Psoriasis and steatotic liver disease: Are PNPLA3 and TM6SF2 polymorphisms suitable for the hepato-dermal axis hypothesis?

INTRODUCTION AND OBJECTIVES: A high prevalence of steatotic liver disease has been described in psoriasis. However, the influence of genetic polymorphisms has yet to be investigated in this scenario. This study aims to determine the frequency of steatosis, advanced liver fibrosis and PNPLA3/TM6SF2 genotypes in individuals with psoriasis and to evaluate the impact of genetic polymorphisms, metabolic parameters and cumulative methotrexate dose on steatosis and fibrosis. MATERIALS AND METHODS: Cross-sectional study that prospectively included psoriasis outpatients, submitted to clinical and laboratory analysis, transient elastography (FibroScan®, Fr) and PNPLA3/TM6SF2 genotyping. Steatosis was defined by CAP ≥275 dB/m and advanced liver fibrosis as transient elastography ≥10 kPa. Logistic regression analysis evaluated the independent variables related to steatosis and fibrosis; p-value< 0.05 was considered significant. RESULTS: One hundred and ninety-nine patients were enrolled (age 54.6 ± 12.6 years, 57.3% female). Metabolic syndrome (MetS), steatosis and advanced liver fibrosis prevalence were 55.8%, 54.8% and 9%, respectively. PNPLA3 and TM6SF2 genotypes frequencies were CC 42.3%/CG 49.5%/GG 8.2% and CC 88.7%/ CT 11.3%/ TT 0%. MetS (OR3.01 95%CI 1.51-5.98; p = 0.002) and body mass index (OR1.17 95%CI 1.08-1.26; p < 0.01) were independently associated with steatosis. Diabetes Mellitus (T2DM) (OR10.76 95%CI 2.42-47.87; p = 0.002) and harboring at least one PNPLA3 G allele (OR5.66 95%CI 1.08-29.52; p = 0.039) were associated with advanced fibrosis, but not TM6SF2 polymorphism or cumulative MTX dose. CONCLUSIONS: MetS and T2DM confer higher odds for steatosis and advanced fibrosis in individuals with psoriasis. PNPLA3 G allele, but not TM6SF2 polymorphism, impacts a 5-fold odds of advanced liver fibrosis.

Challenges of extended venous thromboembolism prophylaxis in medical and surgical patients.

Patients hospitalized for acute medical and surgical illnesses are at risk of developing venous thromboembolism (VTE) during hospitalization and after discharge. Extended pharmacological prophylaxis beyond the hospital stay is recommended for patients undergoing surgeries at high risk for VTE and for selected groups of hospitalized medical patients. This practice involves several challenges, from identification of at-risk populations eligible for extended prophylaxis to choice of the most appropriate anticoagulant and definition of the ideal duration of use. This review will present the main VTE risk assessment models for hospitalized medical and surgical patients, the current recommendations for use of extended prophylaxis, and its limitations and benefits.

Liver Growth and Portal Hypertension Improvement After Percutaneous Recanalization of Chronic Portal Vein Thrombosis in Non-Cirrhotic Participants.

PURPOSE: To evaluate liver function improvement and volume gain after percutaneous recanalization of chronic portal vein thrombosis (PVT) in non-cirrhotic patients. MATERIALS AND METHODS: In this retrospective study, five non-cirrhotic participants between 21 and 67 years old with secondary chronic PVT (4-21 years from diagnose) were submitted to percutaneous portal vein recanalization, followed by varices and shunts embolization. RESULTS: After a mean of 12.6 months, all portal veins remained patent and there was complete resolution of portal hypertension (PH) symptoms in all participants. There was a significant increase in liver volume of 39.8 ± 19.0% (p = 0.042), platelets count of 53120 ± 20188/µl (p = 0.042), and a significant decrease in total bilirubin levels from 1.04 ± 0.23 mg/dL to 0.51 ± 0.09 mg/dL (p = 0.043). We also found a non-significant increase in albumin levels from 3.88 ± 0.39 g/dL to 4.38 ± 0.27 g/dL (p = 0.078) and decrease in spleen diameter from 16.88 ± 4.03 cm to 14.15 ± 2.72 cm (p = 0.068). DISCUSSION: In this retrospective study, even with a small number of participants, we were capable of showing a median of 39.8% increase in liver volume, laboratorial liver function improvement, platelets count and resolution of PH symptoms, including gastroesophageal varices disappearance after portal vein recanalization followed by shunt embolization. CONCLUSION: In this small series of cases, recanalization of chronic PVT in non-cirrhotic participants was feasible, successful and safe despite the prolonged time of occlusion. This is a new and promising approaching to an old and still challenging disease.

