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1.
Nat Rev Gastroenterol Hepatol ; 16(12): 748-766, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31666728

RESUMO

Primary liver cancer (PLC) is the fourth most frequent cause of cancer-related death. The high mortality rates arise from late diagnosis and the limited accuracy of diagnostic and prognostic biomarkers. The liver is a major regulator, orchestrating the clearance of toxins, balancing glucose, lipid and amino acid uptake, managing whole-body metabolism and maintaining metabolic homeostasis. Tumour onset and progression is frequently accompanied by rearrangements of metabolic pathways, leading to dysregulation of metabolism. The limitation of current therapies targeting PLCs, such as hepatocellular carcinoma and cholangiocarcinoma, points towards the importance of deciphering this metabolic complexity. In this Review, we discuss the role of metabolic liver disruptions and the implications of these processes in PLCs, emphasizing their clinical relevance and value in early diagnosis and prognosis and as putative therapeutic targets. We also describe system biology approaches able to reconstruct the metabolic complexity of liver diseases. We also discuss whether metabolic rearrangements are a cause or consequence of PLCs, emphasizing the opportunity to clinically exploit the rewired metabolism. In line with this idea, we discuss circulating metabolites as promising biomarkers for PLCs.


Assuntos
Neoplasias dos Ductos Biliares/metabolismo , Neoplasias Hepáticas/metabolismo , Biomarcadores/metabolismo , Doença Crônica , Progressão da Doença , Humanos , Hepatopatias/complicações , Hepatopatias/metabolismo , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/fisiopatologia , Redes e Vias Metabólicas , Metabolômica , Prognóstico , Biologia de Sistemas
2.
Medicina (B Aires) ; 79(5): 391-396, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671389

RESUMO

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.


Assuntos
Transtornos Nutricionais/sangue , Transtornos Nutricionais/etiologia , Vitamina B 12/sangue , Lesão Renal Aguda/sangue , Lesão Renal Aguda/complicações , Doenças Hematológicas/sangue , Doenças Hematológicas/complicações , Humanos , Hepatopatias/sangue , Hepatopatias/complicações , Neoplasias/sangue , Neoplasias/complicações , Vitamina B 12/efeitos adversos
4.
Artigo em Inglês | MEDLINE | ID: mdl-31546693

RESUMO

Rubella is a systemic virus infection that is usually mild. It can, however, cause severe birth defects known as the congenital rubella syndrome (CRS) when infection occurs early in pregnancy. As many as 8%-13% of children with CRS developed autism during the rubella epidemic of the 1960s compared to the background rate of about 1 new case per 5000 children. Rubella infection and CRS are now rare in the U.S. and in Europe due to widespread vaccination. However, autism rates have risen dramatically in recent decades to about 3% of children today, with many cases appearing after a period of normal development ('regressive autism'). Evidence is reviewed here suggesting that the signs and symptoms of rubella may be due to alterations in the hepatic metabolism of vitamin A (retinoids), precipitated by the acute phase of the infection. The infection causes mild liver dysfunction and the spillage of stored vitamin A compounds into the circulation, resulting in an endogenous form of hypervitaminosis A. Given that vitamin A is a known teratogen, it is suggested that rubella infection occurring in the early weeks of pregnancy causes CRS through maternal liver dysfunction and exposure of the developing fetus to excessive vitamin A. On this view, the multiple manifestations of CRS and associated autism represent endogenous forms of hypervitaminosis A. It is further proposed that regressive autism results primarily from post-natal influences of a liver-damaging nature and exposure to excess vitamin A, inducing CRS-like features as a function of vitamin A toxicity, but without the associated dysmorphogenesis. A number of environmental factors are discussed that may plausibly be candidates for this role, and suggestions are offered for testing the model. The model also suggests a number of measures that may be effective both in reducing the risk of fetal CRS in women who acquire rubella in their first trimester and in reversing or minimizing regressive autism among children in whom the diagnosis is suspected or confirmed.


