidencia se presenta entre los 40 y 50 años, predominantemente en hombres. Objetivos: comparar una cohorte de pacientes con diagnóstico de cirrosis, evaluar sus complicaciones y sobrevida de acuerdo con su etiología, describir los aspectos clínicos y de laboratorio, y determinar el papel del hígado graso. Materiales y métodos: se realizó un estudio de cohorte retrospectiva, en donde se incluyeron pacientes que asistieron a consulta especializada de hepatología en el centro de enfermedades hepáticas y digestivas (CEHYD), en la ciudad de Bogotá, durante enero de 2010 y junio de 2019. Resultados: se revisaron un total de 1200 historias clínicas (56,8 % mujeres). No se evidenció diferencias estadísticamente significativas en las medianas de sobrevida entre los grupos por etiologías, sexo, presencia o no de complicaciones, o Child. Se evidenció que entre mayor edad en el diagnóstico de cirrosis, el riesgo de muerte es mayor; HR 1,04 (IC 95 % 1,02-1,075). Por cada mes que aumenta el seguimiento se reduce el riesgo de muerte en 90 %; HR 0,1 (IC 95 % 0,03-0,29). Por cada mes que aumenta el seguimiento de las complicaciones se reduce el riesgo de muerte en 2 %; HR 0,98 (IC 95 % 0,97-0,99). Conclusiones: La sobrevida por etiología fue similar en los diferentes grupos. La esteatohepatitis no alcohólica (NASH) fue la principal causa de cirrosis en esta cohorte. Se deben orientar esfuerzos a su diagnóstico y manejo en fases tempranas.

Berberine alleviates programmed necrosis of metabolic-associated fatty liver disease via activating Nrf2 pathway in mice / 中华肝脏病杂志

Objective: To investigate the effect of berberine on programmed necrosis of hepatocytes induced by metabolic-associated fatty liver disease (MAFLD) in mice and its related molecular mechanism. Methods: Twenty male C57BL/6N mice were randomly divided into four groups (n=5 in each group): control group (S), fatty liver group (H), berberine group(B), nuclear factor erythroid 2-related factor 2 inhibitor group (Nrf2), and all-trans-retinoic acid (ATRA) group (A). Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), triglycerides (TG), total cholesterol (TC), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) concentrations were detected at the end of week 12 to calculate fatty liver index (liver mass/body mass ratio). Liver tissue was stained with HE, Masson and Oil Red O, and SAF score was used to evaluate the degree of liver injury. The expression levels of hepatic programmed necrosis-related proteins, namely receptor-interacting protein kinase 3 (RIPK3), phosphorylated mixed series protease-like domain (p-MLKL) and Nrf2 were detected by Western blot method. One-way ANOVA was used for intragroup comparisons and LSD-t tests were used for intergroup comparisons. Results: Compared with S group, H group serum ALT, AST, LDH, TG, TC, TNF-α, IL-1β levels and fatty liver index were significantly increased. The liver tissue was filled with vacuolar-like changes and inflammatory cell infiltration. Numerous red lipid droplets were observed with oil red O staining. Collagen fiber hyperplasia was evident with Masson staining. SAF scores (6.60 ± 0.55 and 0.80 ± 0.45) were significantly increased. The expressions of RIPK3 and p-MLKL were up-regulated. Nrf2 level was relatively increased, and the differences were statistically significant (P < 0.05). Compared with H group, berberine intervention group liver biochemical indexes, lipid levels, pro-inflammatory mediator expression, fatty liver index, and SAF score were significantly reduced, and the expression of RIPK3 and p-MLKL were down-regulated, while Nrf2 levels were further increased, and the differences were statistically significant (P<0.05). Compared with B group, treatment with Nrf2 inhibitor had antagonized the protective effect of berberine on fatty liver. Serum ALT, AST, LDH, TG, TC and TNF-α, IL-1β levels, fatty liver index, and SAF scores were significantly increased and the expressions of RIPK3 and p-MLKL were relatively increased, and the differences were statistically significant (P < 0.05). Conclusion: Berberine can significantly improve the metabolic-associated fatty liver disease injury in mice, and its mechanism is related to activation of Nrf2 and inhibition of programmed necrosis of hepatocytes.