Desafios da profilaxia estendida do tromboembolismo venoso em pacientes clínicos e cirúrgicos / Challenges of extended venous thromboembolism prophylaxis in medical and surgical patients

Resumo Pacientes hospitalizados por doenças clínicas e cirúrgicas agudas estão sob risco de desenvolvimento de tromboembolismo venoso (TEV) durante a hospitalização e após a alta. A profilaxia farmacológica estendida além do período da hospitalização é recomendada para pacientes submetidos a cirurgias de alto risco de TEV e para grupos selecionados de pacientes clínicos hospitalizados. Diversos desafios envolvem essa prática, desde o reconhecimento das populações de risco elegíveis para a extensão da profilaxia até a escolha do anticoagulante mais adequado e a definição do tempo ideal de utilização. Os principais modelos de avaliação de risco de TEV em pacientes clínicos e cirúrgicos hospitalizados, as recomendações atuais para uso da profilaxia estendida e suas limitações e benefícios serão apresentados nesta revisão.

Abstract Patients hospitalized for acute medical and surgical illnesses are at risk of developing venous thromboembolism (VTE) during hospitalization and after discharge. Extended pharmacological prophylaxis beyond the hospital stay is recommended for patients undergoing surgeries at high risk for VTE and for selected groups of hospitalized medical patients. This practice involves several challenges, from identification of at-risk populations eligible for extended prophylaxis to choice of the most appropriate anticoagulant and definition of the ideal duration of use. This review will present the main VTE risk assessment models for hospitalized medical and surgical patients, the current recommendations for use of extended prophylaxis, and its limitations and benefits.

Bleeding risk assessment for venous thromboembolism prophylaxis.

Venous thromboembolism (VTE) is one of the main preventable causes of morbidity and mortality in hospitalized patients and fatal pulmonary embolism (PE) may be its first manifestation. Several national and international guidelines recommend using risk assessment models for prescription of VTE prophylaxis in hospitalized patients. Despite evidence and guidelines supporting VTE prevention, use of VTE prophylaxis in hospitalized patients remains suboptimal, which may be because of low awareness of the benefits of VTE prophylaxis, but might also reflect fear of bleeding complications in these patients, since this constitutes one of the main reasons for underutilization of thromboprophylaxis worldwide. Bleeding risk assessment is therefore necessary for adequate prophylaxis prescription and should be carried out concurrently with assessment of the risk of thrombosis. The purpose of this review is to highlight the importance of jointly assessing risk of VTE and risk of bleeding in hospitalized patients.

Liver injury predicts overall mortality in severe COVID-19: a prospective multicenter study in Brazil.

BACKGROUND/PURPOSE: The relationship between liver injury and mortality remains unclear in patients with COVID-19. We aimed to evaluate the prognostic value of aminotransferases levels at hospital admission to predict mortality in patients with COVID-19. METHODS AND RESULTS: This prospective study included 406 patients [57% male, aged 56 years] with COVID-19 hospitalized in 26 centers in Brazil. Overall, 36.7% (95% CI 32.1-41.5) presented at admission with severe disease requiring respiratory support. The prevalence of elevated ALT and AST levels at admission [> 2 × ULN] was 14.0% (95% CI 11.0-17.8) and 12.9% (95% CI 10.0-16.6), respectively. Sixty-two patients [15.3% (95% CI 12.1-19.1)] died during hospitalization and the overall mortality rate was 13.4 (10.5-17.2) deaths per 1000 persons-years. The 15-day-overall survival (95% CI) was significantly lower in patients with ALT levels ≥ 2 × ULN compared to those with ALT < 2 × ULN [67.1% (48.4-80.2) vs 83.4% (76.1-88.6), p = 0.001] and in those with AST levels ≥ 2 × ULN compared to those with AST < 2 × ULN [61.5% (44.7-74.6) vs 84.2% (76.5-89.5), p < 0.001]. The presence of elevated aminotransferases levels at hospital admission significantly increased the risk of in-hospital all-cause mortality adjusted for age-and-sex. Those findings were present in the subgroup of critically ill patients already admitted in need of respiratory support (n = 149), but not in patients without that requirement at admission (n = 257). CONCLUSIONS: Elevated aminotransferases at hospital admission predicted in-hospital all-cause mortality in patients with COVID-19, especially in those with severe disease. Measurement of transaminases levels at hospital admission should be integrated to the care of patients with COVID-19 as an auxiliary strategy to identify patients at higher death risk.