Assuntos
Transtorno Autístico/induzido quimicamente , Hipervitaminose A/complicações , Hepatopatias/complicações , Síndrome da Rubéola Congênita/induzido quimicamente , Rubéola (Sarampo Alemão)/fisiopatologia , Vitamina A/toxicidade , Humanos , Hipervitaminose A/induzido quimicamente , Fígado/metabolismo , Vírus da Rubéola/fisiologia , Vitamina A/metabolismo
5.
Int J Mol Sci ; 20(17)2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31480433

RESUMO

Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases. In addition, osteoporosis is critical in patients receiving a liver transplant. Nevertheless, few studies have evaluated bone diseases in patients with more frequently observed chronic liver disease, such as chronic viral hepatitis, nonalcoholic fatty liver disease and alcoholic liver disease. Osteoporosis is a disease caused by an imbalance in the activities of osteoblasts and osteoclasts. Over the last few decades, many advances have improved our knowledge of the pathogenesis of osteoporosis. Importantly, activated immune cells affect the progression of osteoporosis, and chronic inflammation may exert an additional effect on the existing pathophysiology of osteoporosis. The microbiota of the intestinal tract may also affect the progression of bone loss in patients with chronic liver disease. Recently, studies regarding the effects of chronic inflammation on dysbiosis in bone diseases have been conducted. However, mechanisms underlying osteoporosis in patients with chronic liver disease are complex and precise mechanisms remain unknown. The following special considerations in patients with chronic liver disease are reviewed: bone diseases in patients who underwent a liver transplant, the association between chronic hepatitis B virus infection treatment and bone diseases, the association between sarcopenia and bone diseases in patients with chronic liver disease, and the association between chronic liver disease and avascular necrosis of the hip. Few guidelines are currently available for the management of low bone mineral density or bone diseases in patients with chronic liver disease. Due to increased life expectancy and therapeutic advances in chronic liver disease, the importance of managing osteoporosis and other bone diseases in patients with chronic liver disease is expected to increase. Consequently, specific guidelines need to be established in the near future.


Assuntos
Doenças Ósseas/complicações , Hepatopatias/complicações , Animais , Doenças Ósseas/patologia , Doenças Ósseas/terapia , Doença Crônica , Gerenciamento Clínico , Humanos , Hepatopatias/patologia , Hepatopatias/terapia , Transplante de Fígado
6.
Vet Res Commun ; 43(4): 231-238, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473888

RESUMO

This study was performed to evaluate the hepatocyte-derived microRNA (miR)-122 as novel diagnostic biomarker in canine lymphoma. Fifteen dogs were enrolled in this study. Dogs presented at Small Animal Teaching Hospital, Faculty of Veterinary Medicine, Cairo University. Dogs were divided into 8 clinically healthy dogs act as control and 7 clinically ill dogs. All dogs were subjected to clinical, ultrasonographic, hemato-biochemical and ultrasound-guided fine-needle biopsy for cytological and histopathological investigations. On the basis of these results, 7 dogs were found to be suffering from multicentric lymphoma involving liver. Serum hepatocyte-derived miRA-122 was determined by real-time quantitative polymerase chain reaction in all dogs. Multicentric lymphoma involving liver manifested by inappetance for several days, depression and peripheral lymphadenopathy. Hematological examination showed significant lymphocytosis. Serum biochemical analysis revealed significant increase in ALT, AST, ALP compared to control dogs. Ultrasonography revealed hypoechoic lymphoid aggregation at area of "porta hepatis" and circumscribed hypoechoic nodule interrupt liver parenchyma. Cytology revealed infiltration of liver tissue by lymphoblast cells and histopathology revealed diffuse infiltration of hepatic sinusoids and portal area by uniform population of small lymphocytes. Serum miRNA-122 analysis showed a significant increase represented as 9.00 fold in canine multicentric lymphoma involving liver. Serum hepatocyte-derived miRNA-122 is of diagnostic value, non invasive, stable and easily measurable blood biomarker for the detection of hepatocellular injury in dogs with multicentric lymphoma involving liver.


Assuntos
Doenças do Cão/sangue , Doenças do Cão/fisiopatologia , Regulação Neoplásica da Expressão Gênica , Hepatopatias/veterinária , Fígado/patologia , Linfoma/veterinária , MicroRNAs/sangue , Animais , Doenças do Cão/diagnóstico , Cães , Hepatócitos/patologia , Hepatopatias/sangue , Hepatopatias/complicações , Hepatopatias/diagnóstico , Linfoma/sangue , Linfoma/complicações , Linfoma/diagnóstico , MicroRNAs/genética
7.
Transplant Proc ; 51(9): 3147-3149, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31371215