Anatomopathological findings of Testudines necropsied in the Distrito Federal, Brazil / Achados anatomopatológicos de Testudines necropsiados no Distrito Federal, Brasil

In order to determine the main anatomopathological findings of Testudines necropsied in the Distrito Federal, all necropsy records performed at the "Laboratório de Patologia Veterinária" of the "Universidade de Brasília" (LPV-UnB) on Testudines during the period from January 2008 to July 2020 were reviewed. The 72 cases reviewed were grouped and classified according to species, sex, origin, season of occurrence, and diagnosis. In 69.44% of the cases the species was informed in the necropsy protocols, which included Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) and Podocnemis expansa (2%). In 30.55% of the cases this parameter was not informed and were classified only as Testudines. In 41.66% of the cases the sex was informed, being female 22.22%, male 19.44%, and 58.33% were not informed. Of these animals 79.16% were from environmental agencies and 20.84% from zoos and/or guardians. In 70.83% of the animals analyzed they were directly related to the autumn and winter seasons, with June being the most frequent month (29.17%). The conclusive diagnosis was possible in 68.05% of the cases. The category of disorders caused by injurious agents (48.97%) was the most prevalent, followed by inflammatory disorders (32.65%) and nutritional and metabolic disorders (28.57%). The main diagnoses were carapace and/or plastron fracture with 30.61%, hepatic steatosis (20.40%) and pneumonia (10.22%). Most cases of carapace or plastron fracture and hepatic steatosis occurred in animals from environmental agencies.(AU)

Com o objetivo de determinar os principais achados anatomopatológicos de Testudines necropsiados no Distrito Federal, foram revisadas todas as fichas de necropsia realizadas no Laboratório de Patologia Veterinária da Universidade de Brasília (LPV-UnB) em Testudines, durante o período de janeiro de 2008 a julho de 2020. Os 72 casos revisados foram agrupados e classificados quanto à espécie, sexo, procedência, estação do ano de ocorrência e diagnóstico. Em 69,44% dos casos havia a espécie informada nos protocolos de necropsia, que incluíam Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) e Podocnemis expansa (2%). Em 30,55% dos casos não tiveram esse parâmetro informado e foram classificados apenas como Testudines. Em 41,66% casos foi informado o sexo, sendo fêmea 22,22%, macho 19,44% e não informados 58,33%. Destes animais 79,16% eram de órgão ambiental e 20,84% de zoológicos e ou tutores. Em 70,83% dos animais analisados tiveram direta relação com as estações de outono e inverno, sendo o mês de junho o mais frequente (29,17%). O diagnóstico conclusivo foi possível em 68,05% dos casos. A categoria de distúrbios causados por agentes lesivos (48,97%) foi a mais prevalente, seguido por distúrbios inflamatórios (32,65%) e dos distúrbios nutricionais e metabólicos (28,57%). Os principais diagnósticos foram fratura de carapaça e ou plastrão com 30,61%, esteatose hepática (20,40%) e pneumonia (10,22%). A maior parte dos casos de fratura de carapaça ou plastrão e de esteatose hepática ocorreram em animais provenientes de órgão ambiental.(AU)

Anatomopathological findings of Testudines necropsied in the Distrito Federal, Brazil / Achados anatomopatológicos de Testudines necropsiados no Distrito Federal, Brasil