Avaliação do risco de sangramento na profilaxia do tromboembolismo venoso / Bleeding risk assessment for venous thromboembolism prophylaxis

Resumo O tromboembolismo venoso (TEV) é uma das principais causas preveníveis de morbimortalidade em pacientes hospitalizados, sendo a embolia pulmonar (EP) fatal possivelmente a sua primeira manifestação. Diretrizes nacionais e internacionais recomendam o uso de modelos de avaliação de risco para a prescrição de profilaxia do TEV em pacientes hospitalizados. Apesar das evidências e diretrizes de apoio, o uso da tromboprofilaxia permanece abaixo do ideal, o que pode resultar da baixa conscientização dos benefícios da profilaxia, mas também pode refletir o medo de complicações hemorrágicas, justificando a subutilização da tromboprofilaxia em todo o mundo. A avaliação do risco de sangramento é, portanto, necessária para a adequação de profilaxia e deve ser realizada de forma concomitante à avaliação do risco de trombose. O objetivo desta revisão é salientar a importância da avaliação conjunta do risco de TEV e do risco de sangramento em pacientes hospitalizados.

Abstract Venous thromboembolism (VTE) is one of the main preventable causes of morbidity and mortality in hospitalized patients and fatal pulmonary embolism (PE) may be its first manifestation. Several national and international guidelines recommend using risk assessment models for prescription of VTE prophylaxis in hospitalized patients. Despite evidence and guidelines supporting VTE prevention, use of VTE prophylaxis in hospitalized patients remains suboptimal, which may be because of low awareness of the benefits of VTE prophylaxis, but might also reflect fear of bleeding complications in these patients, since this constitutes one of the main reasons for underutilization of thromboprophylaxis worldwide. Bleeding risk assessment is therefore necessary for adequate prophylaxis prescription and should be carried out concurrently with assessment of the risk of thrombosis. The purpose of this review is to highlight the importance of jointly assessing risk of VTE and risk of bleeding in hospitalized patients.

Guidance on diagnosis, prevention and treatment of thromboembolic complications in COVID-19: a position paper of the Brazilian Society of Thrombosis and Hemostasis and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy

ABSTRACT Hemostatic abnormalities and thrombotic risk associated with coronavirus disease 2019 (COVID-19) are among the most discussed topics in the management of this disease. The aim of this position paper is to provide the opinion of Brazilian experts on the thromboprophylaxis and management of thrombotic events in patients with suspected COVID-19, in the sphere of healthcare in Brazil. To do so, the Brazilian Society of Thrombosis and Hemostasis (BSTH) and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH) have constituted a panel of experts to carefully review and discuss the available evidence about this topic. The data discussed in this document was reviewed by May 9, 2020. Recommendations and suggestions reflect the opinion of the panel and should be reviewed periodically as new evidence emerges.

Guidance on diagnosis, prevention and treatment of thromboembolic complications in COVID-19: a position paper of the Brazilian Society of Thrombosis and Hemostasis and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy.

Hemostatic abnormalities and thrombotic risk associated with coronavirus disease 2019 (COVID-19) are among the most discussed topics in the management of this disease. The aim of this position paper is to provide the opinion of Brazilian experts on the thromboprophylaxis and management of thrombotic events in patients with suspected COVID-19, in the sphere of healthcare in Brazil. To do so, the Brazilian Society of Thrombosis and Hemostasis (BSTH) and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH) have constituted a panel of experts to carefully review and discuss the available evidence about this topic. The data discussed in this document was reviewed by May 9, 2020. Recommendations and suggestions reflect the opinion of the panel and should be reviewed periodically as new evidence emerges.

Role of ambulation to prevent venous thromboembolism in medical patients: where do we stand?

Venous thromboembolism (VTE) encompasses the spectrum of manifestations of deep venous thrombosis and/or pulmonary embolism and is a common, serious, and preventable complication in hospitalized patients. Although immobility plays an important role in determining VTE risk in medical patients, no clear and uniform criteria exist to guide clinicians in assessing immobility. The variation in the descriptions that do exist makes it difficult to interpret and compare the results of randomized clinical trials with respect to the influence of different levels of immobility on the magnitude of VTE risk and the role that early ambulation as an isolated factor plays in prevention of such events. Understanding these limitations is a prerequisite for the proper use and interpretation of VTE risk assessment tools and for indicating the best strategy for preventing venous thrombosis in hospitalized medical patients. The objective of this study was to review the main evidence reported in the literature on the role of ambulation in prevention of VTE.

