Alcohol use patterns and associated variables among the Karipuna indigenous people in the extreme Northern Brazilian Amazon.

The objective of this study was to identify the prevalence and patterns of alcohol consumption and associated factors in the Karipuna indigenous people. A cross-sectional population-based study was conducted with 230 Karipunan respondents aged 15 or over from 12 villages in the state of Amapá, in the extreme northern Brazilian Amazon. The participants completed the Alcohol Use Disorders Identification Test (AUDIT). The prevalence of alcohol use among the Karipuna was 70%. Of these, 59.6% had low-risk use, 38.3% had hazardous or harmful alcohol use, and 2.2% met criteria for probable alcohol dependence. Overall, 40.5% of the respondents had hazardous or harmful alcohol use; 66.6% were men, and 33.4% were women. In the regression analysis, age, sex, religion, not having an occupation, being a student, low educational attainment, suicidal ideation and having sexual intercourse after alcohol consumption were associated with hazardous or harmful alcohol use. Sex and Catholic religion were risk factors for this alcohol use pattern among the Karipuna. The prevalence of problematic alcohol use among the Karipuna is higher than that observed among the general Brazilian population, and preventive screenings should be widely implemented. Efforts to address and minimize the consequences of harmful and hazardous alcohol use among Brazilian Amazonian indigenous populations could be developed.

Hematological and serum biochemistry data on southern brown howler monkeys (Alouatta guariba clamitans) in captivity in Brazil.

BACKGROUND: Physiological values reflect the health condition and responses of individuals to handling in captivity. The aim of this study was to establish hematological and serum biochemistry parameters of clinically healthy animals of the Alouatta guariba clamitans subspecies. METHODS: We collected blood samples from adult males and females kept at the Center for Biological Research of Indaial after chemical containment with 3.9 mg/kg of tiletamine hydrochloride and zolazepam. RESULTS: Significant differences between males and females were found in the levels of erythrocytes, hemoglobin, hematocrit, lymphocytes, neutrophils, platelets, mean corpuscular hemoglobin concentration (MCHC), and gamma-glutamyltranspeptidase (GGT). CONCLUSIONS: Our results suggest the existence of sexual dimorphism in some physiological parameters of A guariba clamitans. The parameters reported herein can be used as reference values for other populations kept under similar conditions.

"KiDS and Diabetes in Schools" project: Experience with an international educational intervention among parents and school professionals.

BACKGROUND: Although it is known that school care is a major challenge in diabetes treatment, there is still no published international initiative. OBJECTIVES: The aims of this study were to introduce an international educational intervention tool, the International Diabetes Federation (IDF) KiDS and Diabetes in Schools project (KiDS project), and to describe its impact on diabetes knowledge and behavior of caregivers and school professionals. METHODS: The KiDS project was developed with the support of IDF and the International Society for Pediatric and Adolescent Diabetes and provides online free material in 10 languages, directed to caregivers and school personnel. A pilot evaluation of the KiDS intervention was performed in Brazil. An educational intervention was conducted in 5 primary schools, with 42 parents and school staff, followed by 2 individual interviews after 1 and 3 months. The results were evaluated in a qualitative study with a descriptive design based on content analysis. RESULTS: School staff acquired new knowledge on diabetes and its treatment. They felt more confident when helping students with diabetes and said the educational intervention promoted a positive impact on the teacher-student relationship, on the caring for health, and on school infrastructure. Family members of children with diabetes stated that the educational intervention gave them an opportunity to strengthen and update information on treatment and improve their knowledge. CONCLUSIONS: The KiDS project is the first international tool directed to foster a safe and supportive environment and a better understanding of diabetes in schools. In this pilot evaluation, it achieved the goal of informing and changing the behavior of parents and school staff, thus improving the care provided to children with diabetes in schools.

The Impact of Early Dermatologic Events in the Survival of Patients with Hepatocellular Carcinoma Treated with Sorafenib.

BACKGROUND AND AIMS: The presence of dermatologic reaction as an adverse event to sorafenib treatment in patients with unresectable hepatocellular carcinoma has been indicated as a prognostic factor for survival in a recent prospective analysis. To date, this is the only clinical predictor of treatment response, which can be evaluated earlier in the treatment and, therefore, contribute to a better and more individualized patient management. MATERIAL AND METHODS: This retrospective study included 127 patients treated with sorafenib under real-life practice conditions in two hepatology reference centers in Brazil. Demographic data, disease/medical history and time of sorafenib administration as well as adverse events related to the medication were recorded in a database. RESULTS: Cirrhosis was present in 94% of patients, 85.6% were Child-Pugh A, 80.3%BCLC-C, 81% had vascular invasion and/or extrahepatic spread and 95% had a performance status 0 to 1.The median duration of treatment was 10.1 months (range: 0.1-47 months).The most common adverse event within the first 60 days of treatment were diarrhea (62.2%) and dermatological reaction (42%).The median overall survival for the cohort was 20 months, and it was higher for patients who developed dermatological reactions within the first 60 days compared to those who did not present this adverse event. CONCLUSION: This retrospective analysis showed the use of sorafenib in patients selected according to BCLC staging, and it is the first external validation of early dermatologic adverse events as a predictor of overall survival in patients with advanced hepatocellular carcinoma.

Fibromax and inflamatory markers cannot replace liver biopsy in the evaluation of non-alcoholic fatty liver disease.

