Introdução: A Síndrome do Intestino Irritável (SII) é uma condição de alta prevalência e com um efeito significativo na qualidade de vida da população. É de etiologia multifatorial, incluindo alterações no eixo cérebro-intestino e na motilidade intestinal, porém, ainda não foi completamente elucidada. Dados recentes apontam sobre uma relação importante da disbiose intestinal na patogênese da SII. O transplante de microbiota fecal (TMF) tem a condição de reestabelecer a homeostase intestinal. Objetivos: Este trabalho objetiva a revisão de publicações científicas que associam o uso do TMF no tratamento da SII, para a posterior análise de sua eficácia terapêutica. Metodologia: A busca literária foi realizada no acervo MEDLINE, através do PubMed, onde angariamos 120 artigos. Através de critérios de inclusão e exclusão sobraram 9 publicações que foram analisados. Resultados: A partir da analise dos estudos, um total de 91 pacientes foram avaliados. O tratamento revelou melhora sintomática em 85.71% dos casos. As diferenças ente os 9 estudos inclusos devem ser levadas em consideração. Não houve homogeneidade entre modelos, vias e uso do antibiótico pré-TMF. Conclusão: O TMF se mostrou eficaz no tratamento da SII, porém são necessários estudos clínicos com maior impacto científico para concretizar esta nova modalidade terapêutica.
Introdução: A Síndrome LPAC (Low-phospholipid-associated cholelithiasis syndrome) é uma forma rara de colelitíase intra-hepática, associada ao defeito na secreção canalicular de fosfolipídios para a bile. Faz parte do espectro de doenças hepáticas associadas a deficiências do ABCB4/ MDR3 e é caracterizada por eventos recorrentes de cólica biliar, colangite aguda ou pancreatite em pacientes após a colecistectomia. Objetivo: Relatar um caso suspeito de LPAC de forma a expandir o conhecimento da doença. Relato de Caso: Paciente feminino, 39 anos, procurou atendimento por quadro de dor em região de hipocôndrio direito comirradiação para dorso, associada a náuseas e vômitos há dois dias. Relatou primeiro episódio de pancreatite aguda em 2019, com seis episódios subsequentes, sendo o últimoem abril de 2020 quando foi submetida à colecistectomia videolaparoscópica durante a internação. Desde então, referiu outros três episódios. Alterações laboratoriais incluíamaumento significativo de lipase. Baseado nos critérios clínicos e laboratoriais, estabeleceu-se diagnóstico de pancreatite aguda e por critérios clínicos suspeita-se do diagnóstico deLPAC. Conclusão: A síndrome LPAC, apesar de pouco documentada na literatura, deve ser lembrada como hipótese diagnóstica em casos de cólica biliar e pancreatite de origem biliar, que recorrem mesmo após a colecistectomia ou se manifestam em pacientes jovens sem fatores de risco clássicos para tais doenças.Palavras chave: Colestase, Ácido ursodesoxicólico, Colelitíase ABSTRACTIntroduction: Low-phospholipid-associated cholelithiasis syndrome (LPAC) is a rare form of intrahepatic lithiasis linked to a defect of phospholipid canalicular secretion intobile. It is part of the spectrum of liver diseases associated with ABCB4/MDR3 deficiencies and is characterized by recurrent events of biliary colic, acute cholangitis, or pancreatitis in patients after cholecystectomy. Objectives: To report a suspected case of LPAC to expand the knowledge of this pathology. Case report: Patient, female, 39 years old, sought medical attention with pain on the right hypochondrium associated with nausea and vomit that initiated two days ago. The patient reported the first episode of acute pancreatitis in 2019 and six more episodes afterward. In the last episode, on April 2020, cholecystectomy was performed during hospitalization. Three more episodes of acute pancreatitis occurred since then. Elevated lipase levels appeared on laboratory evaluation. Therefore, the diagnosis of acute pancreatitis was made based on clinical and laboratory signs and the diagnosis of LPAC was suspected based on clinical signs. Conclusion: Althought there is few articles about LPAC syndrome it must be reminded as a differential diagnosis in cases of recurrence of biliary pain, acute pancreatitis after cholecystectomy, and when these events occur in young patients with no classic risk factors for such diseases.Keywords: Cholestasis, Ursodeoxycholic acid, Cholelithiasis
