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Background: Response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) has been traditionally assessed 1 to 2 years after treatment initiation. With the development of new drugs, some patients may benefit from an earlier introduction of second-line therapies., Aims: This study aims to identify whether well-validated response criteria could correctly identify individuals likely to benefit from add-on second-line therapy at 6 months., Methods: Analysis of a multicenter retrospective cohort which included only patients with clear-cut PBC., Results: 206 patients with PBC (96.6% women; mean age 54 ± 12 years) were included. Kappa concordance was substantial for Toronto (0.67), Rotterdam (0.65), Paris 1 (0.63) and 2 (0.63) criteria at 6 and 12 months, whereas Barcelona (0.47) and POISE trial (0.59) criteria exhibited moderate agreement. Non-response rates to UDCA was not statistically different when assessed either at 6 or 12 months using Toronto, Rotterdam or Paris 2 criteria. Those differences were even smaller or absent in those subjects with advanced PBC. Mean baseline alkaline phosphatase was 2.73 ± 1.95 times the upper limit of normal (× ULN) among responders versus 5.05 ± 3.08 × ULN in non-responders (p < 0.001)., Conclusions: After 6 months of treatment with UDCA, the absence of response by different criteria could properly identify patients who could benefit from early addition of second-line therapies, especially in patients with advanced disease or high baseline liver enzymes levels., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease in which anti-mitochondrial antibodies (AMA) are the diagnostic hallmark. Whether AMA-negative PBC patients represent a different phenotype of disease is highly debated., Aims: The purpose of our study was to compare AMA-positive and AMA-negative PBC patients in a large non-white admixed Brazilian cohort., Methods: The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical features and treatment outcomes of Brazilian PBC patients, stratifying data according to AMA status., Results: A total of 464 subjects (95.4% females, mean age 56 ± 5 years) with PBC were included. Three hundred and eighty-four (83%) subjects were AMA-positive, whereas 80 (17%) had AMA-negative PBC. Subjects with AMA-negative PBC were significantly younger (52.2 ± 14 vs. 59.6 ± 11 years, p = 0.001) and had their first symptom at an earlier age (43.2 ± 13 vs. 49.5 ± 12 years, p = 0.005). Frequency of type 2 diabetes was significantly increased in subjects with AMA-negative PBC (22.5% vs. 12.2%, p = 0.03). Lower IgM (272.2 ± 183 vs. 383.2 ± 378 mg/dL, p = 0.01) and triglycerides (107.6 ± 59.8 vs.129.3 ± 75.7 mg/dL, p = 0.025) and higher bilirubin (3.8 ± 13.5 vs. 1.8 ± 3.4 mg/dL, p = 0.02) levels were also observed in this subgroup. Response to ursodeoxycholic acid varied from 40.5 to 63.3% in AMA-positive and 34 to 62.3% in AMA-negative individuals, according to different response criteria. Outcomes such as development of liver-related complications, death and requirement for liver transplantation were similar in both groups., Conclusions: AMA-negative PBC patients are similar to their AMA-positive counterparts with subtle differences observed in clinical and laboratory features., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: The prospective assessment of Clostridium difficile infection (CDI) impact in inflammatory bowel disease (IBD) flare in outpatient setting has been poorly investigated. We aimed to evaluate the prevalence and the associated factors with CDI in IBD outpatients presenting colitis flares as well as the outcomes following treatment., Methods: In this prospective cohort study, conducted from October, 2014, to July, 2016, 120 IBD patients (55% presenting colitis flare) and 40 non-IBD controls were assessed for CDI. Multivariate regression analysis was performed to identify predictors of CDI. Outcome analysis was estimated for recurrent CDI, hospitalization, colectomy, and CDI-associated mortality., Results: The number of patients with CDI was significantly higher in IBD patients experiencing flares than in both inactive IBD and non-IBD groups (28.8 vs. 5.6 vs. 0%, respectively; p = 0.001). Females (OR = 1.39, 95% CI, 1.13-17.18), younger age (OR = 0.77, 95% CI, 0.65-0.92), steroid treatment (OR = 7.42, 95% CI, 5.17-40.20), and infliximab therapy (OR = 2.97, 95% CI, 1.99-24.63) were found to be independently associated with CDI. There was a dose-related increase in the risks of CDI on patients which had taken prednisone. Those treated with vancomycin had a satisfactory response to therapy, but 21% presented recurrent CDI and 16% were hospitalized. Neither necessity of colectomy nor mortality was noticed in any patient during the investigation., Conclusions: In IBD outpatients presenting colitis flares, CDI is highly prevalent. Females, younger age, infliximab, and notably steroid therapy were independently associated with CDI. Most patients with CDI experienced mild-to-moderate disease, and prompt treatment with vancomycin was highly effective, which seems to reduce the serious complication risks.

Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction., (Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic five minutes before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction., (Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: The effectiveness of antiviral therapy with pegylated interferon and ribavirin for chronic hepatitis C is far from ideal and presents several adverse events. Among such events, there is the depressive episode that can even lead to treatment discontinuity., Objective: Analyze the incidence of depressive episodes in patients with chronic hepatitis C treated with pegylated interferon (IFN-PEG) and ribavirin, as well as the possible factors associated with its occurrence and its impact on patients' sustained virological response., Methods: People with chronic hepatitis C undergoing antiviral therapy were interviewed at the baseline, at the 4th, 12th, 24th and 48th treatment weeks and 4 weeks after the end of it, using the HADS scale for tracking the depressive episode. Patients with HADS ≥9 were subjected to Beck Depression Inventory (BDI-II) to grade the episode. Clinical, sociodemographic, laboratorial and histological variables were obtained to identify factors related to the onset of depression. The sustained virological response rate (negative HCV-RNA 6 months after end of therapy) was compared among patients with and without depressive symptoms., Results: The study comprised 32 patients, most men (59%) with mean age of 54±11.13 years old. Genotype non-1 was prevalent (56%) and 81% of the patients were non-cirrhotic. The depressive episode was diagnosed in 25% of the patients and the peak incidence was found in the 12th treatment week. The depressive episode was moderate in 87% of the patients and only one patient abandoned the treatment. None of the analyzed factors was associated with depressive episode onset. A trend was observed in female patients ( P =0.08). The sustained virological response rate was of 75% and 67% in patients with and without depressive episode, respectively ( P =0.66)., Conclusion: The incidence of depressive episodes in patients with chronic hepatitis C undergoing antiviral therapy was of 25% and the 12th treatment week was the most critical one. The presence of depressive episode did not affect the sustained virological response rate.

Objective: Comparing Health-Related Quality of Life (HRQoL) scores in patients with chronic hepatitis C undergoing double and triple antiviral therapy and analyzing possible factors related to HRQoL., Method: HRQoL was assessed using the Short Form 36 and Chronic Liver Disease Questionnaire, which were applied at baseline and at weeks 4, 12 and 16 of treatment to 32 patients divided into two groups: double therapy with pegylated interferon (IFN-PEG) and ribavirin, and triple therapy with PEG-IFN, ribavirin and telaprevir., Results: The reduction of HRQoL was greater in patients receiving triple therapy compared to those treated with two drugs, the most critical time is at 12 weeks in both groups. After removal of telaprevir, the triple therapy group significantly improved their HRQoL scores. Anxiety and depression before treatment, employment status and race are significantly related to diminished HRQoL., Conclusion: Patients undergoing double and triple therapy have diminished HRQoL indexes, but the addition of telaprevir chooses a more significant decrease.

Background: Patients with subocclusive Crohn's disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction., Material/methods: Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups., Results: There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67-8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons)., Conclusions: In an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy.

Background: Although the cost of Crohn's disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs. MATERIAL/METHODS We evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2-3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups., Results: On an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients., Conclusions: Patients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.