Papel da deambulação na prevenção do tromboembolismo venoso em pacientes clínicos: onde estamos? / Role of ambulation to prevent venous thromboembolism in medical patients: where do we stand?

O tromboembolismo venoso (TEV), que compreende o espectro de manifestações de trombose venosa profunda e/ou embolia pulmonar, é uma complicação comum, grave e evitável em pacientes hospitalizados. Embora a perda da mobilidade recente ou continuada represente um dos principais fatores de risco relacionados ao desenvolvimento de TEV, não existem critérios claros e uniformes para a definição do conceito de imobilidade. A diversidade dessas descrições dificulta a interpretação e a comparação dos resultados de estudos clínicos randomizados no que se refere à influência dos diferentes níveis de imobilidade na magnitude do risco de TEV e ao papel da deambulação precoce, de forma isolada, na prevenção de tais eventos. O entendimento dessas limitações é mandatório para a utilização e interpretação adequadas das ferramentas de avaliação de risco de TEV, e para a indicação da melhor estratégia de prevenção de trombose em pacientes clínicos hospitalizados. O objetivo deste estudo é revisar as principais evidências da literatura quanto ao papel da deambulação na prevenção do TEV

Venous thromboembolism (VTE) encompasses the spectrum of manifestations of deep venous thrombosis and/or pulmonary embolism and is a common, serious, and preventable complication in hospitalized patients. Although immobility plays an important role in determining VTE risk in medical patients, no clear and uniform criteria exist to guide clinicians in assessing immobility. The variation in the descriptions that do exist makes it difficult to interpret and compare the results of randomized clinical trials with respect to the influence of different levels of immobility on the magnitude of VTE risk and the role that early ambulation as an isolated factor plays in prevention of such events. Understanding these limitations is a prerequisite for the proper use and interpretation of VTE risk assessment tools and for indicating the best strategy for preventing venous thrombosis in hospitalized medical patients. The objective of this study was to review the main evidence reported in the literature on the role of ambulation in prevention of VTE

Fibrosis assessment using FibroMeter combined to first generation tests in hepatitis C.

AIM: To evaluate the performance of FibroMeterVirus3G combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis in chronic hepatitis C (CHC). METHODS: First generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis. FibroMeterVirus3G was sequentially applied to unclassified cases from APRI or Forns. Accuracy of non-invasive combination of tests, APRI plus FibroMeterVirus3G and Forns plus FibroMeterVirus3G was evaluated in the Brazilian derivation population. APRI plus FibroMeterVirus3G combination was validated in a population of CHC patients from Angers in France. All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists. Significant fibrosis was considered as METAVIR F ≥ 2. The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests. Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at -70 °C. RESULTS: Seven hundred and sixty CHC patients were included (222 in the derivation population and 538 in the validation group). In the derivation population, the FibroMeterVirus3G AUROC was similar to APRI AUROC (0.855 vs 0.815, P = 0.06) but higher than Forns AUROC (0.769, P < 0.001). The best FibroMeterVirus3G cut-off to discriminate significant fibrosis was 0.61 (80% diagnostic accuracy; 75% in the validation population, P = 0.134). The sequential combination of APRI or Forns with FibroMeterVirus3G in derivation population presented similar performance compared to FibroMeterVirus3G used alone (79% vs 78% vs 80%, respectively, P = 0.791). Unclassified cases of significant fibrosis after applying APRI and Forns corresponded to 49% and 54%, respectively, of the total sample. However, the combination of APRI or Forns with FibroMeterVirus3G allowed 73% and 77%, respectively, of these unclassified cases to be correctly evaluated. Moreover, this combination resulted in a reduction of FibroMeterVirus3G requirement in approximately 50% of the entire sample. The stepwise combination of APRI and FibroMeterVirus3G applied to the validation population correctly identified 74% of patients with severe fibrosis (F ≥ 3). CONCLUSION: The stepwise combination of APRI or Forns with FibroMeterVirus3G may represent an accurate lower cost alternative when evaluating significant fibrosis, with no need for liver biopsy.

