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1.
Zhonghua Bing Li Xue Za Zhi ; 49(4): 329-335, 2020 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-32268669

RESUMO

Objective: To compare the histologic features of immune-mediated hepatitis (IMH) due to immune checkpoint inhibitors (ICIs) monotherapy and combined ICIs anti-angiogenesis tyrosine kinases (TKIs) targeted therapy. Methods: Twenty-one IMH patients who had liver biopsy during ICIs treatment in Zhongshan Hospital of Fudan University from 2015 to 2019 were included. Among them, ten were treated with ICIs monotherapy, and 11 were treated with combined ICIs and anti-angiogenesis targeted therapy. The histologic features of IMH were assessed by HE staining and PD-L1/2 was evaluated by immunohistochemical staining. Results: Patients treated with monotherapy ICIs presented with different levels of lobular hepatitis and portal inflammation. Besides, there were also cholangitis, endothelialitis, Kupffer cells activation and peliosisi hepatitis. Eight cases (8/10) showed mild and two cases (2/10) showed moderate hepatic injury. As for patients receiving combined ICIs and TKIs therapy, the extent of IMH was more severe, with four cases (4/11) showing moderate-severe liver injury, with confluent or bridging necrosis, portal inflammation, cholangitis, interface hepatitis. Among these, one patient developed acute severe hepatitis with massive hepatocyte necrosis and died of multisystem dysfunction. In those cases with severe liver injury, many CD8 positive lymphocytes aggregated in the portal area and hepatic sinusoid, and PD-L1 was expressed in many endothelial cells. There were both 2 cases of death in ICIs monotherapy and combination therapy group. Among the latter group, 1 patient developed acute severe hepatitis with massive hepatocyte necrosis and died of multisystem dysfunction. Conclusion: Compared with ICIs monotherapy, combined ICIs and anti-angiogenesis targeted TKIs therapy may cause overlapping hepatic injury, leading to severe IMH.


Assuntos
Antineoplásicos/uso terapêutico , Células Endoteliais , Hepatite , Hepatite/terapia , Humanos , Imunoterapia , Neovascularização Patológica , Inibidores de Proteínas Quinases
2.
Klin Padiatr ; 232(3): 151-158, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193885

RESUMO

BACKGROUND: Children with idiopathic acute liver failure (IALF) are at a high risk of developing life-threatening bone marrow failure (BMF). The aim of the study was to describe the development, therapy and prognosis of this hepatitis-associated aplastic anaemia (HAAA) in comparison to isolated acquired aplastic anaemia. RESULTS: We retrospectively found 18 patients (9 female) of HAAA between 1984 and 2017 with an age of 1.4-16.4 years. Fifteen of them fulfilled the SAA criteria, 3 had a bone marrow hypoplasia. Eleven of these children received liver transplantation (LTx) (these were 11 of 42 (26%) children receiving LTx for IALF), 6 patients recovered without LTx. The first signs of BMF, thrombocytopaenia and leucocytopaenia, occurred before LTx in all cases. During the follow-up period 8 patients reached haematological remission, 6 received haematopoietic stem cell transplantation (HSCT). Seven children died in a median of 304 days after the first symptoms mostly because of bleedings and infections. To date, extensive investigations failed to detect a genetically, viral or immunological aetiology. No AA was diagnosed in the 41 patients receiving liver transplants during the same period for ALF of known aetiology. As a comparison group, we collected the data of patients with isolated SAA. 73% achieved a remission after Immunosuppressive therapy (IST) without HSCT, and none of them died during the follow-up period. CONCLUSION: Blood counts should be examined early and regularly (0-22 days after onset) in patients with IALF. Aggressive treatment with LTx, IST and HSCT appears to improve the prognosis.