RESUMO

BACKGROUND: Fibrocystic liver-kidney disease is caused by a group of rare and genetically diverse disorders that are associated with kidney cysts or dysplasia and ductal plate malformation in the liver. There have been several reports of liver neoplasias arising in hepatobiliary fibrocystic diseases. However, most were cholangiocarcinoma; cases involving hepatocellular carcinoma (HCC) are rare, and all the reported cases are related with adults. CASE REPORT: A 10-year-old girl with a history of repeated gastrointestinal bleeding underwent banding and sclerotherapy multiple times and had a history of a Portosystemic shunt without any significant benefit. She was referred to us as a case of fibrocystic liver disease with decompensated liver disease for liver transplantation. The patient underwent living donor liver transplantation, and the explanted liver histopathology report is documented. The explant liver weighed 838 g and measured 21 × 13 × 8.5 cm with the attached gallbladder measuring 7 × 3 × 0.2 cm (in wall thickness). The external surface was covered with multiple white nodules ranging in size from 0.4 to 1 cm. Serial slicing revealed an ill-defined, yellow, soft lesion (4 × 2.5 × 2.5 cm) localized in the subcapsular area of the left lobe (segment 4). The rest of the cut surface was green and nodular (cirrhotic). Microscopy from largest nodule was consistent with early hepatocellular carcinoma.The rest of the liver was cirrhotic, and the morphology was consistent with fibrocystic disease of liver. CONCLUSION: We report a rare case of HCC associated with fibrocystic liver disease. When diagnosing fibrocystic liver disease without known risk factors, the presence of HCC must be considered, and vice versa. To our knowledge, this is the first reported case of HCC associated with fibrocystic liver disease in a 10-year-old child.


Assuntos
Carcinoma Hepatocelular/complicações , Cistos/complicações , Hepatopatias/complicações , Neoplasias Hepáticas/complicações , Adulto , Carcinoma Hepatocelular/cirurgia , Criança , Cistos/cirurgia , Feminino , Humanos , Hepatopatias/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Masculino , Fatores de Risco
8.
Curr Gastroenterol Rep ; 21(9): 48, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31367993

RESUMO

PURPOSE OF REVIEW: Pruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology, pathophysiology, evidence-based therapeutic recommendations and currently investigated drugs for pruritus in hepatobiliary disorders. RECENT FINDINGS: Recent epidemiological data suggest pruritus as a common and relevant symptom in immune-mediated liver diseases, i.e., primary biliary cholangitis (PBC) with over 70% affected patients, up to 56% suffering from chronic pruritus. The better pathophysiological understanding of hepatic pruritus has led to the identification of novel therapeutic targets, addressed in drug trials using KOR agonists, PPAR agonists, and ileal bile acid transporter inhibitors. Hepatic itch remains among the most agonizing symptoms for affected patients and a clinical challenge for physicians. Therapeutic recommendations include a guideline-based stepwise approach starting with cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors represent promising future anti-pruritic treatment options.


Assuntos
Hepatopatias/complicações , Prurido/terapia , Humanos , Prurido/epidemiologia , Prurido/etiologia
9.
PLoS One ; 14(7): e0219396, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291351

RESUMO

BACKGROUND & AIMS: Hepatitis C (HCV) is associated with several extrahepatic manifestations, and estimates of the hospitalization burden related to these comorbidities are still limited. The aim of this study is to quantify the hospitalization risk associated with comorbidities in an Italian cohort of HCV-infected patients and to assess which of these comorbidities are associated with high hospitalization resource utilization. METHODS: Individuals aged 18 years and older with HCV-infection were identified in the Abruzzo's and Campania's hospital discharge abstracts during 2011-2014 with 1-year follow-up. Cardio-and cerebrovascular disease, diabetes and renal disease were grouped as HCV-related comorbidities. Negative binomial models were used to compare the hospitalization risk in patients with and without each comorbidity. Logistic regression model was used to identify the characteristics of being in the top 20% of patients with the highest hospitalization costs (high-cost patients). RESULTS: 15,985 patients were included; 19.9% had a liver complication and 48.6% had one or more HCV-related comorbidities. During follow-up, 36.0% of patients underwent at least one hospitalization. Liver complications and the presence of two or more HCV-related comorbidities were the major predictors of hospitalization and highest inpatient costs. Among those, patients with cardiovascular disease had the highest risk of hospitalization (Incidence Rate Ratios = 1.42;95%CI:1.33-1.51) and the highest likelihood of becoming high-cost patients (Odd Ratio = 1.37;95%CI:1.20-1.57). CONCLUSION: Beyond advanced liver disease, HCV-related comorbidities (especially cardiovascular disease) are the strongest predictors of high hospitalization rates and costs. Our findings highlight the potential benefit that early identification and treatment of HCV might have on the reduction of hospitalization costs driven by extrahepatic conditions.