Context: Functional dyspepsia represents a frequent gastrointestinal disorder in clinical practice. According to the Roma III criteria, functional dyspepsia can be classified into two types as the predominant symptom: epigastric pain and postprandial discomfort. Even though the pathophysiology is still uncertain, the functional dyspepsia seems to be related to multiple mechanisms, among them visceral hypersensitivity, changes in the gastroduodenal motility and gastric accommodation and psychological factors., Objective: Evaluate the effectiveness of acupuncture as a complementary to conventional treatment in functional dyspepsia patients., Methods: Randomized clinical trial in which were enrolled patients with functional dyspepsia patients in according with Rome III criteria. One group was submitted to drug therapy and specific acupuncture (GI) and the other to drug therapy and non-specific acupuncture (GII). The gastrointestinal symptoms, presence of psychiatric disorders and quality of life were evaluated, at the end and three months after treatment., Results: After 4 weeks of treatment there was improvement of gastrointestinal symptoms in Group I (55 ± 12 vs 29 ± 8.8; P = 0.001) and Group II (50.5 ± 10.2 vs 46 ± 10.5; P = 0.001). Quality of life was significantly better in Group I than group II (93.4 ± 7.3 vs 102.4 ± 5.1; P = 0.001). Anxiety (93.3% vs 0%; P = 0.001) and depression (46.7% vs 0%; P = 0.004) were significantly lower in Group I than group II. When comparing the two groups after 4 weeks of treatment, gastrointestinal symptoms (29 ± 8.8 vs 46 ± 10.5; P<0.001) and quality of life (102.4 ± 5.1 vs 96 ± 6.1; P = 0.021) were significantly better in Group I than group II. Three months after the treatment, gastrointestinal symptoms remained better only in Group I, when compared to the pre-treatment values (38 ± 11.3 vs 55 ± 12; P = 0.001)., Conclusion: In patients with functional dyspepsia the complementary acupuncture treatment is superior to conventional treatment. Further studies with more patients are needed to confirm these findings.

Objective: To assess the incidence of mood swings (MS) and possible associated factors in patients with Crohn's disease (CD)., Methods: Prospective longitudinal study of 50 patients (60% females; mean age 40.6 years) with a diagnosis of CD over a 16-month follow-up. Clinical activity was assessed by the CD activity index. Psychological status self-report tools (Beck Depression Inventory and the anxiety subscale of the Hospital Anxiety and Depression Scale) were used for mood disorder diagnosis. The tools were applied at baseline and at four-month intervals thereafter., Results: The inflammatory phenotype was the most common (86%); 36% had a previous history of surgery related to CD; 82% were in clinical remission at baseline. MS occurred in 58% of patients; 28% had progression of depression and/or anxiety symptoms from baseline normal mood, and 30% had baseline depressive and/or anxious mood normalized. In 38% of patients with MS, no change in the disease clinical activity could be found (p = 0.015), whereas 20% had a change in CD activity. Female gender and absence of previous surgery related to CD complications were associated with higher MS incidence (p = 0.04 for both)., Conclusion: In this study, a high MS incidence (58%) was found in patients with CD. Female gender and absence of previous surgery from CD complications were associated with a higher MS incidence. Periodic psychological assessment could be useful to detect and approach MS in patients with CD.

Introduction: Approximately 30% of hepatitis C virus (HCV) monoinfected patients present persistently normal alanine aminotransferase (ALT) levels. Most of these patients have a slow progression of liver fibrosis. Studies have demonstrated the rate of liver fibrosis progression in hepatitis C virus-human immunodeficiency virus (HCV-HIV) coinfected patients is faster than in patients infected only by HCV. Few studies have evaluated the histological features of chronic hepatitis C in HIV-infected patients with normal ALT levels., Methods: HCV-HIV coinfected patients (HCV-RNA and anti-HIV positive) with known time of HCV infection (intravenous drugs users) were selected. Patients with hepatitis B surface antigen (HBsAg) positive or hepatitis C treatment before liver biopsy were excluded. Patients were considered to have a normal ALT levels if they had at least 3 normal determinations in the previous 6 months prior to liver biopsy. All patients were submitted to liver biopsy and METAVIR scale was used., Results: Of 50 studied patients 40 (80%) were males. All patients were treated with antiretroviral therapy. The ALT levels were normal in 13 (26%) patients. HCV-HIV co-infected patients with normal ALT levels had presented means of the liver fibrosis stages (0.77±0.44 versus 1.86±1.38; p<0.001) periportal inflammatory activity (0.62±0.77 versus 2.24±1.35; p<0.001) and liver fibrosis progression rate (0.058±0.043 fibrosis unit/year versus 0.118±0.102 fibrosis unit/year) significantly lower as compared to those with elevated ALT., Conclusions: HCV-HIV coinfected patients with persistently normal ALTs showed slower progression of liver fibrosis. In these patients the development of liver cirrhosis is improbable.