In order to determine the main anatomopathological findings of Testudines necropsied in the Distrito Federal, all necropsy records performed at the "Laboratório de Patologia Veterinária" of the "Universidade de Brasília" (LPV-UnB) on Testudines during the period from January 2008 to July 2020 were reviewed. The 72 cases reviewed were grouped and classified according to species, sex, origin, season of occurrence, and diagnosis. In 69.44% of the cases the species was informed in the necropsy protocols, which included Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) and Podocnemis expansa (2%). In 30.55% of the cases this parameter was not informed and were classified only as Testudines. In 41.66% of the cases the sex was informed, being female 22.22%, male 19.44%, and 58.33% were not informed. Of these animals 79.16% were from environmental agencies and 20.84% from zoos and/or guardians. In 70.83% of the animals analyzed they were directly related to the autumn and winter seasons, with June being the most frequent month (29.17%). The conclusive diagnosis was possible in 68.05% of the cases. The category of disorders caused by injurious agents (48.97%) was the most prevalent, followed by inflammatory disorders (32.65%) and nutritional and metabolic disorders (28.57%). The main diagnoses were carapace and/or plastron fracture with 30.61%, hepatic steatosis (20.40%) and pneumonia (10.22%). Most cases of carapace or plastron fracture and hepatic steatosis occurred in animals from environmental agencies.

Com o objetivo de determinar os principais achados anatomopatológicos de Testudines necropsiados no Distrito Federal, foram revisadas todas as fichas de necropsia realizadas no Laboratório de Patologia Veterinária da Universidade de Brasília (LPV-UnB) em Testudines, durante o período de janeiro de 2008 a julho de 2020. Os 72 casos revisados foram agrupados e classificados quanto à espécie, sexo, procedência, estação do ano de ocorrência e diagnóstico. Em 69,44% dos casos havia a espécie informada nos protocolos de necropsia, que incluíam Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) e Podocnemis expansa (2%). Em 30,55% dos casos não tiveram esse parâmetro informado e foram classificados apenas como Testudines. Em 41,66% casos foi informado o sexo, sendo fêmea 22,22%, macho 19,44% e não informados 58,33%. Destes animais 79,16% eram de órgão ambiental e 20,84% de zoológicos e ou tutores. Em 70,83% dos animais analisados tiveram direta relação com as estações de outono e inverno, sendo o mês de junho o mais frequente (29,17%). O diagnóstico conclusivo foi possível em 68,05% dos casos. A categoria de distúrbios causados por agentes lesivos (48,97%) foi a mais prevalente, seguido por distúrbios inflamatórios (32,65%) e dos distúrbios nutricionais e metabólicos (28,57%). Os principais diagnósticos foram fratura de carapaça e ou plastrão com 30,61%, esteatose hepática (20,40%) e pneumonia (10,22%). A maior parte dos casos de fratura de carapaça ou plastrão e de esteatose hepática ocorreram em animais provenientes de órgão ambiental.

Effects of different exercise on liver lipid accumulation and FGF21 secretion in obese rats / 中国应用生理学杂志

Objective: To investigate the effects of continuous exercise training (CT) and high-intensity interval exercise training (HIIT) on liver lipid metabolism and the correlation of the level of fibroblast growth factor 21(FGF21) in serum and liver tissues. Methods: Male SD rats were randomly divided into normal diet group (N) and obesity model group (H) after 1 week of adaptive feeding. Rats in the obesity model group were fed with 45% high-fat diet for about 8 weeks, and 20% weight increase compared with normal rats was considered as obesity. The rats were divided into normal diet control group (LC), normal diet HIIT group (LHI), normal diet CT group (LCT), High fat diet-induced obese control group (OC), obese HIIT group (OHI), and obese CT group (OCT) (n=10). Exercised rats were given weight-bearing swimming training intervention for 8 weeks. Blood samples were collected at least 24h after the last exercise intervention to detect the serum levels of inflammatory factors and FGF21. Liver tissue samples were collected to detect the lipid content, lipid metabolic enzyme content and FGF21 expression level. Results: Compared with LC group, the body weight, serum inflammatory factors levels and hepatic triglyceride content were increased significantly (P＜0.05). Hepatic triglyceride content was downregulated in LHI group and FGF21 expression level was enhanced in LCT group (P＜0.05). Compared with OC group, the body weight and hepatic triglyceride content were decreased significantly (P＜0.05), mitochondrial CPT-1β and β-HAD enzyme contents in liver were increased significantly (P＜0.05) in OHI group, the contents of LPL and FAT/CD36 enzyme in liver and the levels of FGF21 in serum and liver of OCT group were increased significantly (P＜0.05). Conclusion: Both exercise modes can reduce the body weight in normal and obese rats, and lipid deposition in the liver of obese rats. HIIT has a more significant effect on alleviating liver lipid deposition in obese rats by upregulating mitochondrial lipid oxidation level in normal and obese rats. CT improves the levels of FGF21 in serum and liver tissues of normal and obese rats, enhances enzyme contents that involved in fatty acids uptake to the liver, which has limited effect on alleviating lipid deposition in liver of obese rats.