Assuntos
Anemia Aplástica/diagnóstico , Vírus de Hepatite/isolamento & purificação , Hepatite/diagnóstico , Falência Hepática Aguda/complicações , Adolescente , Anemia Aplástica/complicações , Anemia Aplástica/terapia , Anemia Aplástica/virologia , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Transplante de Medula Óssea , Criança , Pré-Escolar , Feminino , Transplante de Células-Tronco Hematopoéticas , Hepatite/complicações , Hepatite/tratamento farmacológico , Humanos , Lactente , Falência Hepática Aguda/terapia , Transplante de Fígado , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento
3.
Zhonghua Er Ke Za Zhi ; 58(3): 213-217, 2020 Mar 02.
Artigo em Chinês | MEDLINE | ID: mdl-32135593

RESUMO

Objective: To discuss the clinical characteristics and management approaches to hepatitis associated aplastic anemia (HAAA) presenting as hemophagocytic lymphohistiocytosis (HLH) at onset. Methods: The clinical data and laboratory results of hospitalized 5 HAAA patients presenting as HLH at onset in Beijing Children's Hospital from January 2017 to May 2019 were analyzed retrospectively. Results: Among 5 cases, there were 4 males and 1 female. The age of onset was 6.0 (2.7-12.7) years. All patients presented with high fever, hepatomegaly, hepatic dysfunction (aspartate aminotransferase 1 716 (1 409-2 570) U/L, alanine aminotransferase 1 699 (937-2 540) U/L) at onset. After admission, the laboratory results showed pancytopenia (white blood cell 1.2 (0.6-6.7) ×10(9)/L, haemoglobin 94 (65-111) g/L, blood platelet 29 (10-41) ×10(9)/L), decreased fibrinogen (1.3 (1.1-2.5) g/L), significantly elevated triglyceride (4.0 (2.8-5.1) mmol/L), ferritin (1 766 (399-5 253) µg/L) and soluble CD25 (27 457 (9 625-44 000) ng/L). Hemophagocytosis was found in the bone marrow smears of all 5 patients. The diagnosis of acute hepatitis and HLH was confirmed. During the treatment of HLH, the blood cells remain below normal level and the further biopsy of bone marrow (iliac bone) indicated low myeloproliferation. After exclusion of congenital bone marrow failure syndromes and other pancytopenic diseases, HAAA was confirmed. After the diagnosis of HAAA, 1 patient received antithymocyte globulin (ATG) and cyclosporin treatment in our hospital, 1 patient received allogeneic stem cell transplantation (HSCT) in other hospital, 2 patients received ATG in other hospitals. Only 1 patient died of severe infection. Conclusions: HAAA can present as HLH at onset. It is mainly manifested by high fever, acute severe hepatitis, pancytopenia, elevated ferritin and hemophagocytosis in the bone marrow. The diagnosis of HAAA should be considered whenever cytopenia could not completely corrected while apparent improvement of HLH and hepatitis related complications were improved after immunosuppressive therapy. ATG or HSCT treatment should be performed as soon as the diagnosis of severe or transfusion dependent aplastic anemia is confirmed.


Assuntos
Anemia Aplástica , Hepatite , Anemia Aplástica/diagnóstico , Anemia Aplástica/etiologia , Soro Antilinfocitário , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Hepatite/complicações , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Masculino , Estudos Retrospectivos
4.
Artigo em Inglês | PAHO-IRIS | ID: phr-51901

RESUMO

To the editor: In the United States (US), an estimated 2.4 million persons have chronic infection with hepatitis C virus (HCV). The number of deaths from HCV-related mortality is greater than that of HIV and tuberculosis combined. Treatment with direct-acting antivirals (DAAs), usually 1-3 pills a day for 8 or 12 weeks, can cure over 95% of patients. Successful treatment of HCV has been shown to greatly reduce liver-related as well as all-cause mortality. American Indian and Alaska Native (AI/AN) people have over twice the national rate of HCV-related mortality. The largest health care provider for AI/AN communities is the Indian Health System, a national network of federal (Indian Health Service), tribal, and urban health facilities, comprised mostly of rural primary care clinics. As part of the Indian Health System response to HCV, health facilities have access to tele-mentoring support such as the ECHO (Extension for Community Healthcare Outcomes) model, which has demonstrated excellent outcomes in treating HCV. The program connects rural clinicians (‘spokes’) to a specialist team (‘hub’). These participants meet regularly via low-bandwidth video conference technology. The format of case-based learning, supported by short didactic presentations, aims to scale up clinical capacity across a health network. Patient presentations entail a brief de-identified standardized form with a patient’s clinical history to assess liver disease severity and determine optimal HCV treatment. [...]