Apendagite epiplóica: tratamento conservador / Epiploic appendagitis: conservative treatment

Apendagite epiplóica (AE) é uma doença inflamatória abdominal incomum, de bom prognóstico, que vem sendo mais freqüentemente diagnosticada em virtude dos avanços nos métodos de imagem. O achado clínico mais freqüente é dor em quadrante inferior esquerdo. O diagnóstico é obtido por meio da tomografia computadorizada. A recuperação do quadro é completa sob tratamento conservador.

Appendagitis is an uncommon inflammatory abdominal disease, with good prognosis; nowadays it is being diagnosed more frequently because of advances in imaging methods. Clinical finding most often described was abdominal pain over left lower quadrant. Diagnosis is obtained through computed tomography. Recovery is uneventful under conservative treatment.

[Epiploic appendagitis: clinical and radiological aspects]. / Apendagite epiplóica: aspectos clínicos e radiológicos.

Epiploic appendagitis is an uncommon inflammatory abdominal disease. Data of 44 patients with a clinical diagnosis of appendagitis were retrospectively evaluated regarding laboratory and imaging findings. They were admitted to Barra D'Or Hospital, Rio de Janeiro, RJ, from February 2005 to September 2006. Eighty-two percent were male and 18 were female, with median age of 44.7 years. The most frequent laboratory findings were hematuria in urinalysis and leucocitosis, presenting in 5% of cases each. Diagnosis was obtained through computed tomography showing paracolic oval lesions, mainly over the descending colon in 52% of patients. Patients were treated with analgesics and anti-inflammatory in an outpatient basis. Recovery was uneventful under conservative treatment.

Apendagite epiplóica: aspectos clínicos e radiológicos / Epiploic appendagitis: clinical and radiological aspects

Apendagite epiplóica é uma doença inflamatória abdominal incomum. Foram avaliados, retrospectivamente, os prontuários de 44 pacientes com diagnóstico de apendagite epiplóica atendidos no Hospital Barra D’Or, Rio de Janeiro, RJ, no período entre fevereiro de 2005 e setembro de 2006, sendo 82 por cento homens e 18 por cento mulheres, com média de idade de 44,7 anos. Buscou-se caracterizar o quadro clínico-laboratorial e radiológico desses pacientes. As alterações laboratoriais mais freqüentes foram piúria e leucocitose, cada uma presente em 5 por cento dos casos. O diagnóstico foi feito por tomografia computadorizada de abdome com achado de lesão ovóide em cólon descendente em 52 por cento dos pacientes. A resolução do quadro clínico foi obtida com tratamento conservador.

Epiploic appendagitis is an uncommon inflammatory abdominal disease. Data of 44 patients with a clinical diagnosis of appendagitis were retrospectively evaluated regarding laboratory and imaging findings. They were admitted to Barra D’Or Hospital, Rio de Janeiro, RJ, from February 2005 to September 2006. Eighty-two percent were male and 18 were female, with median age of 44.7 years. The most frequent laboratory findings were hematuria in urinalysis and leucocitosis, presenting in 5 percent of cases each. Diagnosis was obtained through computed tomography showing paracolic oval lesions, mainly over the descending colon in 52 percent of patients. Patients were treated with analgesics and anti-inflammatory in an outpatient basis. Recovery was uneventful under conservative treatment.

Valor preditivo do hematócrito na caracterização precoce da pancreatite aguda grave / Predictive value of hematocrit on early characterization of severe acute pancreatitis

Introdução: Ao longo da última década, muitos testes têm sido investigados como possíveis marcadores precoces de gravidade na pancreatite aguda (PA). Acredita-se que, identificando a doença mais cedo, seja possível modificar sua evolução e mortalidade. Entre os marcadores recentemente estudados com esse fim, destaca-se o hematócrito (ht). Objetivo: Determinar a prevalência da PA grave, descrever a sua apresentação clínica e identificar o papel do ht como um fator preditivo de gravidade, comparando-o com os critérios de Ranson, com a proteina C reativa titulada (PCRt) e com os achados de tomagrafia computadorizada. Pacientes e Métodos: Foram estudados os pacientes internados com o diagnóstico de PA nos hospitais da Rede D'Or-RJ, entre junho de 2000 e dezembro de 2002. Os exames realizados foram aqueles inerentes à assistência médica prestada. De acordo com os Critérios de Atlanta, os pacientes foram divididos em dois grupos: leve e grave. Resultadoss: Foram incluídos 49 pacientes no estudo, sendo cinco (10,2por cento) casos graves. A etiologia mais comum foi a PA biliar (65,3por cento). Os grupos foram semelhantes em idade, sexo, amilase, lipase e nos demais exames laboratoriais realizados. No grupo grave houve predomínio de complicações sistêmicas, como hipotensão, sepse e insuficiência respiratória, em comparação com as complicações locais. Não houve diferença significativa entre os dois grupos nos valores de ht e PCRt com 24 e 48 horas após o início dos sintomas. O custo e o tempo da internação foram maiores no grupo grave (p<0,001). Conclusão: A prevalência de PA grave foi baixa. Não houve manifestações clínicas ou laboratoriais específicas de gravidade na fase precose da doença. O hematócrito também não foi um fator preditivo de gravidade

