RESUMO: Introdução: Pacientes com diagnóstico de doenças autoimunes apresentam em função da própria doença de base ou do tratamento por drogas imunossupressoras, um maior risco de ocorrência de manifestações graves das parasitoses intestinais. Objetivo. O presente estudo visou avaliar a prevalência de parasitoses intestinais em portadores de doenças autoimunes e em uso de imunossupressores. Metodologia. Foi realizada uma busca ativa através dos prontuários dos pacientes da Reumatologia do Ambulatório de Especialidades Médicas da Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL). Para cada participante foi aplicado um questionário padrão, levando em consideração, caracterização e características socioeconômicas, ambientais, hábitos sanitários e condições clínicas. Para identificação dos parasitos foi realizado o exame parasitológico de fezes pelo método de Hoffman, Pons e Janner. Resultados. Foram realizadas 14 entrevistas e 08 exames parasitológicos de fezes. Houve uma predominância no sexo feminino nos pacientes analisados (85,7%) e as patologias mais encontradas foram Lúpus Eritematoso Sistêmico (LES) e Artrite Reumatoide (AR), sendo cada uma com 35,7%. A polifarmácia esteve presente em todos os participantes. Das medicações utilizadas, o Metotrexato se fez presente em 100% dos participantes, seguido pela Azatioprina (75%) e pela Prednisona (61%). Não foi encontrada positividade de nenhuma espécie de parasito nas fezes analisadas. Conclusão. Devido à escassez de estudos de correlação entre parasitoses intestinais e doenças autoimunes, existe uma grande necessidade de aprofundar-se nessa temática, tendo em vista que as parasitoses intestinais são problemas de saúde pública em todo o Brasil e associadas a uma condição de imunossupressão podem apresentar graves repercussões passíveis de serem evitadas. PALAVRAS-CHAVE: Enteroparasitoses, Doenças autoimunes, Drogas imunossupressoras.
Introduction: Intestinal parasitosis are a public health problem worldwide. There are several risk factors and a high association with some specific labor activities. Objective: The present study assessed the risk factors and prevalence of enteroparasitic diseases in shellfish pickers from one district of Maceió, Alagoas state, Brazil. Methods: Cross-sectional study of 41 female shellfish pickers including parasitological tests in fecal samples and a questionnaire with objective and subjective questions. Sand samples from their working environment were also analyzed. Results: At least one species of parasite was found in 19.51% of the fecal samples. Pathogenic species of Giardia lamblia, Trichuris trichiura, Schistosoma mansoni, Ascaris lumbricoides, Enterobius vermicularis, from the Ancylostomatidae family, and non-pathogenic species of Entamoeba coli were found. Polyparasitism was diagnosed in 37.5% of the positive samples. A total of 57.14% of sand samples contained hookworm larvae. Regarding the risk factor, low educational level was statistically associated to the presence of parasites (p<0.05). Conclusion: Greater investment in basic education is needed to increase the knowledge about preventive measures against parasitic diseases and the promotion food-handling courses in order to change existing inadequate habits in the community. Basic sanitation is also essential in preventing environmental contamination.
Objectives: NASH is a chronic liver disease characterized by fatty liver, inflammation and fibrosis. NASH fibrosis is considered an indicator of long-term adverse outcomes and is associated with a high economic burden, particularly in patients with advanced fibrosis (Stage F$3). Estimated lifetime costs in this population in the US reportedly exceeded $95 billion in 2017. As there are currently no approved treatments in NASH, the aim of this review was to understand if advanced fibrosis is targeted by available off-label therapies and current investigational treatments. Methods: A structured literature review was conducted across multiple databases. Searches were limited to English language studies published between January 2007 and January 2019, and included clinical, observational and review publications, reporting on available and investigational treatments used in NASH. Additional grey literature searches were conducted. Results: In total, 48 publications were included. Although there are no licensed treatments in NASH, nine currently available treatments were used off-label with reported improvements in steatosis and/or fibrosis. Out of these, only pioglitazone, statins, and vitamin E were studied in patients with advanced fibrosis specifically. However, limited improvements in fibrosis were observed in all cases. Additionally, six investigational treatments were identified in various stages of NASH fibrosis: n=4 in F1-F3; n=1 in F2/F3 and n=1 in F3/F4. Despite this, only half (n=3) reported improvements in fibrosis staging. Conclusions: There is an unmet need for licensed treatments in NASH, specifically treatments in advanced fibrosis -only three off-label treatments and one investigational therapy are being studied in these patients, with limited efficacy reported. NASH patients with advanced fibrosis represent a high-burden population and in the absence of effective treatments, lifetime costs and the impact on healthcare systems are likely to rise. Further clinical research into new treatments is needed in this population.
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