Esteatose hepática aguda da gravidez: relato de caso e revisão de literatura

A esteatose hepática aguda da gravidez (EHAG) é uma complicação obstétrica rara e grave, que ocorre durante o terceiro trimestre de gestação. O objetivo deste estudo é o relato de caso de EHAG em paciente internada em hospital terciário. Gestante, 36 anos, na 37ª semana de gravidez previamente hígida até quatro dias antes da admissão hospitalar. Iniciou quadro de dor abdominal em epigástrio e hipocôndrio direito, icterícia progressiva, desidratação, febre e calafrios. Evoluiu com piora dos sintomas, hematêmese, hipotensão e hipoglicemia. A função hepática apresentava alterações. O coagulograma revelava tempo de protrombina e de tromboplastina parcial alargados. Os marcadores virais para hepatites A, B e C foram negativos. No pós-operatório imediato da Cesárea, a paciente evoluiu com distúrbio da coagulação, episódios de hipoglicemia, piora da icterícia e encefalopatia hepática, caracterizando o diagnóstico de insuficiência hepática aguda (IHA). Após quatro dias de tratamento da encefalopatia hepática houve melhora do sensório até apresentar-se consciente, orientada, sem flapping, apenas com tratamento conservador e não preencheu os critérios do King’s Collegue de indicação para transplante hepático. No 15o dia de internação tanto a paciente e filho encontravam-se bem. Com o conhecimento e diagnóstico de EHAG, no reconhecimento precoce de casos mais leves, incluindo interrupção precoce da gravidez por cesariana e grandes volume de plasma fresco congelado e albumina, alternadamente, o prognóstico de EHAG pode melhorar

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil

Abstract INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil

<div><p>Abstract INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.</p></div