Cognitive Impairment in Liver Tranplant Recipients: A Cross-Sectional Study.

OBJECTIVES: The proportion of older transplant recipients has increased. Cognitive impairment is not rare after kidney transplant, but data on this issue in liver transplant recipients are scarse. MATERIALS AND METHODS: In this cross-sectional study, we evaluated all liver transplant recipients from a single center in Brazil from July 2018 to June 2020 in terms of cognitive performance to determine the prevalence of neurocognitive disorder. We compared liver transplant recipients with neurocognitive disorder with liver transplant recipients without neurocognitive disorder. We also compared those with an alcoholic cause of liver transplant with other patients. The presence of depressive symptoms was assessed. We performed correlations of clinical data with cognitive scores. RESULTS: In a sample of 100 recipients with median age of 62 years (interquartile range, 56.2-69 y), neurocognitive disorder was present in 21% of the group. Patients with cognitive impairment were older (68 y [61-72] vs 61 y [52-68]; P = .019) and had a trend to higher proportion of persistent kidney injury (33.3% vs 13.9%; P = .055) versus patients without cognitive impairment. Recipients with alcoholic cause of liver transplant exhibited worse cognitive performance in the Mini-Mental State Examination (score of 26 [23.7-28.2] vs 28 [26-29]; P = .024) and the Alzheimer Disease Assessment Scale-cognitive (score of 10.4 [8.6-14.2] vs 8 [6.3-10]; P = .008) than other patients. Weak negative correlations were shown in cognitive performance scores versus recipient age (Semantic Verbal Fluency test, r = -0.334 [P = .001]; Clock Drawing test, r = -0.209 [P = .037]; Alzheimer Disease Assessment Scale-cognitive, r = -0.323 [P = .001]). CONCLUSIONS: Neurocognitive disorder was common in liver transplant recipients, in part due to increased age. This study also suggested a role for alcoholic cause of liver transplant and persistent kidney injury in the development of cognitive impairment.

Oral candidiasis in liver transplant patients: species identification and antifungal susceptibility profile.

OBJECTIVE: This study aimed to verify oral candidiasis, identify the causative species, and investigate the antifungal susceptibility of yeasts isolated from liver transplant patients. METHODS: A descriptive analysis of 97 patients who underwent liver transplantation was conducted at a hospital. Two clinical examinations (Collections A and B) of the oral cavity were performed. Oral material was collected from all patients, inoculated in Sabouraud Dextrose Agar, and incubated at 35℃ for 48 hours. Samples were identified by molecular sequencing of the internal trascribed space region of rDNA. RESULTS: An antifungal susceptibility test with fluconazole, amphotericin B, and micafungin was performed using the Clinical and Laboratory Standards Institute yeast broth microdilution method. Among the patients, 15 presented with oral candidiasis: eight in Collection A and seven in Collection B. The primary type of candidiasis was atrophic, followed by pseudomembranous candidiasis. The most prevalent species was Candida albicans (nine), followed by Candida glabrata (three), Candida tropicalis (two), and Candida dubliniensis (one). Regarding susceptibility to fluconazole, of the 15 samples, 11 were susceptible, three were susceptible in a dose-dependent manner, and one was resistant. CONCLUSION: The most commonly identified type of candidiasis was atrophic, with C. albicans and C. glabrata being the most prevalent causative species. One fluconazole-resistant isolate each of C. tropicalis and C. albicans were identified.

Oral candidiasis in liver transplant patients: species identification and antifungal susceptibility profile

ABSTRACT Objective This study aimed to verify oral candidiasis, identify the causative species, and investigate the antifungal susceptibility of yeasts isolated from liver transplant patients. Methods A descriptive analysis of 97 patients who underwent liver transplantation was conducted at a hospital. Two clinical examinations (Collections A and B) of the oral cavity were performed. Oral material was collected from all patients, inoculated in Sabouraud Dextrose Agar, and incubated at 35℃ for 48 hours. Samples were identified by molecular sequencing of the internal trascribed space region of rDNA. Results An antifungal susceptibility test with fluconazole, amphotericin B, and micafungin was performed using the Clinical and Laboratory Standards Institute yeast broth microdilution method. Among the patients, 15 presented with oral candidiasis: eight in Collection A and seven in Collection B. The primary type of candidiasis was atrophic, followed by pseudomembranous candidiasis. The most prevalent species was Candida albicans (nine), followed by Candida glabrata (three), Candida tropicalis (two), and Candida dubliniensis (one). Regarding susceptibility to fluconazole, of the 15 samples, 11 were susceptible, three were susceptible in a dose-dependent manner, and one was resistant. Conclusion The most commonly identified type of candidiasis was atrophic, with C. albicans and C. glabrata being the most prevalent causative species. One fluconazole-resistant isolate each of C. tropicalis and C. albicans were identified.

Non-alcoholic fatty liver disease and associated risk factors in health care professionals in a community hospital in Brazil.