Frutose e risco cardiometabólico em indivíduos com preservação da cultura germânica: estudo SHIP-BRASIL / Fructose and cardiometabolic risk of individuals with preservation of the Germanic culture: SHIP-BRAZIL study

Nas últimas décadas, países, como o Brasil, têm apresentado uma curva ascendente na incidência de doenças cardiovasculares (DCV), representando cerca de 30% das mortes totais e 72% da mortalidade por DCNT no Brasil. O atual padrão alimentar brasileiro é caracterizado pelo elevado consumo de alimentos industrializados, com alta densidade calórica e rico em açúcares de adição, onde se destaca o elevado consumo de sacarose e, consequentemente, de glicose e frutose. Ao contrário da frutose encontrada naturalmente em frutas e vegetais, o consumo excessivo exerce múltiplos efeitos negativos à saúde, destacando-se as dislipidemias, hiperuricemia e resistência à insulina e, possivelmente, o RCV. Poucos estudos têm avaliado a interação entre o consumo de frutose e aspectos culturais específicos. O objetivo deste estudo foi avaliar o papel da frutose no risco cardiovascular em descendentes alemães que mantêm a cultura germânica preservada. Trata-se de um estudo com dados primários do momento basal da Coorte "Vida e Saúde em Pomerode (SHIP-BRAZIL)" baseado na avaliação direta de dados socioeconômicos, culturais, clínicos e dietéticos (Questionário de frequência alimentar). Com base na avaliação fenotípica (etnia autodeclarada) e comportamentos sociais (falar alemão em casa, frequentar associação comunitária/cultural e relatar esforços para manter os hábitos alemães no Brasil por meio das vestimentas, músicas e culinária), os indivíduos foram classificados em grupos Germânico e Não germânico. A partir do sangue coletado foram analisados o perfil lipídico (Colesterol total - CT, HDL-c, LDL-c, VLDL, Não-HDL, triglicerídeos - TG), Índice de Castelli I (ICI), Índice de Castelli II (ICII), enzimas hepáticas (gama-glutamiltransferase - GGT, aspartato aminotransferase - AST e alanina minotransferase - ALT), glicose e frutose plasmática. Todos os testes estatísticos foram analisados no programa Statistical Package for the Social Siences® (SPSS) versão 20.0, sendo o nível de significância de p<0,05. Da amostra investigada (n=597), 68,3% pertençam ao grupo Germânico, onde o sexo feminino foi o mais frequente em ambos os grupos (Germânicos= 56,7%; Não germânicos= 57,5%, p=0,892), e predominantemente adultos entre 30 e 60 anos. Em relação às doenças autorrelatadas, o grupo Germânico apresentou maior prevalência de HAS (41,9% versus 24,7%; p<0,001) que o grupo Não germânico, sendo confirmado pela maior frequência no uso de medicamentos anti-HAS (35,1% versus 21,7%; p=0,002) e pela maior pressão arterial sistólica observada (126 mmHg versus 121 mmHg; p<0,001) e valores superiores no sexo masculino. Os homens do grupo Germânico apresentaram