Tratamento da hepatite C com fator promotor do crescimento do hepatócito (phgf) / Treatment of hepatitis C with promoting hepatocyte growth factor

Em 1987, pesquisadores chineses do Hospital da Força Aérea,localizado em Guangzhou, China, extraíram do fígado de porco recém-nato uma substância denominada promoting hepatocyte growth factor (phgf), que funcionaria como um estimulador do crescimento do hepatócito. Para tanto, agiria no DNA do hepatócito, promovendo síntese e divisão celular, com efeitos antifibrose e antiinflamatório. Investigações recentes sugerem que o phgf possa agir no tratamento das hepatites virais. Desenvolveu-se estudo randomizado e controlado do uso intravenoso do phgf em 18 pacientes com diagnóstico histólogico de hepatite crônica ativa ou cirrose hepática em atividade e RNA-VHC positivo. Todos os pacietes apresentavam aumento da ALT por um período mínimo de 12 meses. Outras causas de hepatopatia foram afastadas (viral, auto-imune, medicamentosa, metabólica e alcoólica). O estudo foi aprovado pela Comissão de Ética do Hospital Universitário Clementino Fraga Filho, Rio de Janeiro. O tratamento foi instituído durante três meses e, mensalmente, eram tomadas amostras de sangue para análise do hemograma, leucograma, contagem de plaquetas, TAP e dosagem da ALT. Determinações de carga viral antes e no final do tratamento foram feitas pelo teste Amplicor HCV Monitor-Roche. Todos os pacientes finalizaram o tratamento, sem a ocorrência de efeitos colaterais atribuíveis à medicação. Em três pacientes a ALT normalizou-se durante o uso de phgf(16,9por cento), com retorno aos valores basais pré-tratamento após a sua interrupção. Porém, em relação ao grupo controle, os valores da ALT diminuiram sensivelmente no grupo tratado, com significância estatística. Apesar de a análise média da carga viral ter mostrado nítica diminuição, estatisticamente significativa no grupo que utilizou o phgf, nenhum paciente tratado apresentou negativação do RNA-VHC. Os resultados mostram que a ação do phgf se fez no processo inflamatório sem influir na replicação viral, sugerindo efeito um pouco semelhante ao da ribavirina

Prevalence of hepatitis C infection in patients with non-Hodgkin's lymphomas.

Several studies have suggested an association between hepatitis C virus (HCV) and low-grade B-cell non-Hodgkin's lymphomas. The results, however, have been controversial. Italian and Japanese studies have reported a 40% prevalence rate, but the data were not confirmed by English and Canadian studies. We evaluated the prevalence of HCV infection in 109 patients with non-Hodgkin's lymphomas, and compared it with a control group composed of 67 patients with Hodgkin's disease and 31 patients with chronic lymphocytic leukemia. The prevalence of HCV infection was also determined in blood donors. HCV infection was detected using second and third generation anti-HCV ELISA. Positive results were additionally confirmed using Inno-LIA AbIII and/or RNA-HCV by PCR. Immunohistochemical stains were used to determine B or T cell lineage when the morphological analysis was not sufficient for lymphoma classification. HCV infection was detected in 9% of patients with non-Hodgkin's lymphomas, in 2% of patients in the control group (p=0.036), and in 1.2% of blood donors. There was no difference in the prevalence of HCV infection between patients with B or T cell lymphomas. Blood transfusions or previous surgeries, both risk factors for HCV infection, were detected in 90% of the patients with a positive anti-HCV test, in average 17 and 36 years before the diagnosis of lymphoma, respectively. Seventy percent of the patients with non-Hodgkin's lymphomas and a positive anti-HCV test presented evidence of chronic liver disease when the lymphoma was diagnosed. This study suggests the presence of an association between HCV infection and non-Hodgkin's lymphomas in Brazil.