Multiple Stool Sampling and Specific Parasitological Technique are Crucial to Diagnose Strongyloidiasis in Alcoholic Patients.

PURPOSE: Chronic alcoholism is a well-known risk factor for strongyloidiasis, in these patients the disease is potentially more severe, probably due to the breakdown of local protective barriers and immunosuppression caused by alcohol, which can lead to autoinfection and dissemination. The aim of this study was to evaluate multiple stool sampling and a specific parasitological assay agar plate culture (APC) for the diagnosis of Strongyloides stercoralis in alcoholics. METHODS: APC was compared to sedimentation technique (HPJ; Hoffman, Pons and Janer), as parasitological methods to detect S. stercoralis infection in alcoholic individuals. Three stool samples from 60 alcoholic and 60 non-alcoholic individuals were analyzed. RESULTS: S. stercoralis larvae were observed in 11 (18.3%) alcoholic individuals and 1 (1.7%) nonalcoholic individual (P = 0.0042). In view of the combined results, sensitivity for the APC method was 63.6% (CI 31.6-87.6%) with the first sample reaching 100% (CI 67.8-100%) after analyzing three fecal samples. The HPJ sensitivity was 36.4% (CI 12.4-68.4) in the first sample, reaching 72.7% (CI 39.3-92.7) after three samples analyzed. CONCLUSION: The present results suggest that in alcoholic patients, it is important to repeat stool sampling with specific techniques, especially using the APC method, to avoid misdiagnosis in cases that could evolve to disseminated strongyloidiasis.

Detection of immune complexes and evaluation of alcoholic individuals' serological profile in the diagnosis of strongyloidiasis.

Strongyloidiasis is a human parasitosis that is considered a public health problem. Early diagnosis of this infection is extremely important in immunocompromised patients (i.e. subjects with alcoholism). This study aimed to evaluate anti-Strongyloides immunoglobulin G (IgG) and immunoglobulin A (IgA), assess levels of circulating immune complexes (IC) and determine IgG avidity in serum samples from alcoholic and nonalcoholic individuals. A total of 140 blood samples were collected from male individuals (70 alcoholic and 70 nonalcoholic subjects). Serum was obtained and analysed by enzyme-linked immunosorbent assay for IgG, IgA, IC detection and avidity determination. Anti-Strongyloides IgG was detected in 55.7% of alcoholic subjects and 32.8% nonalcoholics, while IC levels showed frequencies of 38.6% and 17.1% in these groups, respectively. Anti-Strongyloides IgA was lower among alcoholics (4.3%) than nonalcoholics (34.3%). Spearman's correlation coefficient reported a positive correlation between IgG, IC and IgA in alcoholic individuals and no correlation in nonalcoholics. The median avidity index was higher in alcoholics (83.8%) than nonalcoholic subjects (73.2%). In conclusion, this study shows that alcoholic subjects produced specific antibodies against S. stercoralis regardless of the possible immunosuppression caused by chronic alcoholism. Considering that alcoholics are more susceptible to the severe forms of strongyloidiasis, the implementation of immunological methods as a complementary approach to parasitological diagnostics (i.e. detection of IgG, IC and antibody avidity) appears to be an alternative method for early diagnosis in these individuals.

Nutritional assessment in hepatic cirrhosis; clinical, anthropometric, biochemical and hematological parameters.