INTRODUCTION: Health care professionals are vulnerable to several health problems, including overweight, stress and anxiety. As such, non-alcoholic fatty liver disease is a likely diagnosis in this population. OBJECTIVES: To investigate the association between non-alcoholic fatty liver disease and levels of stress and anxiety in a sample of health care workers in a community hospital in the state of Rio Grande do Sul. METHODS: The sample consisted of 107 health care workers who were interviewed and screened for non-alcoholic fatty liver disease based on clinical, imaging and laboratory parameters. Occupational stress was evaluated using Lipp's Stress Symptom Inventory, and anxiety was assessed using the Hamilton Anxiety Rating Scale. RESULTS: The mean age of the sample was 37.6 years. Most participants were female (89.1%) and the most frequent occupation was nursing technicians (83.2%). While 77.22% of participants did not report significant levels of stress, 30.7% did have mild anxiety. Statistical tests did not reveal a significant association between non-alcoholic fatty liver disease and stress (p = 0.688) or anxiety (p = 0.996). CONCLUSIONS: All participants with non-alcoholic fatty liver disease had some degree of anxiety, but only some experienced stress symptoms, according to Lipp's Inventory. Statistical tests did not confirm an association between stress, anxiety and the presence non-alcoholic fatty liver disease. Nevertheless, the potential association between these variables should continue to be investigated given the global rise in the prevalence of non-alcoholic fatty liver disease and its implications for health care workers.

Ecological study of viral hepatitis in Brazil: a geographical and temporal analysis

Introduction: Viral hepatitis is a group of diseases that present high hepatotropism and are related to liver dysfunctions, having either an acute or a chronic course. Their worldwide epidemiology is diverse, with several endemic places, such as South America. The objective of this study was to analyze the epidemiology of viral hepatitis in Brazil, in order to better understand its pattern of distribution and evolution. Method: A temporal aggregation study was conducted using the Viral Hepatitis Database of the Brazilian Ministry of Health. The serological markers used were HBsAg and anti-HCV for hepatitis B and C, respectively. Mortality data were collected from the Mortality Information System for deaths attributed to viral hepatitis. The period analyzed was from 2007 to 2016/17. Results: The incidence was 7.88 (95% CI, 7.30-8.45) for hepatitis B and 11.9 (95% CI, 11.15-12.65) for hepatitis C. Mortality attributed to viral hepatitis was 1.61 (95% CI, 1.35-1.87) deaths per 100,000 people. An analysis of municipal distribution data showed several endemic areas. The Brazilian regions most affected by hepatitis B virus were the northern and southern borders, Santa Catarina coast and Espírito Santo state, while hepatitis C virus was mostly present in metropolitan areas such as Porto Alegre and São Paulo. Conclusions: Viral hepatitis has a diverse geographic distribution in the Brazilian territory, with highly endemic areas. The distribution differs between hepatitis B and hepatitis C viruses. (AU)

Epidemiological profile of viral hepatitis in Rio Grande do Sul and its health macro-regions

Introduction: Viral hepatitis comprises a group of viruses characterized by high global prevalence and hepatic tropism. Its epidemiology is extremely variable throughout the world, and South America is an endemic place. A better understanding of the regional reality is fundamental for proposing new public health measures. Methods: We conducted an aggregate temporal study of the Viral Hepatitis Database of the Ministry of Health of the state of Rio Grande do Sul (RS), with an epidemiological profile of the reactive results of HBsAg and Anti-HCV tests, together with data on mortality from acute Hepatitis B and chronic viral hepatitis from the respective Health Macro-Regions from 2007 to 2015. Results: The incidence of new cases of hepatitis B in RS during the analyzed period was 11 (95% CI, 9.7-12.1) cases per 100,000 inhabitants. Meanwhile, the Northern region of the state, represented by the municipality of Passo Fundo, had 32.7 (95% CI, 28.3-37) and 22.8 (95% CI, 19.5-26) new cases of hepatitis B per 100,000 inhabitants for men and women, respectively. The incidence of new cases of hepatitis C in the State of Rio Grande do Sul was 29.2 (95% CI, 24.5-34.9 in 100,000 inhabitants). Conclusion: Viral hepatitis remains an important pathology in the context of Rio Grande do Sul and its Macro-Regions. (AU)

Epidemiological profile of esophageal cancer mortality in Rio Grande do Sul and its health regions

Introduction: Malignant esophageal neoplasia is a rare tumor, but it has high morbidity and mortality. Early diagnosis and intensive treatment associated with surgical approach remains the best treatment for the disease. Its epidemiology is extremely diverse in the world, even in the same country. Methods: This was a retrospective analysis made from 2000-2015, analyzing the mortality rates of malignant esophageal neoplasia in the state of Rio Grande do Sul (RS) in its 30 Health Regions and in Brazil. The mortality data were collected in the Mortality Information System (SIM) and the population data in the Brazilian Institute of Geography and Statistics (IBGE). Results: The esophageal cancer mortality rate was 8.61 (95% CI, 8.49-8.73) per 100,000 inhabitants in RS, while the national rate was 3.66 (95% CI, 3, 49-3.82), with a significant difference (p <0.0001). The regional distribution was variable, and the West Border region presented the highest rate, 12.91 (95% CI, 12.05-13.77). However, even regions with lower mortality presented twice as much deaths than the national rate. Mortality increased with aging, with the oldest age groups (≥80 years) presenting 69.62 (95% CI, 64.9-74) deaths per 100,000 inhabitants. Conclusion: Esophageal neoplasia is still a very serious condition in the state of RS, being associated with an almost 3-fold higher mortality rate compared to the national rate. Even within the state different epidemiological patterns are found. (AU)

Analysis of the survival of cirrhotic patients enlisted for liver transplantation in the pre- and post-MELD era in southern Brazil.