Introdução: A cirrose hepática é uma doença crônica que cursa com diversas repercussões sistêmicas, uma delas é a disfunção cardiovascular, caracterizada pela queda da resistência vascular periférica e pelo aumento compensatório do débito cardíaco. Tal disfunção manifesta-se principalmente em situações de estresse hemodinâmico, estando muitas vezes normal no repouso. Objetivo: Avaliar a aplicabilidade do Teste de Caminhada de 6 minutos (TC6min) como instrumento sugestivo de disfunção cardiovascular nos pacientes cirróticos, através da correlação entre o desempenho no teste e o status funcional do paciente. Material e Métodos: Trata-se de estudo observacional e transversal do tipo inquérito, realizado em vinte e nove pacientes cirróticos, submetidos ao TC6min. Foram avaliados a distância percorrida por eles e parâmetros clínicos antes e após o teste, sendo o resultado comparado de acordo com sua classificação funcional. Resultados: Dentre os pacientes classe A de Child-Pugh, 6 deles (26,09% do total dessa classe) não atingiram a distância mínima prevista para o TC6min. Ao se analisar a classe B de Child-Pugh, 5 deles (83,33% do total dessa classe) não atingiram a distância mínima. A média da distância percorrida para pacientes Child A foi de 631,5 m, enquanto o previsto foi de 587,2 m. Em relação aos pacientes Child B, a média da distância percorrida foi de 441,0 m, com distância prevista de 541,2m. Foi observada uma significativa correlação inversa entre a distância percorrida e o escore de Child-Pugh (p=0,001). Conclusão: A distância percorrida no teste de caminhada de 6 minutos apresentou correlação inversa com a classificação de Child-Pugh-Turcotte o que demonstra um prejuízo funcional paralelo à piora da doença hepática de base. Ao considerar que os pacientes do estudo não apresentavam comorbidades previamente diagnosticadas que pudessem justificar tal prejuízo, essa associação pode indicar disfunção cardiovascular. Esta, por sua vez, provavelmente está relacionada ao comprometimento sistêmico secundário à cirrose hepática.Descritores: Doenças cardiovasculares, Cardiomiopatias, Cirrose hepática. Triagem, Teste de caminhadaAbstractIntroduction: Hepatic cirrhosis is a chronic disease that has several systemic repercussions. One of them is the cardiovascular dysfunction, characterized by the decrease of the peripheral vascular resistance and the compensatory increase of the cardiac output. Such dysfunction manifests itself mainly in situations of hemodynamic stress, and is often normal at rest. Objective: To evaluate the applicability of the 6-minute walk test (6MinWT) as an instrument suggestive of cardiovascular dysfunction in cirrhotic patients, through correlation between the test performance and the functional status of the patient. Methods: This is an observational and cross-sectional study of the survey type, performed in twenty-nine cirrhotic patients submitted to 6MinWT. The distance walked by them and the clinical parameters before and after the test were evaluated, and the results were compared according to their functional classification. Results: Among Child-Pugh A patients, 6 (26.09% of the total of this class) did not reach the minimum distance predicted for the 6MWT. Analyzing the Child-Pugh B, 5 of them (83.33% of the total of this class) did not reach the minimum distance. The mean distance performed by Child A patients was 631.5 m, while the predicted distance was 587.2 m. In relation to Child B patients, the average distance performed was 441.0 m, with an expected distance of 541.2 m. A significant inverse correlation was observed between the distance walked and the Child-Pugh score (p = 0.001). Conclusion: The distance walked in the 6-minute walk test showed an inverse correlation with the Child-Pugh-Turcotte classification, which demonstrates a functional impairment parallel to the worsening of the underlying liver disease. Considering that the studied patients did not present previously diagnosed comorbidities that could justify such impairment, this association may indicate cardiovascular dysfunction. This, in turn, is probably related to systemic involvement secondary to liver cirrhosis. Key words: Cardiovascular diseases, Cardiomyopathies, Liver cirrhosis, Triage, Walk test.
We report the case of a 68-year-old male with alcohol-related cirrhosis, diagnosed with hepatocellular carcinoma (HCC) not eligible for liver transplant. After immunotherapy with atezolizumab associated with bevacizumab, he underwent a successful living donor liver transplantation (LT), not showing disease evidence or graft injury, maintaining clinically and radiologically stable 14 months after surgery. This is a successful report of combined atezolizumab plus bevacizumab being used as a bridge to LT in a patient with HCC, showing an important finding in therapy in patients with unresectable tumors at diagnosis.