INTRODUCTION: Since malnutrition is common in patients with hepatic cirrhosis (HC) is necessary to investigate the interference of the pathophysiological changes of liver in the methods of diagnosis of the nutritional status. OBJECTIVE: To evaluate the frequency of malnutrition among patients with HC outpatients, using different assessment methods of the nutritional state. METHODS: Nutritional state was determined by subjective global assessment (SGA); body mass index (BMI); percentage of ideal body weight (%BW); triceps skinfold thickness (%TST), mid-arm circumference (%MAC) and of the ideal mid-arm muscle circumference (%MAMC); serum albumin (ALB) and total lymphocyte count (TLC). RESULTS: Seventy-eight patients were evaluated, 56.4% were male and mean age were 53.0 ± 7.7 years. The HC etiology was alcoholic in 56.4% of the cases. According to the classification of Child-Pugh, 48.7% were A, 26.9% were B and 24.4% were C. Variable degrees of malnutrition were diagnosed in 61.5% (SGA), 16.7% (BMI), 17.9% (%BW), 93.6% (%TST), 62.8% (%MAC) and 38.5% (%MAMC) of the patients. The levels of ALB and TLC were compatible with malnutrition diagnosis in 43.6% and 69.2% of the patients, respectively. The frequency of diagnosis of malnutrition increased according to the severity of HC and it also increased in patients with alcoholic etiology. A greater depletion of adipose tissue in women and of muscular tissue in men was demonstrated. CONCLUSIONS: The diagnostic frequency of malnutrition in ambulatory-treated patients varies according to the nutritional evaluation method used. The prevalence of malnutrition is greater in the more advanced stages of HC and in alcoholic etiology.

Introducción: Desde la malnutrición es común en pacientes con cirrosis hepática (CH) es necesario investigar la interferencia de los cambios fisiopatológicos de hígado en los métodos de diagnóstico del estado nutricional. Objetivo: Evaluar la frecuencia de desnutrición en los pacientes con CH ambulatoria, utilizando diferentes métodos de evaluación del estado nutricional. Métodos: El estado nutricional se determinó mediante la valoración global subjetiva (VGS), índice de masa corporal (IMC), porcentaje de peso corporal ideal (% PCI), el pliegue del tríceps (% PT), circunferencia del brazo (% CB) y de la ideales mediados de circunferencia muscular del brazo (% CMB), albúmina de suero (ALB) y recuento total de linfocitos (RTL). Resultados: Setenta y ocho pacientes fueron evaluados, el 56,4% eran varones y la edad media fue 53,0 ± 7,7 años. La etiología fue alcohólica CH en el 56,4% de los casos. De acuerdo con la clasificación de Child-Pugh, el 48,7% eran A, el 26,9% fueron el B y el 24,4% fueron C. Grados variables de desnutrición fueron diagnosticados en un 61,5% (VGS), 16,7% (IMC), 17,9% (% PCI), 93,6% (% PT), 62,8% (% CB) y 38,5% (CMB%) de los pacientes. Los niveles de ALB y RTL fueron compatibles con el diagnóstico de la desnutrición en 43,6% y 69,2% de los pacientes, respectivamente. La frecuencia de diagnóstico de la malnutrición aumenta de acuerdo con la gravedad de CH y también aumentó en los pacientes con etiología alcohólica. Una disminución mayor de tejido adiposo en las mujeres y de tejido muscular en los hombres fue demostrada. Conclusiones: La frecuencia de diagnóstico de la malnutrición en ambulatorio de pacientes tratados varía de acuerdo con el método de evaluación nutricional utilizado. La prevalencia de desnutrición es mayor en las etapas más avanzadas de la CH y de etiología alcohólica.

Nutritional assessment in hepatic cirrhosis; clinical, anthropometric, biochemical and hematological parameters / Evaluación nutricional en cirrosis hepática; los parámetros clínicos, antropométricos, bioquímicos y hematológicos

