Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function.Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection.Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P ‫؍‬ 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio ‫؍‬ 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001).Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV.

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Background: Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals.Methods: This cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography.Results: The prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication. Conclusions:The prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis.

SUMMARY Hepatopulmonary Syndrome (HPS) is a complication of cirrhosis that worsens the disease's prognosis, pre and post liver transplant. The objective of this study is to analyze the prevalence of HPS in cirrhotic patients at our service and to correlate it with oxygen saturation (SatO2) using a pulse oximeter to evaluate if this is useful as a screening test for HPS. A prospective study was conducted in patients with hepatic cirrhosis conventionally selected from 2014 to 2016. All the patients underwent an echocardiogram with microbubbles and oxygen saturation measurement by pulse oximetry. Those with intrapulmonary shunt were submitted to arterial blood gas analysis. The relationship between oxygen saturation and HPS was assessed by the multivariate model of binary logistic regression. We analyzed 77 patients, and 23.3% (18 patients) had all criteria for HPS. The relationship between HPS and SatO2 did not show statistical significance, even after the variables were adjusted for sex, age, and smoking. Oxygen saturation alone was not able to detect HPS in the sample of cirrhotic patients. More accurate methods for screening and diagnosis of the syndrome should be used.

SUMMARYHepatitis C virus (HCV) genotypes and subtypes were determined in hemodialysis patients in the Federal District, Brazil, by sequencing of the 5' noncoding (NC) and nonstructural 5B (NS5B) regions. From 761 patients, 66 anti-HCV-positive samples were tested for HCV RNA. All 51 HCV RNA-positive samples by PCR of the 5' NC region were genotyped as genotypes 1 (90.2%) and 3 (9.8%). Subtype 1a (82.3%) was the most prevalent, followed by subtypes 3a (9.8%), 1b (5.9%) and 1a/1b (2.0%). Forty-two samples could be amplified and genotyped in the NS5B region: 38 (90.5%) as genotype 1, subtypes 1a, and 8 (9.5%) as genotype 3, subtype 3a. For the 42 samples sequenced in both regions, the genotypes and subtypes determined were concordant in 100% and 95.2% of cases, respectively. Two samples presented discrepant results, with the 5' NC region not distinguishing correctly the subtypes 1a and 1b. These findings indicate that the HCV genotype 1, subtype 1a, is the most prevalent among hemodialysis patients in the Federal District, Brazil.

Introduction. Variable prevalence rates have been reported for Low bone mineral density (LBMD). Objectives. To determine the prevalence of LBMD in cirrhotic patients from a hospital outpatient clinic, to identify clinical and laboratory predictors of LBMD, and to determine the mean age at which LBMD was detected in this population. Methods. We conduced a cross-sectional study with 97 patients with liver cirrhosis for the presence of LBMD using bone densitometry of the lumbar spine and femoral neck. The prevalence of LBMD and mean age at detection of LBMD were evaluated. Correlation of LBMD with clinical-laboratory data was assessed, and uni and multivariate statistical analysis was performed. Results. The prevalence of LBMD was 50.5% in the 97 of the cases. LBMD was more frequent in participants over 50 years old (p = 0.001). There were no significant associations between the presence of LBMD and body mass index (p = 0.9), CHILD-PUGH score (p = 0.23), levels of 25-OH vitamin D (p = 0.5), parathyroid hormone (p = 0.5), calcium (p = 0.1), phosphorus (p = 0.3), and current or past smoking (p = 0.7). Age over 50 years remained a predictor of hepatic osteodystrophy even after adjusting for the other variables. Discussion. In conclusion LBMD was prevalent in the cirrhotic population studied. The age at LBMD diagnosis was between 15 and 20 years less than the osteoporosis screening age of the non-cirrhotic population. There were no clinical-laboratory factors that increased the suspicion of LBMD. Further studies are needed to determine whether these findings can be extrapolated to the cirrhotic population.

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A Síndrome Hepatopulmonar (SPH) é definida como uma hipoxemia arterial sistêmica devido a vasodilatações dos capilares intrapulmonares em vigência de uma doença hepática. Em diversos centros de transplante no país e no mundo não há a rotina de realizar ecocardiograma com microbolhas antes do transplante. O objetivo do trabalho é analisar a prevalência de SPH em pacientes cirróticos de nosso serviço e correlacioná-la com a saturação de oxigênio (SatO2) pelo oxímetro de pulso, de forma a avaliar se este seria útil como um exame de triagem no diagnóstico de SPH. Foram selecionados aleatoriamente 102 pacientes portadores de cirrose hepática. Eles foram classificados de acordo com a etiologia e o grau da cirrose (Child-Pough). Dados sobre sexo, idade, antropometria, hábitos de vida e comorbidades foram adicionados ao banco de dados. Em seguida, os pacientes foram submetidos a um ecocardiograma com microblolhas e a oximetria de pulso. Os pacientes com shunt intrapulmonar positivo ao ecocardiograma ou SatO2 abaixo de 94% foram submetidos a gasometria arterial e avaliados quanto a pressão arterial de oxigênio (PaO2) e o gradiente alvéolo-arterial (PA-aO2). Os critérios diagnósticos para SPH foram presença de shunt positivo e PA-aO2 > 15mmHg ou PA-aO2 >20mmHg, se idade superior a 64 anos. Eles foram classificados quanto ao grau da SPH de acordo com a PaO2. A análise da relação entre a SPH e a SatO2 foi realizada pelo modelo multivariado de regressão logística binário. Foram excluídos 25 pacientes por motivo de falecimento, desistência ou não realização dos exames solicitados. Ao final, 77 pacientes foram analisados estatisticamente. As principais etiologias para a cirrose foram vírus da hepatite C e cirrose alcóolica. Os pacientes portadores de Child A perfaziam 65,8% da amostra; 25,3% Child B e 6,3% Child C. O shunt foi positivo em 29,1% dos pacientes. A prevalência de SPH foi de 22,8% (18 pacientes). Dentre estes, 55,5% possuíam SPH leve (PaO2 > 80mmHg), 38,8% SPH moderada (PaO2 60-80mmHg) e 5,5% SPH grave (PaO2 < 60mmHg). A SatO2 < 96% não foi capaz de predizer os indivíduos com SPH, mesmo quando ajustada ao sexo e a idade. Assim, a SatO2, como medida isolada, não pode rastrear indivíduos com SPH, sendo necessário associar o ecocardiograma com microbolhas e a gasometria arterial em todos os pacientes cirróticos, sobretudos naqueles pré-transplante. ABCDExpress 2017;1(2):998Codigo: 61345 Acesso está disponível em www.revistaabcd.com.br e www.sbad2017.com.br Acesso pelo