Objectives: To determine the prevalence of insulin resistance (IR) in non-diabetic patients with chronic hepatitis C, and to assess the association between IR, laboratory parameters and histological findings., Subjects and Methods: Eighty-two patients had their serum analyzed for glucose, lipid profile, C-reactive protein (CRP), ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), HOMA-IR, viral load and HCV genotype. Patients with HOMA-IR levels > 2.5 were considered as carriers of insulin resistance., Results: IR was observed in 27% of patients and was associated with age, waist circumference and body mass index. IR patients were more likely to have more advanced hepatic fibrosis and necroinflammatory activity, higher levels of aminotransferases and liver steatosis than patients without IR., Conclusions: Insulin resistance is often present in patients with chronic hepatitis C, and this parameter is associated with more advanced HCV-related hepatic fibrosis.

Context: Chronic renal disease patients on hemodialysis are at increased risk of infection by hepatitis C virus (HCV). High prevalence rates have been reported from dialysis units worldwide. Recent studies have shown an inverse relation between HCV infection and life expectancy of patients on hemodialysis and those undergoing renal transplant., Objectives: Assess the prevalence of and risk factors for HCV infection in patients undergoing hemodialysis., Methods: A cross-sectional study was undertaken from January to December, 2007. During this period, 236 patients were tested for anti-HCV antibodies with third generation ELISA. Those who tested positive further underwent qualitative PCR testing for HCV-RNA. A subject was considered HCV-infected if both tests (anti-HCV and HCV-RNA) were positive. Monthly serum ALT and the mean for the 12-month period were obtained from 195 patients. Two hundred eight (88.1%) patients answered a standardized questionnaire aiming to identify risk factors for HCV infection., Results: Of the 236 subjects studied, 14.8% (35/236) tested positive for anti-HCV antibodies. Of these, 71.6% (25/35) tested positive for HCV-RNA. Chronic HCV infection was thus prevalent in 10.6% (25/236). Bivariate analysis showed time on hemodialysis, number of blood transfusions, previous peritoneal dialysis and previous sexually transmitted diseases to be the main risk factors for HCV infection. Yet multivariate analysis showed that just time on hemodialysis and previous sexually transmitted diseases were significantly associated with HCV infection. Patients on hemodialysis for over 10 years were 73.9 (CI 17.5-311.8) times as likely to have acquired HCV, compared with those on hemodialysis for up to 5 years. Patients with previous sexually transmitted diseases had a 4.8 times higher risk of HCV infection compared with those without previous sexually transmitted diseases. Mean serum ALT was significantly higher in HCV-infected patients (44.0 +/-13.5 U/L versus 33.5 +/- 8.0 U/L, P<0,001)., Conclusion: HCV infection was highly prevalent in the dialysis unit studied. Time on dyalitic treatment and previous sexually transmitted diseases were the main risk factors for HCV infection. HCV-infected patients on hemodialysis had higher serum ALT levels than those without chronic HCV infection.

Context: Non-adherence to therapy, in any degree is a common event and occurs in several circumstances. It is one of most common cause of fail in therapy of chronic diseases and Crohn's disease is not an exception., Objective: To evaluate in patients with Crohn's disease the prevalence and the risk factors to non-adherence to therapy., Methods: From July 2006, for 12 months, were included prospectively, for non-adhesion to therapy 100 patients with Crohn's disease that were assisted in a Center for Inflammatory Bowel Diseases of University Hospital of Federal University of Juiz de Fora, MG, in Brazil. A modified Morisky & Green Test for Measure of Adherence to Therapy was answered by all of them. According to test the patients were classified in two groups defined as adherence and non-adherence, respectively, and the last one was separated in intentional and non-intentional adhesion. Clinical, psychological and pharmacotherapeutics variables were sought to find the factors related to non-adherence., Results: Sixty four percent of total group were noticed to have a score of non-adherence to therapy according to used test and non-intentional was the most common type of behavior in such patients, and they demonstrated to be conscious of therapy. The comparison of adherent and non-adherent patients displayed a significant tendency to occurrence of non-adherence in younger (P = 0.07) and in non-white patients (P = 0.06). No correlation was observed in comparison of psychological and pharmacotherapeutics variables and non-adherence., Conclusions: In patients with Crohn's disease the prevalence of non-adherence to therapy is high (64%). The younger and non-white patients have higher propensity to non-adherence. In such circumstances efforts should be made to look for strategies to deal with this sort of people suffering from Crohn's disease, trying to increase the degree of adherence in this sort of patients.

