Incidence of uterine post abortion infection at Hospital de Clínicas de Porto Alegre. Is prophylactic antibiotic necessary?

Objetivo: Identificar a incidência de infecção pélvica após aborto espontâneo submetido a esvaziamento uterino num hospital terciário do sul do Brasil e comparar com a literatura internacional. Métodos: Os prontuários eletrônicos do Hospital de Clínicas de Porto Alegre de todas as pacientes que foram submetidas ao esvaziamento uterino por abortamento entre agosto de 2008 e Janeiro de 2012 foram revisados. Foram incluídas no estudo todas as pacientes submetidas à curetagem uterina por abortamento e que tiveram consultas ambulatoriais de revisão após o procedimento. Os dados demográficos e laboratoriais da população estudada, number needed for treatment (NNT) e o number needed to harm (NNH) foram calculados. Resultados: Dos 857 prontuários eletrônicos revistos, 377 pacientes foram submetidas ao esvaziamento uterino por abortamento; 55 casos foram perdidos no seguimento, restando 322 casos que foram classificados como aborto não infectado na admissão. A maioria da população era da raça branca (79%); a prevalência de HIV e VDRL positivos foi de 0,3 e 2%, respectivamente. No seguimento desses 322 casos, num período mínimo de 7 dias, verificou-se que a incidência de infecção pós-procedimento foi de 1,8% (IC95%0,8 a 4). O NNT e o NNH calculado para 42 meses foi de 63 e 39, respectivamente. Conclusão: A incidência de infecção pós-aborto entre agosto de 2008 a janeiro de 2012 foi de 1,8% (0,8 a 4).Objective: To identify the incidence of infection post-uterine evacuation for miscarriage at a tertiary teaching hospital in southern Brazil. Methods: Electronic records of all patients admitted for uterine evacuation for miscarriage between August 2008 and January 2012 were revised. All patients submitted to uterine curettage for miscarriage and had outpatient follow-up were included. Demographic, laboratorial data of the sampled population, the number needed to treat (NNT) and number needed to harm (NNH) were calculated. Results: From 857 reviewed electronic records, 377 underwent uterine evacuation for miscarriage. 55 cases were lost to follow-up, remaining 322 cases classified as non-infected miscarriage at admission. The majority of the population was white (79%); prevalence of positive HIV and VDRL was 0.3 and 2%, respectively. From 322 cases, within a week of follow-up, the incidence of post-miscarriage infection was 1.8% (95%CI 0.8 to 4). In a period of 42 months, the NNT and NNH were 63 and 39, respectively. Conclusion: The incidence of infection after miscarriage between August 2008 and January 2012 was 1.8% (0.8 to 4)

Evaluation of thrombocytopenia in patients with non-alcoholic fatty liver disease without cirrhosis

Introduction and objectives: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in western countries. It is often related to metabolic syndrome, presenting an increased risk of advanced liver disease and cardiovascular-related death. In some etiologies of chronic liver disease, thrombocytopenia has been associated not only with advanced stages of fibrosis but also with autoimmune disease. In NAFLD, however, its prevalence and related factors are still unknown. The aim of this study is to evaluate the prevalence of thrombocytopenia in NAFLD patients without cirrhosis and to investigate its related risk factors. Patients and methods: This was a retrospective study carried out in two tertiary hospitals in the South and Southeast regions of Brazil. Patients diagnosed with NAFLD by liver biopsy were included. Those with other causes of liver disease and/or cirrhosis were excluded. For analysis, patients were divided into two groups, with and without thrombocytopenia. Data was analyzed using a significance level of 5%. Results: 441 non-cirrhotic patients with NAFLD (evaluated by liver biopsy) were included in the study. The prevalence of thrombocytopenia was 3.2% (14/441 patients). In the comparative analysis between groups, thrombocytopenia was associated with male sex (p = 0.007) and level of hemoglobin (p = 0.023). Conclusion: Thrombocytopenia is an infrequent event in NAFLD patients without cirrhosis and is related with male sex and higher hemoglobin levels

Transient hepatic elastography has the best performance to evaluate liver fibrosis in non-alcoholic fatty liver disease (NAFLD)

Introduction and aim: The gold-standard for fibrosis diagnosis in non-alcoholic fatty liver disease (NAFLD) is liver biopsy, despite its invasive approach, sampling limitations and variability among observers. The objective was to validate the performance of non-invasive methods (Fibroscan™; APRI, FIB4 and NAFLD score) comparing with liver biopsy in the evaluation of liver fibrosis in patients with NAFLD. Material and methods: NAFLD patients ≥18 years of age who were submitted to liver biopsy were included and evaluated at two reference tertiary hospitals in Brazil with transient hepatic elastography (THE) assessment through Fibroscan™, APRI, FIB4 and NAFLD scores were determined. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of advanced fibrosis were calculated to evaluate the performance of these non-invasive methods in NAFLD patients, adopting liver biopsy as the gold standard. Results: A total of 104 patients were studied. At three different cutoff values (7.9, 8.7 and 9.6 kPa) THE presented the highest sensitivity values (95%, 90% and 85% respectively), and the highest NPV (98%, 96.4% and 95.1% respectively) for the diagnosis of advanced fibrosis. It also presented the highest AUROC (0.87; CI 95% 0.78–0.97). Conclusion: When compared to the gold standard, transient hepatic elastography presented the best performance for the diagnosis and exclusion of advanced fibrosis in patients with NAFLD, overcoming APRI, FIB4 and NAFLD score