Introduction: Since malnutrition is common in patients with hepatic cirrhosis (HC) is necessary to investigate the interference of the pathophysiological changes of liver in the methods of diagnosis of the nutritional status. Objective: To evaluate the frequency of malnutrition among patients with HC outpatients, using different assessment methods of the nutritional state. Methods: Nutritional state was determined by subjective global assessment (SGA); body mass index (BMI); percentage of ideal body weight (%BW); triceps skinfold thickness (%TST), mid-arm circumference (%MAC) and of the ideal mid-arm muscle circumference (%MAMC); serum albumin (ALB) and total lymphocyte count (TLC). Results: Seventy-eight patients were evaluated, 56.4% were male and mean age were 53.0 ± 7.7 years. The HC etiology was alcoholic in 56.4% of the cases. According to the classification of Child-Pugh, 48.7% were A, 26.9% were B and 24.4% were C. Variable degrees of malnutrition were diagnosed in 61.5% (SGA), 16.7% (BMI), 17.9% (%BW), 93.6% (%TST), 62.8% (%MAC) and 38.5% (%MAMC) of the patients. The levels of ALB and TLC were compatible with malnutrition diagnosis in 43.6% and 69.2% of the patients, respectively. The frequency of diagnosis of malnutrition increased according to the severity of HC and it also increased in patients with alcoholic etiology. A greater depletion of adipose tissue in women and of muscular tissue in men was demonstrated. Conclusions: The diagnostic frequency of malnutrition in ambulatory-treated patients varies according to the nutritional evaluation method used. The prevalence of malnutrition is greater in the more advanced stages of HC and in alcoholic etiology (AU)

Introducción: Desde la malnutrición es común en pacientes con cirrosis hepática (CH) es necesario investigar la interferencia de los cambios fisiopatológicos de hígado en los métodos de diagnóstico del estado nutricional. Objetivo: Evaluar la frecuencia de desnutrición en los pacientes con CH ambulatoria, utilizando diferentes métodos de evaluación del estado nutricional. Métodos: El estado nutricional se determinó mediante la valoración global subjetiva (VGS), índice de masa corporal (IMC), porcentaje de peso corporal ideal (% PCI), el pliegue del tríceps (% PT), circunferencia del brazo (% CB) y de la ideales mediados de circunferencia muscular del brazo (% CMB), albúmina de suero (ALB) y recuento total de linfocitos (RTL). Resultados: Setenta y ocho pacientes fueron evaluados, el 56,4% eran varones y la edad media fue 53,0 ± 7,7 años. La etiología fue alcohólica CH en el 56,4% de los casos. De acuerdo con la clasificación de Child-Pugh, el 48,7% eran A, el 26,9% fueron el B y el 24,4% fueron C. Grados variables de desnutrición fueron diagnosticados en un 61,5% (VGS), 16,7% (IMC), 17,9% (% PCI), 93,6% (% PT), 62,8% (% CB) y 38,5% (CMB%) de los pacientes. Los niveles de ALB y RTL fueron compatibles con el diagnóstico de la desnutrición en 43,6% y 69,2% de los pacientes, respectivamente. La frecuencia de diagnóstico de la malnutrición aumenta de acuerdo con la gravedad de CH y también aumentó en los pacientes con etiología alcohólica. Una disminución mayor de tejido adiposo en las mujeres y de tejido muscular en los hombres fue demostrada. Conclusiones: La frecuencia de diagnóstico de la malnutrición en ambulatorio de pacientes tratados varía de acuerdo con el método de evaluación nutricional utilizado. La prevalencia de desnutrición es mayor en las etapas más avanzadas de la CH y de etiología alcohólica (AU)

Avaliaçäo clínico-laboratorial do fígado em alcoólatras: resultados preliminares / Clinico-laboratory evaluation of the liver in alcohol addicts: preliminary results

Estudando-se 45 alcoólatras sem hepatopatia clínica evidente, pode-se classificá-los em três grupos: 27% dos alcoólatras näo apresentaram nenhuma anormalidade clínica ou laboratorial; 38% apresentaram apenas alteraçöes laboratoriais (sendo que em 59% destes o único exame alterado foi a gamaglutamiltransferase); e 35% apresentaram hepatomegalia. O grupo com hepatomegalia teve média de ingesta etílica total significativamente superior em relaçäo à dos outros dois grupos. Destaca-se a importância, para avaliaçäo do fígado em alcoólatras, do uso dos seguintes parâmetros: ingesta etílica total, hepatomegalia e gamaglutamiltransferase