Background: Studies assessing the efficacy of azathioprine in steroid-dependent patients with Crohn's disease are scarce. The aim of this study was to assess the long-term efficacy and safety of azathioprine, and factors associated with sustained response, in steroid-dependent patients with Crohn's disease., Material/methods: In this prospective, observational study, adult steroid-dependent subjects with Crohn's disease receiving azathioprine therapy were assessed over a 10-year period. Azathioprine dosage was adjusted according to clinical response and occurrence of adverse events. Median treatment duration was 83 months. Steroid therapy was tapered according to protocol., Results: A total of 106 subjects were included. The proportion of subjects remaining in sustained steroid-free remission at 12, 24, 36, 48, and 60 months was 0.61, 0.73, 0.72, 0.70, and 0.70, respectively. Thereafter, the rate of weaning from steroids decreased gradually, reaching a nadir of 0.41 at 108 months. Median time to complete steroid withdrawal was 6 months. Demographic, azathioprine dose, and disease-related data did not correlate with remission. By multivariate analysis, only decreased mean leukocyte count during follow-up was independently associated with steroid-free remission (P=.001). Subjects who achieved an annual mean leukocyte count <6,000/mm(3) were more likely to sustain steroid-free remission (P=.01). Serious adverse events in response to azathioprine were uncommon., Conclusions: Azathioprine therapy offers a meaningful option in the management of steroid-dependent Crohn's disease for up to 10 years. A persistent decrease in leukocyte count may provide a surrogate marker of sustained steroid-free response.

Background: Nosocomial diarrhea seems to be common at intensive care units, although its epidemiology be poorly documented in Brazil., Aim: To determine the incidence and risk factors of diarrhea among adult patients admitted to intensive care units., Methods: Four hundred and fifty five patients were prospectively included during the period between October 2005 and October 2006. Demographic, clinical and biochemical data as well as aspect and number of bowel movements were recorded on a daily basis until discharge from the unit., Results: Diarrhea occurred in 135 (29.5%) patients, lasting 5.4 days average. The time of its onset in according to admission was 17.8 days and similar cases of diarrhea during the same period were recorded in 113 (83.7%) patients. In a multivariate analysis through the logistics regression model, only the number of antibiotics (OR 1.65; I.C. 95% = 1.39-1.95) and the number of days of antibiotic therapy (OR 1.16; I.C. 95% = 1.12-1.20) were statistically associated with the diarrhea occurrence. Each day added of antibiotic therapy, raised in 16% the risk of diarrhea (I.C. 12% to 20%), while the addition of one more antibiotic to the scheme, increased the chances of occurring diarrhea in 65% (I.C. 39% to 95%)., Conclusion: The incidence of nosocomial diarrhea in intensive care units is high (29.5%). The main risk factors for its occurrence were number of prescribed antibiotics and duration of the antibiotic therapy. Besides the enteric precautions, judicious and limited prescription of antimicrobians probably will reduce the occurrence of diarrhea at this unit.

Background: Patients with end-stage renal disease (ESRD) show a high prevalence of hepatitis C, with a negative impact on the survival on hemodialysis and after renal transplantation. We evaluated the efficacy and tolerance of interferon-alpha (IFN-alpha) in HCV-infected ESRD patients on dialysis., Methods: Forty-six HCV-RNA-positive ESRD patients were studied. IFN-alpha regimen consisted of 3 million units three times a week for 12 months, and the patients were followed up for 6 months. End-of-treatment, and sustained biochemical and virological responses were evaluated and tolerance was assessed monthly., Results: A sustained virological response (SVR) was observed in 10/46 patients (22%) and in 10/29 who completed the treatment (34%). Alanine aminotransferase was elevated in 63% of the patients at the beginning of the study and returned to normal levels within the first month in all patients with SVR. Treatment was discontinued because of side effects in 11/46 patients (24%) and six patients (13%) were lost to follow-up., Conclusions: IFN-alpha monotherapy for hepatitis C in dialysis patients shows a high frequency of adverse effects. However, the SVR is high (34%) in patients who complete treatment, emphasizing the importance of careful selection and close follow-up in order to minimize and control possible side effects.