Assuntos
Doenças Cardiovasculares/epidemiologia , Comorbidade , Hepatite C/epidemiologia , Hepatopatias/epidemiologia , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/virologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/virologia , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Feminino , Hepacivirus/patogenicidade , Hepatite C/complicações , Hepatite C/fisiopatologia , Hepatite C/virologia , Custos Hospitalares , Hospitalização , Humanos , Pacientes Internados , Itália/epidemiologia , Fígado/patologia , Fígado/virologia , Hepatopatias/complicações , Hepatopatias/fisiopatologia , Hepatopatias/virologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/virologia
10.
Medicina (Kaunas) ; 55(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277322

RESUMO

Gastric varices are less common than esophageal varices, and their treatment is quite challenging. Gastric varix bleedings (GVB) occur less frequently than esophageal varix (EV) bleedings and represent 10% to 30% of all variceal bleedings. They are; however, more severe and are associated with high mortality. Re-bleeding may occur in 35% to 90% of cases after spontaneous hemostasis. GV bleedings represent a serious clinical problem compared with esophageal varices due to their location. Sclerotherapy and band ligation, in particular, are less effective. Based on the anatomic site and location, treatment differs from EV and is categorized into two groups (i.e., endoscopic or radiologic treatment). Surgical management is used less frequently. Balloon-occluded retrograde transvenous obliteration (BRTO) and cyanoacrylate are safe but there is a high risk of re-bleeding. Portal pressure elevates following BRTO and leads to worsening of esophageal varix pressure. Other significant complications may include hemoglobinuria, abdominal pain, fever, and pleural effusion. Shock and atrial fibrillation are major complications. New and efficient treatment modalities will be possible in the future.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Resultado do Tratamento , Adesivos/normas , Adesivos/uso terapêutico , Oclusão com Balão/métodos , Oclusão com Balão/normas , Varizes Esofágicas e Gástricas/etiologia , Humanos , Hepatopatias/complicações , Hepatopatias/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Derivação Portossistêmica Transjugular Intra-Hepática/normas
11.
Transplant Proc ; 51(6): 1874-1879, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31262437

RESUMO

BACKGROUND: Patients on a waiting list for liver transplantation frequently show core muscle wasting, referred to as sarcopenia, which results in poor prognosis. To date, there has been a lack of research on the association between inflammation mediators, including cytokines, and loss of core muscle mass in cirrhotic patients scheduled for living donor liver transplantation (LDLT). METHODS: Cytokines in serum, such as interleukin (IL)-2, IL-6, IL-10, IL-12, IL-17, interferon-γ, and tumor necrosis factor (TNF)-α, were retrospectively investigated in 234 LDLT patients 1 day before surgery. The psoas muscle area was measured using abdominal computed tomography within 1 month before surgery and used to calculate the psoas muscle index (PMI = psoas muscle area/height2). The study population was classified into 2 groups according to the interquartile range of PMI: a non-sarcopenia group (> 25th quartile) and a sarcopenia group (≤ 25th quartile) in each sex. RESULTS: In both sexes, IL-10 and TNF-α levels were significantly higher in the sarcopenia group than the non-sarcopenia group. In a univariate analysis, male patients showed that serum IL-10 and TNF-α levels were potentially associated with sarcopenia. Serum TNF-α was independently associated with sarcopenia in a multivariate analysis. In female patients, TNF-α was significantly associated with sarcopenia in both univariate and multivariate analyses. Male patients with a PMI ≤ 25th quartile had significantly higher TNF-α levels than those in other quartile ranges, and female patients with a PMI ≤ 25th quartile had a significantly higher TNF-α level than those with a PMI > 75th quartile. CONCLUSIONS: Serum levels of TNF-α are inversely associated with skeletal muscle wasting in both male and female patients scheduled for LDLT.


