Determinant factors in an expressive increasing of liver transplant in a single center

INTRODUÇÃO: O Hospital das Clinicas da Universidade de São Paulo é o maior hospital do Brasil. Seu programa de transplante foi o pioneiro neste país e realizou seu primeiro transplante de fígado em 1968. A lista de espera para transplante de fígado tem cerca de 700 pacientes, e ultrapassou mil há alguns anos. Apesar deste fato, nosso numero de transplantes de fígado não era muito elevado (cerca de 50/ano) e tínhamos, como esperado, alta mortalidade na lista de espera. Este ano aumentamos significativamente o numero de transplantes de fígado, atingindo 3 vezes a média dos últimos anos. OBJETIVO: Nosso objetivo é explicitar os fatores determinantes neste aumento expressivo do numero de transplantes de fígado em um único centro no Brasil. MÉTODOS: Analisamos o numero de transplantes de fígado no mesmo período do ano (de janeiro a setembro) em 2008 e 2009 no Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. Foram avaliadas as razões deste aumento de transplantes de fígado em 2009 neste centro. RESULTADOS: Comparando o período de janeiro a setembro de 2008 com o mesmo período de 2009, o número de transplantes de fígado aumentou em 200% (35 para 105). A imprensa, o sistema de saúde pública, a organização da equipe transplantadora, a internação de pacientes críticos, o preparo pré-operatório, a aceitação de doadores com critérios expandidos, o programa de doadores vivos, e os fígados bipartidos foram determinantes neste aumento de transplantes de fígado nesta instituição. A sobrevida atuarial melhorou com o aumento do número de transplantes (75% para 85%). CONCLUSÃO: Ainda é possível aumentar o número de transplantes de fígado em países em desenvolvimento. O mecanismo desta transformação é multifatorial e necessita de esforço do governo, institucional e multidisciplinar. Apesar do uso de fígados marginais e bipartidos, o aumento do número de transplantes está relacionado a melhor resultado.INTRODUCTION: The Clinical Hospital of Sao Paulo University is the biggest hospital of Brazil. Its transplant program was the pioneer in this country and it performed its first liver transplant in 1968. The adult waiting list for liver transplant has about 700 patients nowadays, and it has had more than a thousand some years ago. Even though, our number of liver transplants was not so high (about 50 a year) and we had, as expected, high waiting list mortality. This year we raised significantly our liver transplant number, increasing in 3 times our past few years’ average. AIM: We would like to highlight the determinant factors in this expressive increasing number of liver transplants in a single center in Brazil. METHODS: We analyzed the number of liver transplants in the same period of the year (from January to September) in 2008 and 2009 at the Clinical Hospital of Sao Paulo University Medical School. It was evaluated the reasons of the increasing rate of liver transplants in 2009 at this center. RESULTS: Comparing the period from January to September 2008 with the same period of 2009, the liver transplant number increased 200% (35 to 105) .Mass media, public health system policy, transplant team organization, hospitalization of critical patients, preoperative prepare, acceptance of expanded criteria donors, living donor program, and split livers were determinant in this raising of liver transplants at this institution. The actuarial survival rate improved with the increasing number of liver transplants (75% to 85%). CONCLUSION: It is still possible to increase the number of liver transplants in developing countries. The mechanism of such change is multifactorial and it needs government, institutional and multidisciplinary efforts. Besides the use of marginal and split livers, the increasing rate of transplants is related to better outcome

Leukocyte ratios are useful early predictors for adverse outcomes of COVID-19 infection

Leukocyte biomarkers, including the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte-(MLR), platelet-to-lymphocyte (PLR) ratios and systemic immune-inflammation index (SII) have been associated with severity and mortality of patients with COVID-19. The purpose of this study was to evaluate the association of baseline leukocyte biomarkers calculated in the emergency department (ED) with the disease severity and mortality. This was a retrospective cohort study that evaluated 1,535 (mean age 57+18 years) patients with SARS-CoV-2 infection in the ED of a single reference center. Outcomes were severity, defined as intensive care unit (ICU) admission requirement, and in-hospital mortality. All leukocyte biomarkers were calculated in the ED before the hospital admission. Their ability to predict the severity and mortality was measured using receiver operating characteristic (ROC) curves. Severity and mortality were observed in 30.9% and 12.6% of the patients, respectively, and were significantly correlated with NLR, MLR, PLR and SII, but only NLR was independently associated with both outcomes on multivariate analysis. Analysis of ROC curves revealed that NLR (0.78 for severity and 0.80 for mortality) and SII (0.77 for severity and 0.75 for mortality) had the best ability to predict mortality, when compared to other ratios. The highest AUC was observed for NLR, employing cut-off points of 5.4 for severity and 5.5 for mortality. Leukocyte biomarkers, particularly NLR, are capable of predicting the severity and mortality of patients with SARS-CoV-2 infection and could be important adjunct tools to identify patients in the ED that are more prone to develop adverse outcomes