BACKGROUND: To evaluate the performance of a non-invasive test (Fibromax™, Ferring Pharmaceutical, Saint-Prex, Switzerland) and inflamatory markers (IL-1ß, IL-6, IL-8, TNF-α, MCP-1) in the diagnosis and staging of patients with non-alcoholic fatty liver disease. METHODS: Patients older than 18 years with steatosis were prospectively evaluated at a tertiary hospital in southern Brazil. Liver biopsy, Fibromax™ test and inflamatory markers (IL-1ß, IL-6, IL-8, TNF-α, MCP-1) were performed. Measures of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were used, considering liver biopsy as the gold standard. RESULTS: Seventy-three Fibromax™ tests were analyzed. SteatoTest presented a sensitivity of 95.5% and PPV of 97.0% for the diagnosis of steatosis. NashTest obtained a sensitivity of 83.3%, specificity of 37.5%, PPV of 90.9% and NPV of 23.1% for the diagnosis of non-alcoholic steatohepatitis (NASH). FibroTest presented a sensitivity of 38.9%, specificity of 92.7%, PPV of 63.6% and NPV of 82.3% to evaluate advanced fibrosis. In the evaluation of patients with grade 2 and 3 steatosis, ROC analyses showed an area under the curve (AUROC) for SteatoTest of 0.68 (P=0.015). NashTest AUROC was 0.59 (P=0.417) for the evaluation of NASH. FibroTest AUROC was 0.79 (P<0.001) for advanced fibrosis. Kappa coefficient values for SteatoTest, NashTest and FibroTest were not statistically significant. Thirty-seven patients performed also analysis of the inflamatory markers, showing that patients with inflammatory activity grade 2-3 on liver biopsy had significantly higher levels of IL6 (P=0.016) and lower TNF-α (P=0.034), but there was no other difference when analysed fibrosis or steatosis. CONCLUSIONS: The Fibromax™ test and the inflamatory markers (IL-1ß, IL-6, IL-8, TNF-α, MCP-1) did not present a satisfactory performance to be considered a good alternative to replace liver biopsy in the evaluation of non-alcoholic fatty liver disease.

RESULTS OF IMMUNOHISTOCHEMISTRY IN THE DIFFERENTIAL DIAGNOSIS OF EARLY HEPATOCELLULAR CARCINOMA AND NODULES WITH HIGH-GRADE DYSPLASIA IN PATIENTS WITH CIRRHOSIS.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver and cirrhosis is considered a pre-malignant disease. In this context, the evolutionary sequence from low grade dysplastic nodule and high grade dysplastic nodule (HGDN) to early HCC and advanced HCC has been studied. The differential diagnosis between HGDN and early HCC is still a challenge, especially in needle biopsies. OBJECTIVE: To evaluate an immunohistochemistry panel to differentiate dysplastic nodules and HCC. METHODS: Patients with cirrhosis who underwent surgical resection or liver transplantation were included. The sensitivity, specificity and accuracy for the diagnosis of neoplasia were analyzed by evaluating five markers: heat shock protein 70, glypican 3, glutamine synthetase, clathrin heavy chain and beta-catenin. P≤0.05 was considered statistically significant. RESULTS: One hundred and fifty-six nodules were included; of these, 57 were HCC, 14 HGDN, 18 low grade dysplastic nodules and 67 regenerative macronodules. Sensitivity of HCC diagnosis was 64.9% for glypican 3 and 77.2% for glutamine syntetase, while specificity was 96.0% and 96.0% respectively. When the panel of four markers was considered (excluding beta catenin), the specificity ranged from 87.9% for one positive marker to 100% for at least three markers. The best accuracy for HCC diagnosis was obtained with at least two positive markers, which was associated with a sensitivity of 82.5% and specificity of 99%. CONCLUSION: Differential diagnosis of dysplastic nodules and HCC by morphological criteria can be challenging. Immunomarkers are useful and should be used for the differential diagnosis between HCC and HGDN.

Percutaneous ethanol injection before liver transplantation in the hepatocellular carcinoma.

BACKGROUND/OBJECTIVES: The study evaluates the outcome of patients who performed orthotopic liver transplantation (LT) as treatment for hepatocellular carcinoma (HCC), with percutaneous ethanol injection (PEI) while on the waiting list, verifying the effectiveness of this treatment in producing tumor necrosis and avoiding dropout and identifying treatment-related complications. MATERIAL AND METHODS: Medical records of 97 patients on the waiting list for LT at Hospital Clinic of Barcelona were examined. Sixty-two (56.3%) patients had been treated with PEI (group 1); 35 (31.8%) had not received any anti-tumor therapy before LT (group 2). RESULTS: Complete necrosis of the tumor was observed in 38/59 (64.3%) patients. The presence of additional nodules in the explant and the diameter of the main tumor of group 1 was significantly lower than in group 2 (p = 0.002). Dropout related to tumor progression occurred in 4.8% and 8.5%, and tumor recurrence in 5% and 6.2% for groups 1 and 2, respectively. Major complications were not evidenced after 421 PEI sessions and there was no tumor implant in the needle traject. CONCLUSIONS: In conclusion, the percutaneous treatment of HCC with PEI is a safe and effective method before the LT.

Improving the school experience of children with diabetes: Evaluation of the KiDS project.