Introduction: Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection results in more severe forms of liver disease in nonuremic patients; however, the impact of HCV coinfection is not clearly known in end-stage renal disease (ESRD) patients with HBV infection. We sought to determine the impact of HCV coinfection in HBV-infected ESRD patients., Patients and Methods: The HBsAg-positive ESRD patients evaluated between March 1999 and May 2003 were divided into two groups: group B, HBV infection alone, and group BC, HBV-HCV coinfection (anti-HCV-positive). Both groups were compared regarding epidemiological, laboratory, and histological findings. A liver biopsy was obtained in cases with evidence of viral replication and/or elevated alanine aminotransferase., Results: One hundred patients (73% men) with mean age of 42 +/- 11 years (55 patients in group B and 45 in group BC) were studied. Comparison between groups showed a difference in time on hemodialysis and duration of infection, which were higher in group BC (P < .001 and P = .001, respectively) and in history of blood transfusion, which was also more frequent in group BC (P = .04). Liver biopsies, obtained from 15 patients in group B and 28 patients in group BC, showed no difference in frequency of septal fibrosis (60% in group B vs 48% in group BC, P = .46) or interface hepatitis (73% vs 71%, P = .99)., Conclusions: HBV-HCV coinfection was related to a longer time on hemodialysis, longer duration of infection, and history of blood transfusion. Contrary to nonuremic patients, HCV coinfection was not associated with more severe forms of liver disease in ESRD patients.

Acute pancreatitis is one of the complications associated with severe primary and secondary hypertriglyceridemia. The frequency of hypertriglyceridemia in patients with pancreatitis ranges from 4 to 53%. The elevation in serum triglycerides probably induces the release of free fatty acids, responsible for the pancreatic damage. During a three year study, nine patients with acute pancreatitis due to hypertriglyceridemia were followed up at the University Hospital of Federal University and at the "Hospital Monte Sinai" (Juiz de Fora, MG, Brazil). Suggestive clinical manifestations, especially superior abdominal pain, nausea, vomiting and ileus, were found in all the patients; however, only three showed elevated serum amylase levels. All had triglyceride levels above 1000 mg/dl (11.3 mmol/L). The evolution after clinical treatment was good in eight patients (two needed parenteral nutrition). The only death observed was due to shock and acute respiratory distress, refractory to clinical management. The maintenance treatment aimed at withdrawing the predisposing conditions and reduction of the triglyceride levels prevented recurrence of acute pancreatitis episodes during the 23 months of follow-up.

The authors present the results of a prospective study on percutaneous needle biopsy of the liver conducted at the Hepatology Outpatients' Ward of the Gastroenterology Unit of the University Hospital -" Universidade Federal de Juiz de Fora", MG, Brazil. In 16 months 61 biopsies were made in patients with chronic liver disease according to the technique described by menghini. The inclusion criteria were established by The Patient Care Committee of The American Gastroenterological Association. Abdominal ultrasound was done before and after the procedure. The patients stayed six hours under control (blood pressure and pulse rate) in the hospital. After 24 hours other clinical, laboratorial and ultrasonic control were performed. The main complication was local pain or in the right shoulder (32 patients--52.5%). Abdominal ultrasound after 24 hours revealed only one hematoma of the abdominal wall (1.8%). This study shows that the outpatient needle liver biopsy is a safe procedure with low complication rate when performed in a judicious way, by specialized personnel and under strict clinical control.

The authors describe their experience, in a prospective survey, with the prevalence rates of intestinal parasites in patients with hepatic cirrhosis admitted to the Gastroenterology Unit of University Hospital of Federal University in Juiz de Fora, Brazil, whose fresh stools were examined by Hoffman-Pons-Janner, Baermann-Moraes and Willis methods. They compare the results of stool exams with two control groups and look for a relation with cirrhosis' etiology. A higher prevalence of some parasites was observed in cirrhosis than in people with other digestive diseases (group I). mainly for the Strongyloides stercoralis, found in 40.2%, chiefly in alcoholic cirrhosis. Oddly no one of the group I admitted in the same period had strongyloidiasis. Another group including all the people who had stool samples examined in the same period at the hospital had 1.91% of that helmintic infection (group II). A comparison is also made with the prevalence in schoolchildren between the ages of 7 and 14 studies eight years before (13.16%). Other parasites were also observed in different incidence between those with cirrhosis and the other groups and the results are presented. They conclude that hepatic cirrhosis must be included in the list of conditions which increases the risk of Strongyloides stercoralis infection.