Several barriers to access hepatocellular carcinoma (HCC) screening in Brazil and the large number of patients diagnosed at advanced disease stages, without prospect of curative treatment, are indicatives that access to early HCC diagnosis and treatment is not equitably guaranteed for entire population. The aim of the current study is to investigate the determining factors hindering the access to HCC screening and early diagnosis, based on abdominal ultrasound (US) application to risk patients. Descriptive and longitudinal study carried out in reference outpatient clinic, based on questionnaire application to patients at risk for HCC. Fifty patients (mean age of 59 years), whose main disease etiology lied on alcohol, and hepatitis B and C viruses, were evaluated; 76% of them underwent US monitoring on a regular basis and 58% understood the importance of undergoing such an examination. The main barriers to access examination comprised scheduling (25%) and financial issues (12.5%). Eight patients were diagnosed with HCC (16% of sample), 50% of them were diagnosed at the first consultation and 37.50% did not know about the importance of such diagnosis (Table); curative treatment was no longer applicable to 62.50% of these patients. It is worth emphasizing the essential role played by half-yearly screening in the early diagnosis and curative treatment of HCC. It is necessary developing policies focused on identifying and placing HCC patients at risk in health surveillance programs, as well as on providing greater access to, and education about the important role played by these exams.
Relato de caso de dupla recidiva de neurocriptococose com o objetivo de divulgar informações e fomentar discussão sobre essa, que é a terceira infecção fúngica mais comum após transplante de órgãos sólidos e que é de difícil manejo e com literatura escassa. Alguns pacientes apresentam resultados desfavoráveis a despeito da instituição de terapia antifúngica, como morte prematura devido às complicações da doença, controle tardio da infecção ou até mesmo não controle da infecção apesar da terapia instituída. Casos refratários apresentam prognóstico pior.
Objetivo: Analisar e verificar a efetividade do tratamento não farmacológico na abordagem inicial da DRGE. Método: Este trabalho será realizado no ambulatório de gastroenterologia do Hospital da Santa Casa de Misericórdia de Vitória (HSCMV), serão selecionados pacientes diagnosticados com DRGE em abordagem inicial não farmacológica para a doença. Será observado após um período de um mês, o resultado dessa intervenção, de modo que, possa ser analisado e correlacionado o grau de dedicação do paciente com o resultado obtido com a terapia não farmacológica e a necessidade de utilizar Inibidores da Bomba de Prótons (IBP) para episódios sintomáticos da DRGE. Resultado: É esperado uma melhora nos sintomas da DRGE nos pacientes em fase inicial do tratamento, realizando apenas mudanças no estilo de vida do paciente, sem que haja a necessidade da terapia farmacológica com IBP. Conclusão: Pacientes que realizam todas as mudanças no estilo de vida tendem a utilizar menos inibidor de bomba de prótons. No entanto, novos trabalhos precisam ser realizados para confirmar tais achados.
ABSTRACT Background: Sarcopenia is a syndrome characterized by progressive and generalized loss of muscle mass and strength, observed to varying degrees in patients with various chronic conditions. In cirrhotic patients, it reflects protein-energy malnutrition due to metabolic protein imbalance and is associated with worsened prognosis and reduced post-liver transplantation survival. Objective: To evaluate the epidemiological distribution of diminished hand grip (HG) strength in cirrhotic patients at an outpatient clinic of Santa Casa de Misericórdia in Vitória-ES, Brazil, seeking its association with liver function and cirrhosis complications. Methods: Cross-sectional, epidemiological, and single-center study. A questionnaire was administered to patients and HG strength was measured using a dynamometer, with three interval measures taken for 3 seconds each. Results: The study’s total population was 64 cirrhotic patients, with a mean age of 58 years and alcohol as the most prevalent etiology. Reduced HG strength was defined based on two reference values: using cutoff point 1, reduced HG strength was identified in 33 patients (51.6%); according to cutoff point 2, 23 (35.9%) had reduced HG strength. The study showed that, among the parameters observed, there was an association between the female gender and diminished HG strength in both cutoff points. Additionally, it was noted that patients with a score of 15 or more on the Model for End-Stage Liver Disease (MELD) had decreased HG strength at cutoff point 2. The study showed no association between decreased HG strength and the occurrence of cirrhosis complications in the population studied. Conclusion: In our study, we obtained a diminished HG strength variation of 35-52%, which was related to higher MELD scores, suggesting an association with worse clinical outcomes. Therefore, the presence of reduced muscle strength in cirrhotic patients may be linked to prognostic factors and should be valued as clinical data in the management of these patients.
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