BACKGROUND: The International Diabetes Federation (IDF) launched the Kids and Diabetes in School (KiDS) project in collaboration with the International Society for Paediatric and Adolescent Diabetes (ISPAD) and Sanofi Diabetes to inform and teach school staff, children and parents on the management of diabetes in school. Brazil and India were chosen as pilot countries. METHODS: The evaluation was conducted using a qualitative methodology using semi-structured face to face in-depth interviews. Five out of fifteen schools were selected, where teachers and parents of children with and without diabetes were interviewed. Interviews took place one and three months after the implementation of KiDS. FINDINGS: Diabetes knowledge among the school staff and parents of children without diabetes was very limited prior to the KiDS Project in both countries. After introducing the KiDS information pack both groups mentioned increased knowledge on the management of diabetes. This was reflected through healthier food choices at school and the encouragement of physical activities. Increased awareness and understanding in the school staff were observed by parents of children with diabetes. INTERPRETATION: The KiDS project received positive feedback on the educational materials. The pack was deemed informative, interesting and engaging, creating increased awareness and understanding among school staff, parents and children. The project has created a demand for diabetes intervention in schools. The pack has been translated into fourteen languages and was downloaded over 17,000 times by November 2018.

Occult hepatitis B virus infection in patients with chronic liver disease due to hepatitis C virus and hepatocellular carcinoma in Brazil.

BACKGROUND: The prevalence and consequences of occult HBV infection in patients with chronic liver disease by HCV remain unknown. AIMS: To evaluate the prevalence of occult HBV infection in a population of HCV-infected patients with hepatocellular carcinoma. METHODS: The serum samples were tested for HBV DNA by nested PCR and liver tissue analysis was carried out using the immunohistochemical technique of 66 HBsAg-negative patients: 26 patients with chronic hepatitis by HCV (group 1), 20 with hepatocellular carcinoma related to chronic infection by HCV (group 2) and 20 with negative viral markers for hepatitis B and C (control group). RESULTS: Occult HBV infection was diagnosed in the liver tissue of 9/46 (19.5%) HCV-infected patients. Prevalence of occult B infection was evaluated in the HCV-infected patients with and without hepatocellular carcinoma, and there were seven (77.7%) of whom from group 2, conferring a 35% prevalence of this group. No serum sample was positive for HBV DNA in the three groups. CONCLUSION: Occult infection B is frequently detected in liver tissue of HCV-infected patients, especially in cases of hepatocellular carcinoma. However large studies are needed to confirm that co-infection could determine a worse progress of chronic liver disease in this population.

Sintomas ansiosos entre estudantes de uma universidade na fronteira franco-brasileiro / Anxious symptoms among students at a university on the French-Brazilian border / Síntomas de ansiedad entre estudiantes de una universidad en la frontera franco-brasileña

Objetivo: estimar a prevalência de sintomas ansiosos em estudantes de uma universidade na fronteira franco brasileira. Método: estudo transversal e descritivo realizado com 233 estudantes de uma universidade localizada na fronteira franco brasileira, através de questionários com questões fechadas e aspectos relacionados ao BAI. Resultados: predomínio de adultos jovens (82,4%) com idade entre 20 a 40 anos, sexo feminino (58,6%), solteiros (51,9%), evangélicos (39,9%), realizam atividades curriculares em concomitância as remuneradas (59,7%). Inventário de Beck apontou, ansiedade mínima (67,2%), ansiedade leve (15,5%), ansiedade moderada (12,9%) e ansiedade severa (4,3%). Conclusão: os dados demonstram baixa prevalência de sintomas de ansiedade severa entre os estudantes, contudo considera imprescindível o cuidado e medidas preventivas que retardem ou impossibilitem o adoecimento mental dentre o público investigado

Objective: to estimate the prevalence of anxiety symptoms among students at a university on the Brazilian franc border. Method:cross-sectional and descriptive study carried out with 233 students from a university located on the Brazilian franc border, through questionnaires with closed questions and aspects related to the Beck Anxiety Inventory. Results: predominance of young adults (82.4%) aged between 20 and 40 years old, female (58.6%), single (51.9%), evangelical (39.9%), carry out curricular activities concomitantly paid women (59.7%). Beck's inventory pointed to minimal anxiety (67.2%), mild anxiety (15.5%), moderate anxiety (12.9%) and severe anxiety (4.3%). Conclusion: the data show a low prevalence of symptoms of severe anxiety among students, however, it is essential to take care and preventive measures that slow or prevent mental illness among the investigated public

Objetivo: estimar la prevalencia de los síntomas de ansiedad entre los estudiantes de una universidad en la frontera del franco brasileño. Método: estudio transversal y descriptivo realizado con 233 estudiantes de una universidad ubicada en la frontera brasileña francesa, utilizando cuestionarios con preguntas cerradas y aspectos relacionados con el Inventario de ansiedad de Beck. Resultados: predominio de adultos jóvenes (82.4%) con edades entre 20 y 40 años, mujeres (58.6%), solteros (51.9%), evangélicos (39.9%), realizan actividades curriculares concomitantemente mujeres remuneradas (59,7%). El inventario de Beck señaló ansiedad mínima (67.2%), ansiedad leve (15.5%), ansiedad moderada (12.9%) y ansiedad severa (4.3%). Conclusión: los datos muestran una baja prevalencia de síntomas de ansiedad severa entre los estudiantes, sin embargo, es esencial tener cuidado y tomar medidas preventivas que retrasen o prevengan las enfermedades mentales entre el público investigado