CONTEXT: Transplantation is the only cure for decompensated cirrhosis. Model for End-Stage Liver Disease (MELD) is used in liver allocation. OBJECTIVES: Comparing survival of enlisted populations in pre- and post-MELD eras and estimating their long-term survival. METHODS: This is a retrospective study of cirrhotics enlisted for transplantation during pre- and post-MELD eras. Survival curves were generated using Kaplan-Meier's model. Cox's model was used to determine risk factors for mortality. Exponential, Weibull's, normal-log and Gompertz's models were used to estimate long-term survival. RESULTS: The study included 162 patients enlisted in pre-MELD era and 184 in post-MELD period. Kaplan-Meier's survival curve of patients enlisted in post-MELD era was better than that of pre-MELD period (P = 0.009). This difference remained for long-term estimates, with a survival of 53.54% in 5 years and 44.64% in 10 years for patients enlisted in post-MELD era and of 43.17% and 41.75% for pre-MELD period. Era in which patients had been enlisted (P = 0.010) and MELD score at enlistment (P<0.001) were independently associated to survival with hazard ratios of 0.664 (95% CI-confidence interval = 0.487-0.906) and 1.069 (95% CI = 1.043-1.095). CONCLUSIONS: MELD-based transplantation policy is superior to chronology-based one, promoting better survival for enlisted patients, even in long-term.

Analysis of thessurvival of cirrhotic patients nlisted for liver transplantatiion in the pre- and post-meld era in southern Brazil / Análise da sobrevida de pacientes cirróticos listados para transplante ortotópico de fígado nas eras pré e pós MELD no Sul do Brasil

Context Transplantation is the only cure for decompensated cirrhosis. Model for End-Stage Liver Disease (MELD) is used in liver allocation. Objectives Comparing survival of enlisted populations in pre- and post-MELD eras and estimating their long-term survival. Methods This is a retrospective study of cirrhotics enlisted for transplantation during pre- and post-MELD eras. Survival curves were generated using Kaplan-Meier’s model. Cox’s model was used to determine risk factors for mortality. Exponential, Weibull’s, normal-log and Gompertz’s models were used to estimate long-term survival. Results The study included 162 patients enlisted in pre-MELD era and 184 in post-MELD period. Kaplan-Meier’s survival curve of patients enlisted in post-MELD era was better than that of pre-MELD period (P = 0.009). This difference remained for long-term estimates, with a survival of 53.54% in 5 years and 44.64% in 10 years for patients enlisted in post-MELD era and of 43.17% and 41.75% for pre-MELD period. Era in which patients had been enlisted (P = 0.010) and MELD score at enlistment (P<0.001) were independently associated to survival with hazard ratios of 0.664 (95% CI-confidence interval = 0.487-0.906) and 1.069 (95% CI = 1.043-1.095). Conclusions MELD-based transplantation policy is superior to chronology-based one, promoting better survival for enlisted patients, even in long-term. .

Contexto O transplante é a única cura para a cirrose descompensada. O Model for End-Stage Liver Disease (MELD) é usado na alocação de órgãos. Objetivos Comparar a sobrevida da população listada para transplante nas eras pré e pós-MELD e estimar sua sobrevida a longo prazo. Métodos Este é um estudo retrospectivo, de cirróticos listados para transplante nas eras pré e pós-MELD. Curvas de sobrevida foram criadas através do modelo de Kaplan-Meier. O modelo de Cox foi utilizada para determinar fatores de risco para mortalidade. Os modelos exponencial, Weibull, log-normal e Gompertz foram usados para estimar sobrevida de longo prazo. Resultados Incluíram-se 162 pacientes listados na era pré-MELD e 184 listados na pós-MELD. A curva de Kaplan-Meier para os pacientes listados na era pós-MELD foi melhor que a da pré-MELD (P = 0,009). Esta diferença permaneceu nas estimativas de longo prazo, com sobrevida de 53,54% em 5 anos e de 44,64% em 10 anos para pacientes listados na era pós-MELD e de 43,17% e 41,75% no período pré-MELD. A era em que os pacientes eram listados (P = 0,010) e o MELD de inscrição (P<0,001) estiveram associados de maneira independente à sobrevida, com razão de riscos de 0,664 (intervalo de confiança-IC 95% = 0,487-0,906) e de 1,069 (IC 95% = 1,043-1,095). Conclusões A política de transplantes baseada no escore MELD é superior à baseada no tempo de espera em lista, promovendo melhor sobrevida, mesmo em longo prazo. .