Assuntos
Hepatite C , Mortalidade , Doenças Transmissíveis , Nativos do Alasca , Índios Norte-Americanos , Saúde da População Urbana , Serviços Urbanos de Saúde , Hepatite , Telemedicina , Telemedicina para as Zonas Rurais e Remotas , Serviços de Saúde do Indígena , Saúde de Populações Indígenas , Organizações Indígenas
5.
Zhonghua Gan Zang Bing Za Zhi ; 28(1): 92-96, 2020 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-32023709

RESUMO

Extracellular vesicles (EVs) are small bilayer lipid membrane vesicles that can be released by most cell types and detected in most body fluids. EVs exert key functions for intercellular communication via transferring their bioactive cargos to recipient cells or activating signaling pathways in target cells, and hence participate in the variety of diseases including the occurrence and development of liver diseases. In recent years, the prevalence of nonalcoholic fatty liver disease (NAFLD) has increased. Currently there is no reliable method except invasive liver biopsy for the diagnosis of liver inflammation or fibrosis staging. Therefore, the search for the corresponding markers of noninvasive circulation continues to be active, and extracellular vesicles are one of the most concerned. To this end, we reviewed current knowledge about the physical characteristics, biological components, and isolation methods of extracellular vesicles, and introduced the concept of using circulating cell-derived vesicles as a new diagnostic marker for nonalcoholic fatty liver disease.


Assuntos
Vesículas Extracelulares , Hepatopatia Gordurosa não Alcoólica , Biomarcadores , Comunicação Celular , Hepatite , Humanos
6.
Am J Psychiatry ; 177(4): 335-341, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32046532

RESUMO

OBJECTIVE: Previous studies have suggested that infections increase the risk of schizophrenia. In this study, the authors aimed to investigate 1) whether infections increase the risk of substance-induced psychosis, and 2) whether infections increase the risk of converting from substance-induced psychosis to schizophrenia. METHODS: The study data were drawn from the combined nationwide Danish registers and included all people born in Denmark since 1981. The authors used Cox proportional hazards regression with infections as time-varying covariates, estimating hazard ratios and 95% confidence intervals. Infections were operationalized both as any infection and by the site of infection. RESULTS: The study included 2,256,779 individuals, for whom 3,618 cases of incident substance-induced psychosis were recorded. Any infection increased the risk of substance-induced psychosis (hazard ratio=1.30, 95% CI=1.22-1.39). For the first 2 years, the risk was doubled. Hepatitis was the infection most strongly associated with substance-induced psychosis (hazard ratio=3.42, 95% CI=2.47-4.74). Different types of infections were linked with different types of substance-induced psychosis. Most associations remained significant after controlling for potential confounders, such as substance use disorders. Only hepatitis predicted conversion to schizophrenia after substance-induced psychosis (hazard ratio=1.87, 95% CI=1.07- 3.26). CONCLUSIONS: The study results support the hypothesis of an immunological component to psychosis.


Assuntos
Infecções/epidemiologia , Psicoses Induzidas por Substâncias/epidemiologia , Esquizofrenia/epidemiologia , Adolescente , Adulto , Infecções do Sistema Nervoso Central/epidemiologia , Dinamarca/epidemiologia , Progressão da Doença , Feminino , Gastroenterite/epidemiologia , Hepatite/epidemiologia , Humanos , Incidência , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Infecções do Sistema Genital/epidemiologia , Infecções Respiratórias/epidemiologia , Fatores de Risco , Sepse/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Infecções Urinárias/epidemiologia , Adulto Jovem
7.
PLoS One ; 15(2): e0229218, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069337

RESUMO

BACKGROUND AND AIMS: Chronic liver disease (CLD) and cirrhosis are leading causes of death globally with the burden of disease rising significantly over the past several decades. Defining the etiology of liver disease is important for understanding liver disease epidemiology, healthcare planning, and outcomes. The aim of this study was to validate a hierarchical algorithm for CLD and cirrhosis etiology in administrative healthcare data. METHODS: Consecutive patients with CLD or cirrhosis attending an outpatient hepatology clinic in Ontario, Canada from 05/01/2013-08/31/2013 underwent detailed chart abstraction. Gold standard liver disease etiology was determined by an attending hepatologist as hepatitis C (HCV), hepatitis B (HBV), alcohol-related, non-alcoholic fatty liver disease (NAFLD)/cryptogenic, autoimmune or hemochromatosis. Individual data was linked to routinely collected administrative healthcare data at ICES. Diagnostic accuracy of a hierarchical algorithm incorporating both laboratory and administrative codes to define etiology was evaluated by calculating sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and kappa's agreement. RESULTS: 442 individuals underwent chart abstraction (median age 53 years, 53% cirrhosis, 45% HCV, 26% NAFLD, 10% alcohol-related). In patients with cirrhosis, the algorithm had adequate sensitivity/PPV (>75%) and excellent specificity/NPV (>90%) for all etiologies. In those without cirrhosis, the algorithm was excellent for all etiologies except for hemochromatosis and autoimmune diseases. CONCLUSIONS: A hierarchical algorithm incorporating laboratory and administrative coding can accurately define cirrhosis etiology in routinely collected healthcare data. These results should facilitate health services research in this growing patient population.