Fatores associados ao uso nocivo de drogas em motoristas "pirateiros" / Factors associated with harmful drug use in "pirate" drivers / Factores asociados con el uso nocivo de drogas en conductores "pirata"

Objetivo: verificar os fatores associados ao uso nocivo de drogas entre os motoristas de transportes alternativos. Método: trata-se de um estudo quantitativo, descritivo, realizado com 40 "pirateiros". Os dados foram coletados por meio de um questionário e o Alcohol, Smoking and Substance Test (ASSIST). Na análise estatística, inicialmente, empregou-se as tabelas de frequência simples no sentido de caracterizar a amostra. Utilizou-se, no segundo momento, o teste qui-quadrado de Pearson, com nível de significância de 5%, para teste de associação. Resultados: verificou-se associação nas variáveis: uso de tabaco com estado civil (p=0,022); anfetamina com idade (p=0,002); álcool com estado civil (p-valor=0,013). Conclusão: conclui-se que deve haver medidas de prevenção e promoção da saúde entre os motoristas, haja vista que estes profissionais estão diariamente exercendo atividades laborais, destacando a necessidade de políticas públicas locais.(AU)

Objective: to verify the factors associated with harmful drug use among alternative transportation drivers. Method: this is a quantitative, descriptive study, carried out with 40 "pirates". The data were collected through a questionnaire and the Alcohol, Smoking and Substance Test (ASSIST). In the statistical analysis, simple frequency tables were initially used to characterize the sample. At the second moment, the chi-square test of Pearson was used, with a significance level of 5%, for the association test. Results: the following variables were associated: tobacco use with marital status (p=0.022); amphetamine with age (p=0.002); alcohol with marital status (p-value=0.013). Conclusion: it is concluded that there should be prevention and health promotion measures among drivers, since these professionals are performing daily work activities, highlighting the need for local public policies.(AU)

Objetivo: verificar los factores asociados al consumo de drogas nocivas entre los conductores de transporte alternativo. Método: se trata de un estudio cuantitativo, descriptivo, realizado con 40 "piratas". Los datos fueron recolectados a través de un cuestionario y el Alcohol, Smoking and Substance Test (ASSIST). En el análisis estadístico, inicialmente, se empleó las tablas de frecuencias simples en orden para caracterizar la muestra. Se utilizó en el segundo paso la prueba de chi-cuadrado de Pearson, con un nivel de significancia del 5%, para la prueba de asociación. Resultados: hubo asociación en las variables: consumo de tabaco con estado civil (p = 0,022); anfetamina con la edad (p = 0,002); alcohol con el estado civil (p-valor = 0,013). Conclusión: se concluye que deben existir medidas de prevención y promoción de la salud entre los conductores, dado que estos profesionales están realizando diariamente actividades laborales, destacando la necesidad de políticas públicas locales.(AU)

Binge drinking e fatores associados em indígenas da etnia Karipuna / Binge drinking and associated factors in indigenous people from Karipuna / Binge drinking y factores asociados en indígenas de la etnia Karipuna

OBJETIVO: identificar a prevalência do uso em binge em indígenas Karipuna e verificar a associação desse uso com variáveis sociodemográficas, clínicas e comportamentais da amostra. MÉTODO: trata-se de um estudo transversal realizado com 230 indígenas de 12 aldeias Karipuna em Oiapoque. Obteve-se o rastreio do uso em binge por meio da Questão-Chave. Coletaram-se os dados entre maio e dezembro de 2017. Realizaram-se, a priori, a análise de frequência das variáveis envolvidas no estudo e, na sequência, o teste qui-quadrado e o modelo de regressão logística. RESULTADOS: revela-se que a prevalência do uso em binge foi de 24,8% de uma a três vezes; de 20,4% de quatro a seis vezes; de 12,2% de sete a dez vezes e de 9,6% em mais de dez vezes. Associaram-se os seguintes fatores: estudante (OR=2,99); migração da aldeia de origem (OR=2,22); uso de preservativo (OR=2,62) e relações sexuais após o consumo de álcool (OR=1,61). CONCLUSÃO: alerta-se que o uso ocasional de risco de álcool demanda consideração, bem como o conhecimento das particularidades da população ora investigada, a fim de estabelecer controle, planejamento de recursos terapêuticos para que se alcancem resultados efetivos nas ações planejadas e principalmente nas que são adotadas na prática a fim de prevenir um uso abusivo de álcool.

OBJECTIVE: to identify the prevalence of use in binge in indigenous Karipuna and to verify the association of this use with sociodemographic, clinical and behavioral variables of the sample. METHOD: this is a cross-sectional study carried out with 230 indigenous people from 12 Karipuna villages in Oiapoque. Binge use screening was obtained through the Key Question. Data was collected between May and December 2017. A priori, the frequency analysis of the variables involved in the study was carried out, following the chi-square test and logistic regression model. RESULTS: it is revealed that the prevalence of use in binge was 24.8% from one to three times; 20.4% four to six times; 12.2% seven to ten times and 9.6% more than ten times. The following factors were associated: student (OR = 2.99); migration from the village of origin (OR = 2.22); condom use (OR = 2.62) and sexual intercourse after alcohol consumption (OR = 1.61). CONCLUSION: it is warned that the occasional use of alcohol risk demands consideration, as well as knowledge of the particularities of the population now investigated, in order to establish control, planning of therapeutic resources so that effective results are achieved in the planned actions and especially in those that are adopted in practice in order to prevent alcohol abuse.

