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INTRODUCTION:: According to the guidelines, the viral load of 2,000 IU/mL is considered the level to differentiate between inactive carriers and HBeAg(-) chronic hepatitis B patients. Even so, liver damage may be present in patients with lower viral load levels, mainly related to regional variations. This study aims to verify the presence of liver injury in patients with viral load below 2,000 IU/mL. METHODS:: Patients presenting HBsAg(+) for more than six months, Anti-HBe(+)/HBeAg(-), viral load below 2,000 IU/mL and serum ALT levels less than twice the upper limit of normality underwent liver biopsy. Clinical and laboratory characteristics were evaluated in relation to the degree of histologic alteration. Liver injury was considered advanced when F ≥ 2 and/or A ≥ 2 by the METAVIR classification. RESULTS:: 11/27 (40.7%) patients had advanced liver injury, with a mean viral load of 701.0 (± 653.7) IU/mL versus 482.8 (± 580.0) IU/mL in patients with mild injury. The comparison between the mean values of the two groups did not find a statistical difference (p = 0.37). The average of serum aminotransferases was not able to differentiate light liver injury from advanced injury. CONCLUSIONS:: In this study, one evaluation of viral load did not exclude the presence of advanced liver damage. Pathologic assessment is an important tool to diagnose advanced liver damage and should be performed in patients with a low viral load to indicate early antiviral treatment.
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Introdução: A telemedicina refere-se à prestação de serviços médicos pelo uso da tecnologia da informação e comunicação entre pacientes e prestadores de serviços. A cirurgia plástica é um campo especialmente favorável à aplicação da telemedicina, dado que a inspeção visual do paciente orienta tanto o diagnóstico como o acompanhamento clínico. Métodos: Foi realizada revisão integrativa nos artigos publicados em telemedicina em cirurgia plástica na base de dados PubMed, utilizando os termos MeSH: "telemedicine" AND "plastic surgery". Após rastreamento e aplicação de critérios de elegibilidade, o texto completo dos artigos remanescentes foi digitalizado, com seus dados extraídos para análise detalhada. Resultados: Foram identificados 134 artigos, todos em inglês, na busca inicial no PubMed. Após rastreamento e aplicação dos critérios de exclusão, foram incluídos 12 estudos para a revisão integrativa. Os artigos encontrados nesta revisão demonstraram benefícios na utilização da telemedicina aplicada à cirurgia plástica, de forma mais pronunciada no acompanhamento pósoperatório dos pacientes, redução ou extinção da necessidade de visitas presenciais, satisfação dos pacientes nas consultas realizadas por telemedicina, redução de custos financeiros, redução de tempo de resposta para referências, acurácia diagnóstica semelhante à avaliação presencial e melhoria ao acesso de cuidado especializado a lugares remotos, tanto geográfica quanto socialmente desfavoráveis. Quatro artigos discutiram barreiras e limitações, observadas ou potenciais, ao uso da telemedicina na cirurgia plástica, como: segurança dos dados, legislação, custos e percepção de influência negativa na comunicação médico-paciente. Conclusão: Os estudos analisados demonstram ganho expressivo nos conhecimentos acerca da telemedicina aplicada à cirurgia plástica nos últimos anos.
Introduction: Telemedicine refers to providing medical services through information technology and communication between patients and service providers. Plastic surgery is a field especially favorable to the application of telemedicine since visual inspection of the patient guides both diagnosis and clinical follow-up. Methods: An integrative review was performed in the articles published in telemedicine in plastic surgery in the PubMed database, using the terms MeSH: "telemedicine" AND "plastic surgery." After tracking and applying eligibility criteria, the remaining articles' full text were digitized, with their data extracted for detailed analysis. Results: A total of 134 articles were identified, all in English, in the initial search for PubMed. After screening and application of the exclusion criteria, 12 studies were included for the integrative review. The articles found in this review demonstrated benefits in the use of telemedicine applied to plastic surgery. Especially in the postoperative follow-up of patients, in the reduction or extinction of the need for face-to-face visits, in the satisfaction of patients in the consultations carried out by telemedicine, in the reduction of financial costs and response time for referrals, in the diagnostic accuracy similar to the face-to-face assessment and in improving access to specialized care in remote places, both geographically and socially unfavorable. Four articles discussed barriers and limitations, observed or potential, to the use of telemedicine in plastic surgery, such as data security, legislation, costs and perception of negative influence on doctor-patient communication. Conclusion: The analyzed studies show an expressive gain in knowledge about telemedicine applied to plastic surgery in recent years.