Assuntos
Algoritmos , Carcinoma Hepatocelular/diagnóstico , Bases de Dados Factuais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hepatite/diagnóstico , Cirrose Hepática/diagnóstico , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Carcinoma Hepatocelular/etiologia , Codificação Clínica , Estudos de Coortes , Feminino , Hepatite/etiologia , Humanos , Cirrose Hepática/etiologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/etiologia , Prognóstico
8.
Recurso na Internet em Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46951

RESUMO

En el Día Mundial de la Hepatitis 2019, la OMS pide a todos los países que "Inviertan en eliminar la hepatitis" a través de la elaboración de presupuestos y el financiamiento de los servicios de eliminación dentro de sus planes de cobertura de salud universal.


Assuntos
Hepatite , Hepatite Viral Humana
9.
Gene ; 730: 144289, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31846709

RESUMO

Interferon lambda proteins activate the JAK-STAT signalling pathway, resulting in upregulation of genes with antiviral effects. The interferon lambda family was initially thought to be redundant to the interferon alpha family, which signals through the same pathway, except for the more limited expression of the IFNLR1 receptor. However, recent studies show that interferon lambdas uniquely protect tissue barriers against a wide range of important viral infections. The interferon lambda 4 gene (IFNL4) was discovered in 2013. The IFNL4 protein is determined by the IFNL4-ΔG/TT (rs368234815) variant. The ancestral IFNL4-ΔG allele generates IFNL4, whereas IFNL4-TT causes pre-mature termination of the protein. Surprisingly, although interferons are generally antiviral proteins, the genotypes that generate the IFNL4 protein are strongly linked to impaired clearance of hepatitis C virus (HCV). IFNL4 genotype has also been linked to variation within the HCV genome, as well as risk of hepatic fibrosis, certain cancers and some infectious diseases. There has been very strong evolutionary selection against the ancestral IFNL4-ΔG allele, which is the major form in African populations, but the minor allele in Europeans and Asians. The reason for this selection and the biological mechanisms underlying observed phenotypic associations remain to be explained.


Assuntos
Interleucinas/genética , Interleucinas/metabolismo , Alelos , Grupos de Populações Continentais/genética , Evolução Molecular , Frequência do Gene/genética , Variação Genética/genética , Genótipo , Hepacivirus/genética , Hepatite/genética , Humanos , Interleucinas/fisiologia , Fenótipo , Polimorfismo de Nucleotídeo Único/genética
10.
MMWR Morb Mortal Wkly Rep ; 68(29): 637, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31851651

RESUMO

World Hepatitis Day, observed each year on July 28, was established to raise awareness and promote understanding of viral hepatitis around the world. The theme of this year's World Hepatitis Day is "Invest in Eliminating Hepatitis," underscoring the need to increase commitment for hepatitis response. In 2015, an estimated 257 million persons were living with hepatitis B and 71 million with hepatitis C worldwide (1).


Assuntos
Saúde Global , Conhecimentos, Atitudes e Prática em Saúde , Hepatite/prevenção & controle , Aniversários e Eventos Especiais , Humanos
11.
Zhongguo Zhong Yao Za Zhi ; 44(22): 4953-4961, 2019 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-31872606