OBJETIVO: identificar la prevalencia del uso de binge en indígenas Karipuna y verificar la asociación de este uso con las variables sociodemográficas, clínicas y comportamentales de la muestra. MÉTODO: se trata de un estudio transversal realizado con 230 indígenas de 12 aldeas Karipuna en Oiapoque. Se obtuvo el rastreo del uso de binge por medio de la pregunta clave. Se recogieron los datos entre los meses de mayo y diciembre de 2017. Se realizaron, a priori, el análisis de la frecuencia de las variables del estudio y a continuación se realizó el test chi-cuadrado y el modelo de regresión logístico. RESULTADOS: se revela que la prevalencia del uso de binge fue de 24,8% de una a tres veces; de 20,4% de cuatro a seis veces; de 12,2% de siete a diez veces y de 9,6% en más de diez veces. Se asociaron los siguientes factores: estudiante (OR=2,99); migración de la aldea de origen (OR=2,22); uso de preservativo (OR=2,62) y relaciones sexuales después de consumo de alcohol (OR=1,61). CONCLUSIÓN: se advierte que el uso ocasional de riesgo de alcohol demanda atención, así como tomar conocimiento de las particularidades de la población que está siendo investigada, con la finalidad de establecer control y planificar recursos terapéuticos, para que sean alcanzados resultados efectivos, en las acciones planificadas y, principalmente, en aquellas que son adoptadas en la práctica, con la finalidad de prevenir el uso abusivo del alcohol.

Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study.

AIM: To determine the incidence of hepatocellular carcinoma (HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients. METHODS: In this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis. RESULTS: Four hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients (16.6%), with an estimated cumulative incidence of 2.6% in the 1st year, 15.4% in the 5th year, and 28.8% in the 10th year. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients (P < 0.001). Early-stage HCC was more often detected in patients who underwent surveillance every 6 mo or less (P = 0.05). However, survival was not different between patients with early stage vs non-early stage tumors [HR = 0.54 (0.15-1.89), P = 0.33]. CONCLUSION: HCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.

Papel da imunohistoquímica no diagnóstico diferencial do carcinoma hepatocelular precoce e dos nódulos com displasia de alto grau em pacientes com cirrose / Results of immunohistochemistry in the differential diagnosis of early hepatocellular carcinoma and nodules with high-grade dysplasia in patients with cirrhosis

ABSTRACT BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver and cirrhosis is considered a pre-malignant disease. In this context, the evolutionary sequence from low grade dysplastic nodule and high grade dysplastic nodule (HGDN) to early HCC and advanced HCC has been studied. The differential diagnosis between HGDN and early HCC is still a challenge, especially in needle biopsies OBJECTIVE: To evaluate an immunohistochemistry panel to differentiate dysplastic nodules and HCC. METHODS: Patients with cirrhosis who underwent surgical resection or liver transplantation were included. The sensitivity, specificity and accuracy for the diagnosis of neoplasia were analyzed by evaluating five markers: heat shock protein 70, glypican 3, glutamine synthetase, clathrin heavy chain and beta-catenin. P≤0.05 was considered statistically significant. RESULTS: One hundred and fifty-six nodules were included; of these, 57 were HCC, 14 HGDN, 18 low grade dysplastic nodules and 67 regenerative macronodules. Sensitivity of HCC diagnosis was 64.9% for glypican 3 and 77.2% for glutamine syntetase, while specificity was 96.0% and 96.0% respectively. When the panel of four markers was considered (excluding beta catenin), the specificity ranged from 87.9% for one positive marker to 100% for at least three markers. The best accuracy for HCC diagnosis was obtained with at least two positive markers, which was associated with a sensitivity of 82.5% and specificity of 99%. CONCLUSION: Differential diagnosis of dysplastic nodules and HCC by morphological criteria can be challenging. Immunomarkers are useful and should be used for the differential diagnosis between HCC and HGDN.

RESUMO CONTEXTO: O carcinoma hepatocelular (CHC) é o câncer primário do fígado mais frequente e a cirrose é considerada uma doença pré-maligna. Nesse contexto, a sequência evolutiva do nódulo displásico de baixo grau e nódulo displásico de alto grau (NDAG) para CHC precoce e CHC avançado tem sido estudada. O diagnóstico diferencial entre NDAG e CHC precoce ainda é um desafio, principalmente em biópsias por agulha. OBJETIVO: Avaliar um painel de imunohistoquímica para diferenciar nódulos displásicos de CHC. MÉTODOS: Foram incluídos pacientes com cirrose submetidos à ressecção cirúrgica ou transplante de fígado. A sensibilidade, especificidade e acurácia para o diagnóstico da neoplasia foram analisadas avaliando cinco marcadores: proteína de choque térmico 70kDa, glipican 3, glutamina sintetase, clatrina de cadeia pesada e beta-catenina. P≤0,05 foi considerado estatisticamente significativo. RESULTADOS: Cento e cinquenta e seis nódulos foram incluídos; destes, 57 eram CHC, 14 NDAG, 18 nódulos displásicos de baixo grau e 67 macronódulos regenerativos. A sensibilidade do diagnóstico de CHC foi de 64,9% para glipican 3 e 77,2% para glutamina sintetase, enquanto a especificidade foi de 96,0% e 96,0%, respectivamente. Quando o painel de quatro marcadores foi considerado (excluindo beta catenina), a especificidade variou de 87,9% para um marcador positivo a 100% para pelo menos três marcadores. A melhor acurácia para o diagnóstico de CHC foi obtida com pelo menos dois marcadores positivos, o que foi associado a uma sensibilidade de 82,5% e especificidade de 99%. CONCLUSÃO: O diagnóstico diferencial de nódulos displásicos e CHC por critérios morfológicos pode ser desafiador. Imunomarcadores são úteis e devem ser usados para o diagnóstico diferencial entre CHC e NDAG.