A imunoglobulina policlonal humana anti-antígeno de superfície da hepatite B reduz a freqüência da rejeição aguda após transplante de fígado

BACKGROUND: Use of polyclonal anti-hepatitis B surface antigen immunoglobulin (HBIg) has been shown to reduce hepatitis B virus (HBV) recurrence after liver transplantation (LT) and to decrease the frequency of acute cellular rejection (ACR). However, the protective role of HBIg against ACR remains controversial, since HBV infection has been also associated with a lower incidence of ACR. AIM: To assess the relationship between HBIg immunoprophylaxis and the incidence of rejection after LT. METHODS: 260 patients (158 males, 43 ± 14 years old) submitted to LT were retrospectively evaluated and divided into three groups, according to the presence of HBsAg and the use of HBIg. Group I was comprised of HBsAg-positive patients (n = 12) that received HBIg for more than 6 months. Group II was comprised of HBsAg-positive patients that historically have not received HBIg or have been treated irregularly for less than 3 months (n = 10). Group III was composed of 238 HBsAg-negative subjects that have not received HBIg. RESULTS: HBIg-treated patients (group I) had significantly less ACR episodes, when compared to group II and III. No differences between groups II and III were observed. CONCLUSIONS: Long-term HBIg administration contributes independently to reduce the number of ACR episodes after LT.INTRODUÇÃO: O emprego da imunoglobulina policlonal anti-antígeno de superfície da hepatite B (HBIg) tem reduzido a recorrência da hepatite B após transplante hepático (TH), assim como também a freqüência de rejeição celular aguda (RCA). No entanto, o papel protetor da HBIg contra a RCA permanece controverso, pois a própria infecção por vírus B foi também associada a menor incidência de RCA. OBJETIVOS: Verificar a relação entre HBIg e a freqüência de RCA após TH. MÉTODOS: 260 pacientes (158 do sexo masculino, com 43 ± 14 anos) submetidos a TH foram avaliados, retrospectivamente, e divididos em três grupos de acordo com a presença de AgHBs e uso de HBIg. O grupo I foi constituído por 12 pacientes com AgHBs que receberam HBIg por mais de 6 meses; o grupo II foi formado por 10 pacientes com AgHBs que não receberam HBIg regularmente; o grupo III foi composto por 238 indivíduos sem AgHBs que não receberam HBIg. RESULTADOS: Nos pacientes do grupo I houve freqüência significantemente menor de episódios de RCA, em comparação ao que se observou nos grupos II e III. Nenhuma diferença ocorreu entre os grupos II e III. CONCLUSÕES: A administração profilática de HBIg contribui independentemente para reduzir a freqüência dos episódios de RCA após a realização de TH

Hepatitis E virus infection increases the risk of diabetes and severity of liver disease in patients with chronic hepatitis C virus infection