RESUMO

To systemically analyze the efficacy and safety of Babaodan Capsules in treatment of viral hepatitis. Databases such as CNKI,Wan Fang Date,VIP,Sino Med,PubMed,and Cochrane Library were electronically searched for relevant randomized controlled trials about Babaodan Capsules in the treatment of viral hepatitis,from database establishment to November 11,2018. Two researchers independently screened the literature and extracted data according to the inclusion criteria. GRADE system was used to evaluate evidence quality,and we used the Cochrane Rev Man 5. 3 software for Meta-analysis. Six randomized controlled trials including 520 subjects were included. Babaodan Capsules combined with conventional treatment were used as intervention measures,and the conventional treatment was used as the control measures. The results showed Babaodan Capsules combined with conventional treatment had better efficacy on reducing the total bilirubin( MD =-16. 25,95% CI[-19. 86,-12. 63]),alanine aminotransferase( MD =-26. 62,95% CI[-41. 18,-12. 06]),total bile acid( MD=-46. 02,95%CI[-49. 18,-42. 85]) and improving clinical efficiency( RR = 1. 34,95%CI[1. 13,1. 59]) than conventional treatment alone. In addition,Babaodan Capsules combined with conventional treatment can delay the progression of liver fibrosis to some extent. Qualitative analysis showed that the combined treatment regimen was more effective in relieving clinical symptoms. There was no significant difference between the two regimens in increasing albumin and prothrombin activity. Babaodan Capsules combined with conventional treatment showed no adverse reactions. In summary,for patients with viral hepatitis,the combination of Babaodan Capsules and conventional treatment has more advantages in reducing total bilirubin,alanine aminotransferase and total bile acid and is more effective in improving clinical symptoms as compared with conventional Western medicine,with no serious adverse reactions. Its clinical application with syndrome differentiation method can be considered. However,due to the limited number and quality of the original researches,more multi-center,high-quality randomized controlled trials are needed for further verification.


Assuntos
Antivirais/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Hepatite/tratamento farmacológico , Cápsulas , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
Biomed Res Int ; 2019: 9726786, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886272

RESUMO

Although gut dysbiosis appears in 20%-75% of cirrhotic patients, there are limited data on microbiota profiles in viral hepatitis cirrhotics and its role in progression to cirrhosis. Further understanding on the relationship between gut dysbiosis and cirrhosis presents a unique opportunity in not only predicting the development of cirrhosis but also discovering new therapies. Recent advances have been made on identifying unique microbiota in viral hepatitis cirrhotics and adopting the microbiota index to predict cirrhosis. Therapeutic intervention with microbiome-modulating has been explored. Cirrhosis from viral infection has unique bacterial or fungal profiles, which include increased numbers of Prevotella, Streptococcus, Staphylococcaceae, and Enterococcus, as well as decreased Ruminococcus and Clostridium. In addition, the gut microbiota can stimulate liver immunity, effectively helping hepatitis virus clearance. In clinical settings, CDR, GDI, Basidiomycota/Ascomycota, specific POD, and so forth are efficient microbiota indexes to diagnose or prognosticate cirrhosis from viral hepatitis. FMT, probiotics, and prebiotics can restore microbial diversity in cirrhotic patients with viral hepatitis, decrease ammonia serum or endotoxemia levels, prevent complications, reduce rehospitalization rate, and improve prognosis. Cirrhotics from viral hepatitis had unique bacterial or fungal profiles, associated with specific metabolic, immune, and endocrinological statuses. Such profiles are modifiable with medical treatment. The role of gut archaea and virome, implementation of FMT, microbiota metabolites as adjuvant immunotherapy, and microbiota indexes for prognostication deserve attention.


Assuntos
Disbiose , Microbioma Gastrointestinal , Hepatite , Cirrose Hepática , Disbiose/fisiopatologia , Disbiose/virologia , Humanos , Fígado/fisiologia , Fígado/virologia , Cirrose Hepática/fisiopatologia , Cirrose Hepática/virologia
13.
Arq. ciências saúde UNIPAR ; 23(3): [171-180], set-dez. 2019.
Artigo em Português | LILACS | ID: biblio-1046155