valores superiores de peso, IMC e CC quando comparados às mulheres e ao grupo Não germânico. Perfil oposto foi observado para o percentual de MG que foi superior no grupo feminino. A classificação dos parâmetros antropométricos confirmou que o grupo Germânico teve maior risco de complicações cardiovasculares associado à elevada CC (72% versus 53%. p<0,001). Embora os grupos Germânico e Não germânico tenham apresentado perfil lipídico e enzimas hepáticas semelhantes, os indivíduos do sexo masculino em ambos os grupos apresentaram maiores valores de glicemia, frutose, enzimas hepáticas e ICI e II, assim como menor valores de HDL-c, quando comparados às mulheres. Embora o autorrelato de diagnóstico de esteatose hepática no grupo Germânico tenha sido cerca de três vezes superior ao grupo Não germânico, os resultados de ultrassonografia hepática não identificaram diferenças, segundo grupos e sexo. A estimativa do risco cardiovascular mostrou que os indivíduos do grupo Não germânico apresentaram maior frequência de alto risco cardiovascular. A frutose plasmática não se correlacionou com o consumo de frutose (r= -0,013; p=0,556), entretanto, a avaliação dos grupos alimentares segundo grau de processamento mostrou que o grupo Germânico teve maior consumo de alimentos processados e ultraprocessados, caracterizado principalmente pelo elevado consumo de sucos, refrigerantes, doces e feijoada/feijão tropeiro. Em conjunto, destacou-se o elevado consumo de alimentos ricos em sacarose e consequentemente em frutose. Observamos que a frutose plasmática no grupo Germânico se correlacionou positivamente com a CC (p=0,001), perfil lipídico (TG, TG/HDL, p<0,001), enquanto observou-se correlação negativa com o HDL-c (p<0,001). Essas correlações foram mais robustas no grupo Não germânico. Os indivíduos do grupo Germânico apresentaram um risco de ter elevada concentração de frutose 75% superior ao grupo Não germânico. No modelo múltiplo, os indivíduos do grupo Germânico apresentaram o dobro de chances de terem HAS, e CC com valores indicativos de elevado RCV, porém menor chance de terem DLP. A inclusão da frutose no modelo de regressão mostrou tendência de maior RCV nos indivíduos germânicos com maior concentração de frutose no plasma. No modelo ajustado pela idade e sexo, a HAS perde a significância, enquanto a associação com a frutose se torna significativa. No modelo que também inclui o consumo de álcool, tabagismo e uso de medicamentos como variável de ajuste, apenas CC e DLP se mantiveram associados à preservação da cultura germânica. Com base nestes resultados podemos concluir que a preservação da cultura germânica se associou ao elevado consumo de frutose e essa manteve relação com elevada adiposidade, pressão arterial, diabetes mellitus e esteatose hepática, entretanto não houve impacto no perfil lipídico e na estimativa do risco cardiovascular.