Consumo de bebidas alcoólicas e prática do binge drinking entre cabeleireiros / Consumption of alcoholic beverages and practice of binge drinking among hairdressers

RESUMO Objetivo verificar o consumo de bebidas alcóolicas e a prática do binge drinking entre os cabeleireiros. Métodos estudo transversal realizado com 51 profissionais de salões de beleza. Utilizou-se de um questionário com características sociodemográficas e sobre as práticas do consumo de bebidas alcoólicas. Para a identificação do uso em binge drinking, pautou-se a questão-chave. Realizou-se a análise estatística descritiva e inferencial. Resultados 84,3% eram consumidores de álcool, 51,0% tinham de um a dez anos de consumo e 72,5% consumiam a cerveja. Em relação ao uso em binge, 37,3% da amostra faziam uso ocasional de risco, pelo menos, uma vez ao mês. Os maiores índices de binge drinking estavam relacionados ao gênero masculino, aos solteiros e jovens e a religião evangélica foi associada a um menor ou nenhum consumo de bebidas alcoólicas. Conclusão os dados apontaram o consumo alcoólico e o uso em binge frequente relacionados à provável dependência alcoólica.

ABSTRACT Objective to verify the consumption of alcoholic beverages and the practice of binge drinking among hairdressers. Methods cross-sectional study conducted with 51 beauty salon professionals. We used a questionnaire with socio-demographic characteristics and about the practices of consumption of alcoholic beverages. For the identification of the use in binge drinking, the key question was guided. Descriptive and inferential statistical analysis was performed. Results 84.3% were alcohol consumers, 51.0% had between one and ten years of consumption and 72.5% consumed beer. In relation to the use in binging, 37.3% of the sample made occasional use of risk, at least once a month. The highest rates of binge drinking were related to male gender, single and young and the evangelical religion was associated with a lower or no consumption of alcoholic beverages. Conclusion the data pointed to alcohol consumption and frequent binge use related to likely alcohol dependence.

Padrão do consumo de álcool entre mototaxistas / Pattern of alcohol consumption among motorcycle taxi drivers

RESUMO Objetivo identificar os fatores associados ao padrão de consumo de álcool entre mototaxistas. Métodos estudo transversal, realizado com 68 profissionais mototaxistas. Utilizou-se de questionário sociodemográfico, aspectos relacionados ao trabalho, acidentes de trânsito e do Alcohol Use Disorders Identification, para padrão do uso de álcool. Adotaram-se o teste de associação do qui-quadrado e exato de Fisher para análise de dados e regressão logística. Resultados verificou-se que 48,5% consumiam bebidas alcoólicas, 75,0% apresentaram consumo de baixo risco, 16,2% de risco, 7,4% de uso nocivo e 1,5% possível dependência. As variáveis que obtiveram significância foram naturalidade, uso de bebidas alcoólicas e quantidade de doses bebidas no dia. Conclusão observou-se tendência entre a naturalidade e o consumo de risco. Ademais, fazer uso de bebida alcoólica mensalmente e a quantidade de doses maior do que cinco doses, no mesmo dia, aumentaram 20 vezes e 10,0% a mais a chance de desencadear o consumo problemático de álcool.

ABSTRACT Objective to identify the factors associated with the pattern of alcohol consumption among motorcycle taxi drivers. Methods cross-sectional study, carried out with 68 motorcycle taxi professionals. A socio-demographic questionnaire, work-related aspects, traffic accidents and the Alcohol Use Disorders Identification were used, for the pattern of alcohol use. The Chi-square and Fisher's exact association tests were used for data analysis and logistic regression. Results it was found that 48.5% consumed alcoholic beverages, 75.0% had low risk consumption, 16.2% risk, 7.4% harmful use and 1.5% possible dependence. The variables that obtained significance were naturalness, use of alcoholic beverages and quantity of drinks drunk in the day. Conclusion there was a trend between naturalness and risky consumption. In addition, using alcoholic beverages monthly and the amount of doses greater than five doses, on the same day, increased 20 times and 10.0% more the chance of triggering problematic alcohol consumption.

Noninvasive imaging assessment of non-alcoholic fatty liver disease: focus on liver scintigraphy.