RESUMO

O processo de envelhecimento populacional e o aumento do número de casos de Infecções Sexualmente Transmissíveis (IST) em idosos evidenciam a necessidade de ações voltadas para a terceira idade. Trata-se um estudo analítico observacional transversal, exploratório, com o objetivo de investigar situações de vulnerabilidade relacionadas à IST em idosos usuários de um Centro de Testagem e Aconselhamento para DTS/Aids de um município de médio porte do estado da Bahia, Brasil, no período de 2006 a 2012. Foram utilizados dados secundários de 233 usuários, com 60 anos ou mais, coletados dos Formulários de Entrada do Sistema de Informação do Centro de Testagem e Aconselhamento, prontuários clínicos e folha de descrição do atendimento. Houve predomínio de usuários do sexo masculino (60,94%), faixa etária de 60 a 70 anos (75,97%), cor parda (26,61%), casados (61,80%), aposentados (57,08%) e com escolaridade de 4 a 7 anos de estudo (35,19%). A maioria relatou a relação sexual como tipo de exposição (76,39%), preferência heterossexual (92,27%) e parceria fixa (72,96%). A frequência de uso do preservativo foi baixa com o parceiro não fixo (32,73%) e com o parceiro fixo (5,58%). A prevalência de IST foi 25,32%, com maior percentual entre os homens. A IST mais prevalente foi a hepatite C (10,73%), seguida da hepatite B (8,58%), sífilis (7,73%) e HIV (3,43). A faixa etária menor que 70 anos mostrou associação estatisticamente significativa com a presença de IST. Os resultados evidenciaram práticas sexuais inseguras e elevada vulnerabilidade dos idosos às IST, havendo necessidade de ações preventivas direcionadas a esse grupo populacional, considerando suas necessidades e especificidades.


The population aging process and the increase in the number of cases of Sexually Transmitted Infections (STI) in the elderly shows the need of actions aimed at that population. This is an exploratory, observational, cross-sectional study to investigate vulnerability situations related to Sexually Transmitted Infections in elderly users of an STD/AIDS Counseling Center of a medium-sized city in the state of Bahia, Brazil, from 2006 to 2012. The study used secondary data from 233 users aged 60 or older, collected from the Counseling Center Information System Admission Forms, clinical records and service description sheet. There was a predominance of male users (60.94%), 60 to 70 years old (75.97%), brown (26.61%), married (61.80%), retired (57,8%) and with 4 to 7 years of schooling (35,19%). Most reported sexual intercourse as the exposure type (76.39%), heterosexual preference (92.27%) and stable partnership (72.96%). The frequency of condom use was low with non-stable partners (32.73%) and with stable partners (5.58%). The prevalence of STI was 25.32%, with greater percentage among men. The most prevalent STI was hepatitis C (10.73%), followed by hepatitis B (8.58%), syphilis (7.73%) and HIV (3.43). The age group younger than 70 years showed a statistically significant association with the presence of STI. The results evidenced unsafe sexual practices and high vulnerability of the elderly to STIs, requiring preventive actions aimed at that population group, considering their needs and specificities.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Idoso , Sífilis/prevenção & controle , Doenças Sexualmente Transmissíveis/classificação , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Hepatite/prevenção & controle , Envelhecimento
15.
Acta Biochim Biophys Sin (Shanghai) ; 51(11): 1087-1095, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31609412

RESUMO

Autophagy, a metabolic pathway that plays an important role in maintaining the dynamic balance of cells, has two types, i.e. non-selective autophagy and selective autophagy. The role of non-selective autophagy is primarily to allow cells to circulate nutrients in an energy-limited environment, while selective autophagy primarily cleans up the organelles inside the cells to maintain the cell structure. The NLRP3 inflammasome is an innate immune response produced by the organism that can promote the secretion of interleukin-1ß and interleukin-18 through caspase-1 activation and resist the damage of some pathogens. However, when the NLRP3 inflammasome is overactivated, it can cause various inflammatory diseases, such as inflammatory liver disease and inflammatory bowel disease. Many previous studies have shown that autophagy can inhibit the NLRP3 inflammasome, while in recent years, new studies have found that autophagy can also promote the NLRP3 inflammasome in some cases, and the NLRP3 inflammasome can, in turn, affect autophagy. In this review, the interaction between autophagy and the NLRP3 inflammasome is explored, and then the application of this interaction in disease treatment is discussed.


Assuntos
Autofagia/fisiologia , Hepatite/metabolismo , Inflamassomos/metabolismo , Doenças Inflamatórias Intestinais/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Animais , Humanos , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Camundongos , Ratos
16.
JAAPA ; 32(11): 12-13, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31592933

Assuntos
Hepatite , Humanos
17.
Urologe A ; 58(11): 1353-1360, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31659370

RESUMO

Effective vaccines against various urologically important diseases have been established for a long time, nevertheless, vaccination activities are generally underperformed in urology. Consistently low vaccination rates, e.g. for human papillomavirus (HPV) vaccines and a widespread vaccination hesitancy characterize the situation especially in men. This article highlights the importance of various aspects of vaccinations in urology and focuses on the improvement of consultation techniques for vaccinations to increase the vaccination rate and acceptance in the future.