Assuntos
Hepatopatias/sangue , Transplante de Fígado , Sarcopenia/sangue , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/sangue , Adulto , Citocinas/sangue , Feminino , Humanos , Hepatopatias/complicações , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Músculos Psoas/patologia , Estudos Retrospectivos , Sarcopenia/etiologia , Sarcopenia/patologia , Tomografia Computadorizada por Raios X , Listas de Espera
12.
Acta Gastroenterol Belg ; 82(2): 309-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314193

RESUMO

The study of glycomics is a novel and fascinating approach for the development of biomarkers. It has become clear that in the field of liver disease specific glycomic patters are present in specific disease states, which has led to the development of diagnostic biomarkers. In this manuscript, we will describe two new applications of this technology for the development of prognostic biomarkers. The first biomarker is associated with the risk of hepatocellular carcinoma development in patients with compensated cirrhosis. The second biomarker is present in perfusate and is related to the risk of primary non function occurrence after liver transplantation. The technology used for these biomarkers could easily be implemented on routine capillary electrophoresis equipment.


Assuntos
Glicômica , Hepatopatias/sangue , Transplante de Fígado , Biomarcadores Tumorais/análise , Humanos , Hepatopatias/complicações , Hepatopatias/patologia , Prognóstico
13.
Expert Rev Clin Pharmacol ; 12(9): 859-865, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352834

RESUMO

Introduction: Thrombocytopenia is a common hematological abnormality in patients with chronic liver disease (CLD), occurring in 64%~84% of patients with cirrhosis or fibrosis. Due to the increased risk of bleeding, thrombocytopenia potentially affects management of CLD, such as surgery or liver biopsy. Avatrombopag is a new oral thrombopoietin (TPO) receptor agonist, activating TPO receptor and increasing megakaryocytic proliferation/differentiation and platelet production. Areas covered: This review summarizes the collected data concerning pharmacokinetics, clinical efficacy, safety and tolerability profiles of avatrombopag for the management of thrombocytopenia in patients with CLD. Expert opinion: Avatrombopag is recently approved by Food and Drug Administration (FDA) for the treatment of thrombocytopenia in patients with CLD who are scheduled to undergo a procedure. Based on the available clinical trials, avatrombopag is superior to placebo in reducing the need for platelet transfusions or rescue procedures for bleeding. Avatrombopag is also recommended as alternative to platelet transfusions.


Assuntos
Hepatopatias/complicações , Tiazóis/uso terapêutico , Tiofenos/uso terapêutico , Trombocitopenia/tratamento farmacológico , Doença Crônica , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Cirrose Hepática/complicações , Hepatopatias/fisiopatologia , Transfusão de Plaquetas/métodos , Receptores de Trombopoetina/agonistas , Tiazóis/efeitos adversos , Tiazóis/farmacologia , Tiofenos/efeitos adversos , Tiofenos/farmacologia , Trombocitopenia/etiologia
15.
Medicine (Baltimore) ; 98(30): e16491, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348258

RESUMO

RATIONALE: Reactive lymphoid hyperplasia (RLH) of the liver is an uncommon benign lesion. It is usually difficult to differentiate from hepatocellular carcinoma (HCC), peripheral-type cholangiocellular carcinoma (CCC), combined HCC-CCC, and liver metastases. On account of its rarity and controversial issues, we report a case report and review the literature to discuss its clinical features, treatments, radiological, and immunohistochemical characteristics. PATIENT CONCERNS: A 54-year-old woman had a history of primary biliary cirrhosis and chronic cholecystitis. She complained of finding a lesion in the right liver during her last medical check-up by abdominal B type ultrasound. The Contrast-enhanced computed tomography revealed a circular and low-density lesion in the right posterior lobe of the liver, approximately 22.0 × 18.7 mm in size. On magnetic resonance imaging, the lesion showed low-signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Laboratory test results were almost normal. DIAGNOSIS: After the postoperative pathological and immunohistochemical examination, the patient was finally diagnosed as having RLH. INTERVENTIONS: The patient received right posterior lobe hepatectomy and cholecystectomy. OUTCOMES: The patient was discharged 11 days after surgery. No evidence of recurrence was noted 1 year after the surgery. LESSONS: Although RLH of the liver is rare, it is necessary to be considered in a liver lesion, especially in female patients. This case report may advance the understanding of RLH of the liver and reduce the number of mistakenly diagnosed patients.