OBJECTIVES: Co-infection with hepatitis A or B viruses may aggravate liver injury in patients infected with hepatitis C virus (HCV). However, few studies have assessed co-infection with hepatitis E virus (HEV) and HCV. Therefore, this study aimed to assess the prevalence and impact of HEV infection among Brazilian patients with chronic HCV infection. METHODS: This observational study included adult patients with chronic HCV infection who were naive to antiviral therapy from January 2013 to March 2016. A total of 181 patients were enrolled, and HEV serology and PCR were performed for all patients. RESULTS: Seropositivity for anti-HEV IgG was detected in 22 (12.0%) patients and anti-HEV immunoglobulin M in 3 (1.6%). HEV RNA showed inconclusive results in nine (4.9%) patients and was undetectable in the remaining patients. HEV serology positive patients had more severe liver disease, characterized by liver fibrosis ≥3 versus ≤2 (p<0.001), Aspartate Aminotransferase-to-Platelet Ratio Index of ≥1.45 (p=0.003), and Fibrosis-4 score of ≥3.25 (p=0.001). Additionally, the odds of HEV-positive patients developing diabetes mellitus were 3.65 (95% CI 1.40-9.52) times the corresponding odds of HEV-negative patients. A case-control-based histological analysis (n=11 HEV-HCV-positive patients and n=22 HCV-positive patients) showed no significant differences between the groups. CONCLUSIONS: This prevalence is higher than that reported in previous studies of the general population in Brazil. Thus, HEV infection may influence the severity of liver disease and may represent an additional risk of developing diabetes mellitus in patients with HCV infection

Management and treatment of decompensated hepatic fibrosis and severe refractory Schistosoma mansoni ascites with transjugular intrahepatic portosystemic shunt

This study aimed to report the first case of a patient with hepatosplenic schistosomiasis mansoni, refractory ascites and portal vein thrombosis treated with a transjugular intrahepatic portosystemic shunt (TIPS), at the Instituto de Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. After the procedure, the patient recovered favorably and progressed with portal pressure reduction and no deterioration of the liver function. Endovascular shunt modification is a conservative medical approach that often helps in reducing symptoms significantly, making it a less invasive and a safer alternative to liver transplantation for the treatment of schistosomiasis with portal hypertension

Carbono orgânico e agregação do solo em áreas sob diferentes densidades de plantio da cultura da bananeira/ Organic carbon and soil aggregation in banana planting areas under different cropping densities

 A banana é uma das frutas mais consumidas in natura no Brasil.  Apesar de vários estudos terem sido realizados avaliando as modificações nos atributos químicos do solo em áreas cultivadas com bananeira, poucos são aqueles em que atributos físicos do solo são mensurados, bem como as modificações no estoque de carbono orgânico. O objetivo deste estudo foi avaliar o efeito de diferentes densidades de plantio de banana da variedade tipo “RBS Princesa” no estoque de carbono no solo, na estabilidade e distribuição dos agregados do solo e na matéria orgânica do solo, obtida através dos fracionamentos granulométrico e químico. O estudo foi realizado em um Argissolo Amarelo, no qual foram dispostos 6 tratamentos, variando somente a densidade de plantio, com quatro repetições. Foram coletadas amostras deformadas para a determinação do carbono orgânico do solo e realização do fracionamento granulométrico. Para a avaliação da densidade do solo e da estabilidade dos agregados, foram coletadas amostras indeformadas. A estabilidade dos agregados foi determinada pelo tamisamento via úmida e via seca. Os tratamentos com maiores espaçamentos entre plantas, consequentemente menores densidades de plantio, contribuíram para um maior teor de carbono orgânico total, estabilidade dos agregados, carbono orgânico associado aos minerais e estoque de carbono orgânico associado aos minerais na camada superficial do solo. Quanto ao fracionamento químico para a classe dos macroagregados foram verificados os maiores teores de carbono na fração humina, já para as frações ácido fúlvico e ácido húmico os maiores teores foram verificados na classe dos microagregados

Rarity of monodominance in hyperdiverse Amazonian forests.

Tropical forests are known for their high diversity. Yet, forest patches do occur in the tropics where a single tree species is dominant. Such "monodominant" forests are known from all of the main tropical regions. For Amazonia, we sampled the occurrence of monodominance in a massive, basin-wide database of forest-inventory plots from the Amazon Tree Diversity Network (ATDN). Utilizing a simple defining metric of at least half of the trees ≥ 10 cm diameter belonging to one species, we found only a few occurrences of monodominance in Amazonia, and the phenomenon was not significantly linked to previously hypothesized life history traits such wood density, seed mass, ectomycorrhizal associations, or Rhizobium nodulation. In our analysis, coppicing (the formation of sprouts at the base of the tree or on roots) was the only trait significantly linked to monodominance. While at specific locales coppicing or ectomycorrhizal associations may confer a considerable advantage to a tree species and lead to its monodominance, very few species have these traits. Mining of the ATDN dataset suggests that monodominance is quite rare in Amazonia, and may be linked primarily to edaphic factors