Noninvasive diagnoses of nonalcoholic fatty-liver disease (NAFLD) involve the use of serologic markers and imaging methods, such as conventional ultrasonography (US), computed tomography, and magnetic resonance imaging. Although these methods are reliable for the noninvasive detection of moderate to severe fatty changes in the liver, they are not reliable for detecting nonalcoholic steatohepatitis (NASH) and fibrosis. New imaging technologies, such as US-based transient elastography, acoustic radiation force impulse and magnetic resonance-based elastography, can reportedly be used to determine the severity of liver fibrosis associated with NASH. In this context, the field of nuclear medicine through liver scintigraphy has recently been proposed, and is being explored for use in the diagnosis of NASH. More importantly, nuclear medicine may contribute to the distinction between simple steatosis and NASH. For example, the enhanced release of cytokines and the decrease in the phagocytic activity of Kupffer cells play important roles in the pathogenesis of NASH. Removal of technetium-99m colloid from circulation by Kupffer cell phagocytosis therefore provides a valuable imaging technique. Thus, nuclear medicine is poised to provide useful tools for the evaluation of patients with NAFLD. However, the evidence is still scarce, and more studies with larger samples are needed to identify their role before they are used in clinical practice.

Síndrome de Burnout entre trabalhadores de uma universidade na fronteira franco brasileira / Síndrome de Burnout entre trabajadores de una universidad en la frontera franca brasileña / Burnout syndrome among university workers at the brazilian free frontier

Objetivo: estimar a prevalência da Síndrome de Burnout entre trabalhadores de uma universidade na fronteira franco brasileira e verificar os fatores associados. Método: estudo transversal e descritivo realizado com 53 trabalhadores de uma universidade localizada na fronteira franco brasileira, através de formulários eletrônicos (google docs). Resultados: predomínio do sexo masculino (56,6%), faixa etária de 30 a 39 anos (64,2%), solteiros (47,2%), se declaram pardos (49,1%), especialistas (34%) e sem filhos (75,5%). Destes, 26,4% indivíduos tem a possibilidade de desenvolver a síndrome, 37,8% estão em fase inicial da síndrome, 22,6% a síndrome começa a se instalar e 13,2% estar em uma fase considerável da síndrome, tendo como preditor a variável sexo (p=0,01). Conclusão: nenhum dos entrevistados pontuou na categoria (nenhum indício de Burnout), o que torna preocupante as condições de trabalhos que estão submetidos, sendo imperativo medidas preventivas que retardem ou impossibilitem o adoecimento mental dentre a população investigada

Objective: to estimate the prevalence of Burnout Syndrome among university workers at the Brazilian Free Frontier and to verify the associated factors. Method: a cross - sectional and descriptive study carried out with 53 workers from a university located on the Brazilian - Brazilian border, using electronic forms (google docs). Results: male (56.6%), 30 to 39 years old (64.2%), single (47.2%), brown (49.1%), specialists (34%) and without children (75.5%). Of these, 26,4% individuals have the possibility to develop the syndrome, 37,8% are in the initial phase of the syndrome, 22,6% the syndrome begins to settle and 13,2% are in a considerable phase of the syndrome, having as predictor the gender variable (p = 0.01). Conclusion: none of the interviewees scored in the category (no evidence of Burnout), which makes the conditions of work that are submitted worrisome, being imperative preventive measures that delay or prevent mental illness among the population investigated

Objetivo: estimar la prevalencia del Síndrome de Burnout entre trabajadores de una universidad en la frontera franca brasileña y verificar los factores asociados. Método: estudio transversal y descriptivo realizado con 53 trabajadores de una universidad ubicada en la frontera franca brasileña, a través de formularios electrónicos (google docs). Resultados: predominio del sexo masculino (56,6%), grupo de edad de 30 a 39 años (64,2%), solteros (47,2%), se declaran pardos (49,1%), especialistas (34%), y sin hijos (75,5%). De estos, 26,4% individuos tienen la posibilidad de desarrollar la síndrome, 37,8% están en fase inicial del síndrome, 22,6% a síndrome comienza a instalarse y 13,2% estar en una fase considerable de la síndrome, teniendo como predictor la variable sexo (p = 0,01). Conclusión: ninguno de los entrevistados puntuó en la categoría (ningún indicio de Burnout), lo que hace preocupante las condiciones de trabajos que están sometidos, siendo imperativo medidas preventivas que retarden o imposibiliten el enfermo mental entre la población investigada

Intervenções breves junto a utentes da atenção primária em uso de risco e nocivo de álcool / Intervenciones breves con pacientes de atención primaria en uso de riesgo y nocivo de alcohol / Brief interventions for primary care users on risky and harmful use of alcohol

RESUMO Objetivo: avaliar o efeito das intervenções breves na redução do consumo de álcool em utentes de uma Unidade de Saúde Familiar. Método: estudo pré-experimental, avaliação antes e depois (quatro meses) de 205 utentes (grupo único). Utilizou-se o Alcohol Use Disorders Identification Test (AUDIT). A coleta ocorreu em Coimbra, Portugal, nos meses de maio/junho e setembro/outubro de 2019. Utilizou-se o teste Wilcoxon para avaliação dos efeitos das intervenções. Resultados: na primeira avaliação, 189 (92,2%) encontravam-se na zona I; 15 (7,3%) na zona II e 1 (0,5%) na zona IV. No seguimento, quatro meses após as intervenções com os 15 utentes que pontuaram zona 2, teve-se perda da amostra de 5, demonstrando que 10 (60%) pontuaram zona I, 3 (30%) zona II e 1 (10%) zona III. Conclusão: as intervenções breves são recursos efetivos na detecção precoce do consumo de álcool, sendo necessários à disseminação nos cuidados primários à saúde.