Assuntos
Hepatopatias/diagnóstico , Pseudolinfoma/diagnóstico , Colecistectomia , Colecistite/complicações , Feminino , Hepatectomia , Humanos , Cirrose Hepática Biliar/complicações , Hepatopatias/complicações , Hepatopatias/cirurgia , Pessoa de Meia-Idade , Pseudolinfoma/complicações , Pseudolinfoma/cirurgia
16.
Neurol India ; 67(3): 732-737, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347545

RESUMO

Context: Restless leg syndrome (RLS) has been reported to be common in patients with cirrhosis. The relation of RLS with severity of liver disease is, however, unclear. Aim: We studied the association between occurrence of RLS and severity of cirrhosis. Setting and Design: Single centre, prospective, observational study. Materials and Methods: Adult patients with cirrhosis and relatively stable clinical condition and no associated neurological condition were prospectively studied. Severity of liver disease was graded as Child-Turcotte-Pugh (CTP) class A, B or C; using Model for End-Stage Liver Disease (MELD) score; and as a binary variable (compensated or decompensated disease). Each subject underwent an initial screening for RLS, followed by a re-evaluation by an independent neurologist to confirm the diagnosis, using the International RLS Diagnostic Criteria. In patients with RLS, its severity was assessed using a validated Hindi translation of the International RLS severity (IRLS) scoring system. Statistical Analysis Used: Data for categorical variables were expressed as proportions and compared using chi-squared test, and those for numerical variables were expressed as median and range, and compared using Wilcoxon rank sum test. Results: Among the 356 patients with cirrhosis studied (median [range] age: 48 [18-83] years; 241 [67.7%] male; CTP A/163, B/172, C/21; MELD 11 [6-41]; decompensated 51.7%), 36 (10.1%) had RLS. RLS severity was mild (1), moderate (15), severe (19) or very severe (1). Compared to those without RLS, patient with RLS had a lower MELD score (9 [6-25] versus 11 [6-41], P = 0.04), and a comparable distribution of CTP classes and frequency of decompensated liver disease. The prevalence and severity of RLS were not different between those with compensated and those with decompensated cirrhosis. Conclusion: In the Indian population, RLS is common in patients with cirrhosis. Its occurrence did not show any increase with the severity of liver disease.


Assuntos
Cirrose Hepática/epidemiologia , Hepatopatias/epidemiologia , Síndrome das Pernas Inquietas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Cirrose Hepática/complicações , Hepatopatias/complicações , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome das Pernas Inquietas/complicações , Índice de Gravidade de Doença , Adulto Jovem
17.
Transplant Proc ; 51(6): 1939-1945, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303414

RESUMO

AIMS: Our aim was to review the rate of biliary duct stones (BDS) after liver transplantation (LT), risk factors, and treatments, and to identify predictive factors for their onset. METHODS: LTs performed in our center from 2004 to 2014 were studied. Risk factors for the onset of BDS were identified using univariable Cox's proportional hazards models. RESULTS: Three hundred and sixty-four grafts with 317 duct-to-duct end-to-end biliary anastomosis on a T-tube and 47 hepaticojejunal anastomosis (HJ) were analyzed. BDS were identified in 13 of 364 (3.5%) grafts, including 10 duct-to-duct end-to-end biliary anastomosis on a T-tube grafts (3.2%) and 3 HJ grafts (6.4%). Predictive factors for BDS were biliary strictures (hazard ratio [HR] 9.94; 95% confidence interval [95% CI] 3.25-30.4), bilirubin (HR 1.04; 95% CI 1.01-1.06, for 1 unit increase), Model for End-Stage Liver Disease score (HR 1.07; 95% CI 1.01-1.14, for 1 unit increase), surgery time (HR 1.04; 95% CI 1.01-1.08, for 10-minute increase), hepatocellular disease (HR 8.3; 95% CI 1.09-64.0), hepatic artery thrombosis (HR 6.71; 95% CI 1.47-30.6), and retransplantation (HR 3.69; 95% CI 1.02-13.43). Among 51 grafts (14%) with biliary strictures, female sex was identified as a risk factor for BDS (HR 5.19; 95% CI 1.29-20.98). Multimodality treatment of BDS was often successful but open surgery was still needed in 23% of them. One-, 5-, and 10-year graft survival was not influenced by the onset of BDS. CONCLUSION: Main predictive factor for BDS in liver grafts is biliary stricture. Recipient's age and body mass index failed to show any statistical importance. In grafts with biliary strictures, female sex is the main risk factor for BDS. In the absence of biliary strictures, hepatic artery thrombosis lead to an increase in the risk of BDS. Multimodality treatment of BDS is often successful. BDS do not influence outcome.