In recent decades, countries such as Brazil have shown an upward curve in the incidence of cardiovascular diseases (CVD), representing about 30% of total deaths and 72% of NCD mortality in Brazil. The current Brazilian dietary pattern is characterized by high consumption of processed foods, with high caloric density and rich in added sugars, where the high consumption of sucrose and, consequently, glucose and fructose stand out. Unlike the fructose found naturally in fruits and vegetables, excessive consumption exerts multiple negative effects on health, especially dyslipidemia, hyperuricemia, insulin resistance, and possibly cardiovascular risk. Few studies have evaluated the interaction between fructose intake and culturally specific aspects. The aim of this study was to evaluate the role of fructose on cardiovascular risk in German descendants who maintain preserved Germanic culture. This is a study with primary data from the baseline moment of the "Life and Health in Pomerode (SHIP-BRAZIL) Cohort" based on direct assessment of socioeconomic, cultural, clinical and dietary data (Food Frequency Questionnaire). Based on phenotypic evaluation (self-reported ethnicity) and social behaviors (speaking German at home, attending community/cultural associations, and reporting efforts to maintain German habits in Brazil through dress, music, and cooking), the individuals were classified into Germanic and Non-Germanic groups. From the blood collected, the lipid profile was analyzed (total cholesterol - TC, HDL-c, LDL-c, VLDL, Non-HDL, triglycerides - TG), Castelli Index I (ICI), Castelli Index II (ICII), liver enzymes (gamma-glutamyltransferase - GGT, aspartate aminotransferase - AST and alanine aminotransferase - ALT), plasma glucose and fructose. All statistical tests were analyzed using the Statistical Package for the Social Siences® (SPSS) version 20.0 software, with a significance level of p<0.05. Of the investigated sample (n=597), 68.3% belonged to the Germanic group, where the female gender was the most frequent in both groups (Germanic= 56.7%; Non-Germanic= 57.5%, p=0.892), and predominantly adults between 30 and 60 years old. Regarding self-reported diseases, the Germanic group showed higher prevalence of HAS (41.9% versus 24.7%; p<0.001) than the Non-Germanic group, being confirmed by the higher frequency in the use of anti-SAH medications (35.1% versus 21.7%; p=0.002) and by the higher systolic blood pressure observed (126 mmHg versus 121 mmHg; p<0.001) and higher values in males. Men in the Germanic group had higher weight, BMI and WC values when compared to women and the Non-Germanic group. Opposite profile was observed for the percentage of FM that was higher in the female group. The classification of anthropometric parameters confirmed that the Germanic group had a higher risk of cardiovascular complications associated with high WC (72% versus 53%. p<0.001). Although the Germanic and Non-Germanic groups had similar lipid profile and liver enzymes, male subjects in both groups had higher blood glucose, fructose, liver enzymes and ICI and II values, as well as lower HDL-c values, when compared to females. Although the self-reported diagnosis of hepatic steatosis in the Germanic group was about three times higher than in the non-Germanic group, the liver ultrasound results did not identify differences according to groups and sex. Estimation of cardiovascular risk showed that individuals in the Non-Germanic group had a higher frequency of high cardiovascular risk. Plasma fructose did not correlate with fructose consumption (r= -0,013; p=0.556), however, the evaluation of food groups according to the degree of processing showed that the Germanic group had higher consumption of processed and ultra-processed foods, characterized mainly by high consumption of juices, soft drinks, sweets and feijoada/tropical beans. Together, the high consumption of foods rich in sucrose and consequently in fructose stood out. We observed that plasma fructose in the Germanic group correlated positively with WC (p=0.001), lipid profile (TG, TG/HDL, p<0.001), while a negative correlation was observed with HDL-c (p<0.001). These correlations were more robust in the Non-Germanic group. Individuals in the Germanic group had a 75% higher risk of having high fructose concentration than the Non-Germanic group. In the multiple models, individuals in the Germanic group were twice as likely to have HAS, and CC with values indicative of high CRV, but less likely to have DLP. The inclusion of fructose in the regression model showed a trend towards higher CVR in Germanic subjects with higher plasma fructose concentration. In the model adjusted for age and sex, SAH loses significance, while the association with fructose becomes significant. In the model that also includes alcohol consumption, smoking, and medication use as adjustment variables, only WC and DLP remained associated with Germanic culture preservation. Based on these results we can conclude that the preservation of Germanic culture was associated with high fructose consumption and this maintained a relationship with high adiposity, blood pressure, diabetes mellitus, and hepatic steatosis; however there was no impact on lipid profile and cardiovascular risk estimation.

Triatriatum sinistrum em adulto assintomático: relato de caso / Cor triatriatum sinistrum in an asymptomatic adult: a case report

Cor triatriatum é um anomalia cardíaca congênita rara frequentemente diagnosticada na primeira infância. Este estudo de caso apresenta um adulto com um achado acidental de cor triatriatum sinistrum. Com base na apresentação clínica, o paciente foi tratado de forma conservadora. São apresentados achados de imagens ecocardiográficas de cor triatriatum sinistrum deste paciente juntamente de revisão narrativa da literatura sobre essa doença.(AU)

Cor triatriatum is a rare congenital heart anomaly often diagnosed in early childhood. This case study features an adult with an incidental finding of cor triatriatum sinistrum. Based on the clinical presentation, the patient was treated conservatively. Cor triatriatum sinistrum echocardiographic image findings of this patient are presented along with a narrative review of the literature about this disease. (AU)