RESUMEN: Objetivo: Evaluar el efecto de intervenciones breves en la reducción de ingesta alcohólica de usuarios de una Unidad de Salud Familiar. Método: Estudio preexperimental, evaluación antes y después (cuatro meses) de 205 usuarios (grupo único). Se utilizó Alcohol Use Disorders Identification Test (AUDIT). Datos recolectados en Coímbra, Portugal, en mayo/junio y setiembre/octubre de 2019. Se aplicó test Wilcoxon para evaluar el efecto de las intervenciones. Resultados: En la primera evaluación, 189 (92,2%) estaba en zona I; 15 (7,3%) en zona II y 1 (0,5%) en zona IV. En el seguimiento, cuatro meses después de las intervenciones con los 15 usuarios de zona II, se observó pérdida de la muestra de 5, expresando que 10 (60%) puntuaron como zona I, 3 (30%) zona II; y 1 (10%), zona III. Conclusión: Las intervenciones breves constituyen recursos efectivos para detección precoz del consumo alcohólico, siendo necesaria su diseminación en atención primaria de salud.

ABSTRACT Objective: to evaluate the effect of brief interventions in decreasing alcohol use in users of a Family Health Unit. Method: a pre-experimental study, before and after evaluation (four months) of 205 users (single group). The Alcohol Use Disorders Identification Test (AUDIT) was used. Data collection took place in Coimbra, Portugal, in May/June and September/October 2019. The Wilcoxon test was used to assess the effects of the interventions. Results: in the first assessment, 189 (92.2%) were in zone I; 15 (7.3%) in zone II and 1 (0.5%) in zone IV. In the follow-up, four months after the interventions with the 15 users who scored zone 2, there was a sample loss of 5, showing that 10 (60%) scored zone I, 3 (30%) zone II and 1 (10%) zone III. Conclusion: brief interventions are effective resources in the early detection of alcohol use, which are necessary for dissemination in primary health care.

Percepção dos familiares de pessoas com esquizofrenia: análise lexicográfica através do IRAMUTEQ / Perception of schizophrenic´s relatives: lexicographic analysis through IRAMUTEQ / Percepción de los familiares de personas con esquizofrenia: análisis lexicográfico a través del IRAMUTEQ

Objetivo: Conhecer através da lexicografia gráfica, o vocabulário mais frequente por meio da percepção dos familiares de pessoas com esquizofrenia. Método: Estudo descritivo de abordagem qualitativa, desenvolvido com cinco familiares de um município do extremo norte brasileiro, na região da fronteira franco-brasileira. Os dados foram obtidos por meio de entrevista individual, processados no software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ) e analisados a nuvem de palavras, Classificação Hierárquica Descendente, através do dendograma e Análise Fatorial de Correspondência. Resultados: A palavra mais comum foi "não", no qual desmontou o sentido de negatividade da doença, o que demonstra uma rejeição por parte do familiar. Conclusão: A partir disso, percebeu-se que o IRAMUTEQ é uma ferramenta valiosa na busca deste vocabulário e a partir disso o conhecimento da percepção dos envolvidos neste estudo, sendo rodeadas de sentimentos de desvalia e fatores nos quais dificultam o convívio familiar, pois, há dificuldade em associar e entender os comportamentos resultantes da doença (AU)

Objective: To know through graphic lexicography, the most frequent vocabulary by of the perception of relatives of people with schizophrenia. Method: Descriptive study of a qualitative approach, developed with five family members of a municipality in the extreme north of Brazil, in the Franco-Brazilian border region. The data were obtained through individual interview, processed in the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires IRAMUTEQ software and analyzed the word cloud, Descending Hierarchical Classification, through the dendogram and Correspondence Factor Analysis. Results: The most common word was "no", in which it dismantled the sense of negativity of the disease, which demonstrates a rejection on the part of the familiar. Conclusion: Based on this, IRAMUTEQ was found to be a valuable tool in the search for this vocabulary and from this the knowledge of the perception of those involved in this study, being surrounded by feelings of devaluation and factors in which family life is difficult, there is difficulty in associating and understanding the behaviors resulting from the disease (AU)

Objetivo: Conocer a través de la lexicografía gráfica, el vocabulario más frecuente por meio de la percepción de los familiares de personas con esquizofrenia. Método: Estudio descriptivo de abordaje cualitativo, desarrollado con cinco familiares de un municipio del extremo norte brasileño, en la región de la frontera franco-brasileña. Los datos fueron obtenidos por medio de una entrevista individual, procesados en el software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ) y analizados la nube de palabras, Clasificación Jerárquica Descendente, a través del dendograma y Análisis Factorial de Correspondencia. Resultados: La palabra más común fue "no", en el cual desmontó el sentido de negatividad de la enfermedad, lo que demuestra un rechazo por parte del familiar. Conclusión: A partir de eso, se percibió que el IRAMUTEQ es una herramienta valiosa en la búsqueda de este vocabulario ya partir de ello el conocimiento de la percepción de los involucrados en este estudio, estando rodeadas de sentimientos de desvalorización y factores en los que dificultan la convivencia familiar, hay dificultad en asociar y entender los comportamientos resultantes de la enfermedad (AU)