Autoimmune hepatitis and primary biliary cholangitis overlap syndrome after COVID-19

COVID-19 is commonly associated with high serum levels of pro-inflammatory cytokines, and the post-infection status can disturb self-tolerance and trigger autoimmune responses. We are reporting a 45-year-old male who was admitted with fatigue, jaundice, elevated liver enzymes (with cholestatic pattern), and acute kidney injury two weeks after recovering from a mild SARS-CoV-2 infection. Serologies for viral hepatitis and anti-mitochondrial antibody were negative, while anti-nuclear and anti-smooth muscle antibodies were positive. There were no signs of chronic liver disease, and a magnetic resonance cholangiography showed no dilatation of biliary ducts. Histologic evaluation of the liver evidenced numerous foci of lobular necrosis without ductopenia or portal biliary reaction. Considering the autoantibody profile and histologic changes, the medical team started oral prednisone, but there was a suboptimal biochemical response in the outpatient follow-up. Two months later, a second liver biopsy was performed and revealed non-suppurative destructive chronic cholangitis, extensive areas of confluent necrosis with hepatocytes regenerating into pseudorosettes, and numerous plasma cells. According to the Paris Criteria, the patient was then diagnosed with an autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC-OS). After adding azathioprine and ursodeoxycholic acid to the treatment, there was a satisfactory response. This is the second worldwide report of an AIH-PBC-OS triggered by COVID-19, but the first case with a negative anti-mitochondrial antibody. In this setting, histologic evaluation of the liver by an experienced pathologist is a hallmark of achieving the diagnosis and correctly treat the patient

Interdisciplinaridade no ensino superior: análise da percepção de professores de controladoria em cursos de ciências contábeis na cidade de São Paulo Interdisciplinarity in higher eduction: analysis of the perception of teachers of management control in accounting programs in the city of São Paulo

Este estudo buscou conhecer, analisar e descrever a percepção de professores da disciplina de Controladoria em cursos de Ciências Contábeis em Instituições de Ensino Superior - IES - na cidade de São Paulo, sobre a interdisciplinaridade e sua importância na formação dos contadores. É uma pesquisa descritiva-qualitativa, com dados obtidos em entrevistas com sete professores de quatro IES. Verificou-se que a interdisciplinaridade não é adotada de forma explícita no curso e nem nas práticas de seus atores; porém, os docentes percebem sua importância para a prática pedagógica, a melhoria da qualidade de ensino e a formação discente. As falas revelaram trocas informais de ideias e de experiências de ensino no contexto universitário. Os professores mostraram-se preocupados em se inteirar do conjunto de disciplinas, mas mostraram pouco compromisso com uma integração mais planejada e uma prática de ensino compartilhada, tendo o Projeto Político Pedagógico - PPP - como o lócus prático no curso. A interdisciplinaridade é mais pensada e falada do que vivenciada. Conclui-se que, embora os professores sejam sensíveis à importância da interdisciplinaridade na formação dos futuros contadores, persiste uma distância entre o falado, o pensado e o efetivamente praticado no contexto universitário.<br>The aim of this research is to understand, analyze and describe the perception of Controllership professors in accounting undergraduate programs in Universities in the city of São Paulo, concerning the importance of interdisciplinary work in the formation of accountants. It is a descriptive- qualitative research, and its data was obtained by means of an interview with seven professors from four universities. It was verified that the interdisciplinary work is not completely adopted in the program. Moreover, it is not adopted by their actors in their practices. However, its importance for the pedagogical practice is perceived by those professors, as well as for enhancing the teaching and the formation of the students. It was also revealed that there is an informal exchange of ideas, as well as an exchange of teaching experience in the university context. It was shown that the professors are preoccupied with taking part in the subjects' context, but have little commitment with a better planned integration and a shared teaching practice, for they only apply the Pedagogical and Political Project - PPP as a focus in the program. Therefore, it can be said that the interdisciplinary work is nothing more than thoughts put into words. It can be concluded that, although those professors perceive the importance of the interdisciplinary work in their students' formation, the distance between thoughts and words still exists in the university context