Assuntos
Ductos Biliares/cirurgia , Cálculos Biliares/etiologia , Jejuno/cirurgia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Anastomose Cirúrgica/efeitos adversos , Morte Encefálica , Colestase/complicações , Feminino , Cálculos Biliares/terapia , Sobrevivência de Enxerto , Humanos , Hepatopatias/complicações , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Diabetes Metab Syndr ; 13(3): 2208-2213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235158

RESUMO

AIMS: Glucose tolerance abnormalities are frequently observed in patients with chronic liver disease (CLD). Insulin resistance (IR) has been suggested to be a major factor responsible for these abnormalities in CLD. However studies relating IR with severity of CLD are scarce in Nigeria. This study assessed insulin resistance and glucose tolerance abnormalities in CLD and their relationship with the severity of CLD in a tertiary hospital in South-West, Nigeria. METHODS: This cross sectional study involved 100 subjects with CLD. Ethical clearance was obtained and informed consent was granted by participants. Participants were interviewed using a structured proforma; physical examination and relevant investigations were performed. Insulin resistance was measured using the homeostasis model assessment (HOMA-IR) Data was analysed using Statistical Package for Social Sciences version 20.0 and p value of <0.05 was considered significant. RESULTS: Mean age of the study participants was 51.9 ±â€¯11.9 years, and mean duration of CLD was 15.9 ±â€¯5.8 months. Glucose tolerance abnormalities were present in 66 subjects (66%) and increased from 16.1% in Child Pugh's class A to 90.0% in class C. HOMA-IR positively correlated with age, body mass index, serum blood glucose, duration and severity of CLD. Increasing age, presence of hepatocellular carcinoma, Child Pugh's class B and class C were associated with glucose tolerance abnormalities. CONCLUSION: Glucose tolerance abnormalities and insulin resistance were highly prevalent among chronic liver disease subjects studied and seemed to parallel the severity of CLD, determined by the Child Pugh's score.


Assuntos
Biomarcadores/sangue , Glicemia/análise , Intolerância à Glucose/sangue , Intolerância à Glucose/etiologia , Resistência à Insulina , Hepatopatias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Feminino , Seguimentos , Intolerância à Glucose/epidemiologia , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prognóstico , Fatores de Risco , Adulto Jovem
20.
Res Vet Sci ; 125: 136-140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31226571

RESUMO

Periodontal disease (PD) is one of the most frequent and widespread inflammatory diseases in dogs. The onset of PD pathogenesis is prompted by the dental microbial biofilm combined with the animal immune-inflammatory response. Along with local effects, systemic consequences can occur secondary to dental plaque-associated bacteraemia, affecting distant tissues and organs. The main goal of this retrospective study was to access and evaluate the association between PD and systemic consequences (renal, hepatic and cardiac) in a group of 136 dogs. Clinical records of all animals were assessed for general and systemic information, further analysed by general linear model and Odds-Ratio. Animals were organized in two groups, PD group and control group, formed by animals without PD. In this population, increasing age was proven to be a risk factor (OR = 1.04, p < .01) for PD establishment. Small breeds (<10 Kg) were the most prevalent in the PD group, being more susceptible to this disease. On the other hand, no influence of gender or reproductive status in PD progression was observed. Regarding systemic diseases, a statistically significant association (p = .026) was obtained between PD and cardiac disease. Results show that PD can have a significant adverse impact on animals' health, being related with systemic consequences, which may increase morbidity and mortality rates of these animals. PD prevention, with focus on owner's information about this disease and its management, are essential points for an active PD control program.


Assuntos
Doenças do Cão/epidemiologia , Cardiopatias/veterinária , Nefropatias/veterinária , Hepatopatias/veterinária , Doenças Periodontais/veterinária , Animais , Cães , Feminino , Cardiopatias/complicações , Cardiopatias/epidemiologia , Nefropatias/complicações , Nefropatias/epidemiologia , Hepatopatias/complicações , Hepatopatias/epidemiologia , Masculino , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Portugal/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
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