Assuntos
Hepatite/prevenção & controle , Programas de Imunização , Vacinas contra Papillomavirus , Urologia/métodos , Cobertura Vacinal , Vacinação/estatística & dados numéricos , Vacinas Anticâncer/administração & dosagem , Humanos , Masculino , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Encaminhamento e Consulta , Infecções Urinárias/prevenção & controle
18.
BMC Infect Dis ; 19(1): 874, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640598

RESUMO

BACKGROUND: Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis typically occurs in rural regions. CASE PRESENTATION: We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis. Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far, just two in adults and both from Barcelona. A revision of the literature is performed. CONCLUSIONS: Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients. Furthermore there are only few cases in the literature that describe the histopathological changes that we found in this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy can elucidate the diagnosis.


Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Visceral/complicações , Leishmaniose Visceral/tratamento farmacológico , Falência Hepática Aguda/etiologia , Anfotericina B/uso terapêutico , Biópsia , Diagnóstico Diferencial , Febre/etiologia , Hepatite/tratamento farmacológico , Hepatite/etiologia , Hepatite/parasitologia , Humanos , Falência Hepática Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase
19.
In Vivo ; 33(5): 1697-1702, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471426

RESUMO

BACKGROUND/AIM: Chemotherapy is often halted due to abnormal liver function resembling hepatitis. But the cause can be extrahepatic portal venous obstruction (EHPVO) with hepatic enzyme elevation rather than being an adverse effect of chemotherapy. We investigated EHPVO with hepatic enzyme elevation in patients with cancer. PATIENTS AND METHODS: Data of these hospitalized patients with solid tumors between January 2013 and September 2017 were collected. The criteria for study inclusion were: (i) Extrahepatic malignancy; (ii) computed tomographic scans showing a tumor with external compression of the extrahepatic portal vein; and (iii) serum aminotransferase (AST) or alanine transaminase (ALT) level three times above the normal value. RESULTS: Thirteen out of 377 (3%) patients developed EHPVO with hepatic enzyme elevation, as demonstrated from computed tomographic scan. Four cases (31%) also had vascular thrombosis (three portal vein and one inferior vena cava). Serum AST increased from 34±11 to 169±94 U/l. ALT increased from 9±38 to 177±104 U/l. There was no relationship of EHPVO with viral markers and cirrhosis. Six cases received chemotherapy with liver function improvement. CONCLUSION: EHPVO occurred in patients with metastatic cancer, leading to hepatic enzyme elevation resembling hepatitis without hepatitis risk factors and cirrhosis. Before withholding chemotherapy due to hepatic enzyme elevation, the possibility of EHPVO should firstly be excluded.


Assuntos
Constrição Patológica/diagnóstico , Hepatite/complicações , Hepatite/diagnóstico , Neoplasias/complicações , Veia Porta/patologia , Doenças Vasculares/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Constrição Patológica/etiologia , Feminino , Hepatite/sangue , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Tomografia Computadorizada por Raios X , Doenças Vasculares/etiologia
20.
Medicina (B Aires) ; 79(4): 284-286, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487249

RESUMO

Endomyocardial fibrosis is a restrictive cardiomyopathy with high morbidity and mortality rates, prevalent in the sub-Saharan Africa region but infrequent in our population. It has a close relation with blood hypereosinophilia. Hypoxic hepatitis is frequently observed in intensive care units and its diagnosis is clinical. It shows a typical enzyme pattern with high mortality too. There are multiple mechanisms responsible for this condition, such as ischemia, passive congestion and dysoxia. We described the case of a 35 year-old cocaine addict woman diagnosed with endomyocardial fibrosis and hypereosinophilic syndrome who developed cardiogenic shock with hypoxic hepatitis. The patient evolved favorably with the appropriate treatment.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Fibrose Endomiocárdica/etiologia , Hepatite/complicações , Síndrome Hipereosinofílica/complicações , Choque Cardiogênico/complicações , Adulto , Fibrose Endomiocárdica/diagnóstico , Feminino , Humanos , Hipóxia/complicações
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