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Hepatocellular carcinoma in patients without cirrhosis: relevance and clinical characteristics

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Hepatoma Research 2018年第5期4卷 22-27页

作者： Kellyane Santana Dias Carvalho Luciano E.Fonseca helma p.cotrim Medicine School Universidade Federal da BahiaSalvador 40110-060Brazil University Hospital Edgar Santos Universidade Federal da BahiaSalvador 40110-060Brazil

Aim: The present study evaluated the frequency of hepatocellular carcinoma (HCC) in patients without cirrhosis. Methods: HCC patients were recruited from two reference centers for liver disease in Northeast Brazil from 2010 to 2016. The diagnosis of HCC and cirrhosis was based on international criteria. Results: A total of 169 patients were included, and 16% (27) of the patients did not have hepatocellular carcinoma in non-cirrhosis (HCC-NC). The mean age of HCC-NC was 64.4 ± 11.3 years, and 74.1% of the patients were male. The main risk factors were hepatitis C virus (HCV) in 29.6% (8), nonalcoholic steatohepatitis (NASH) in 14.8% (4) and hepatitis B virus (HBV) in 11.1% (3). Histological HCC diagnosis was performed in 81.5% (22) of the patients, and in 18.5% (5) of these patients, the diagnosis was performed by ultrasonography, computed tomography or nuclear magnetic resonance imaging methods. Single nodules were found in 56% of HCC-NC (14) when assessed by imaging methods. Conclusion: The frequency of HCC-NC was elevated and more common in males. HCV, NASH and HBV were the most frequent risk factors. These data contribute to discussion on future protocols and criteria for the early diagnosis and treatment of HCC in patients with chronic liver disease without cirrhosis.

关键词： Hepatocellular carcinoma primary liver tumor liver cirrhosis

Diet and intestinal bacterial overgrowth: Is there evidence?

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World Journal of Clinical Cases 2022年第15期10卷 4713-4716页

作者： Claudineia Souza Raquel Rocha helma pinchemel cotrim programa de pós graduacao em Medicina e Saúde Universidade Federal da BahiaSalvador 40110-060BABrazil Sciences of Nutrition Federal University of BahiaSalvador 40110-060BABrazil

The intestinal microbiota and its role in health and disease processes have been the subject of several *** is known that changes in the intestinal microbiota occur due to several factors,such as the use of medication,age,lifestyle and diseases,which can modify intestinal homeostasis and lead to excessive growth of bacteria in the small intestine,triggering a clinical condition called small bowel bacterial overgrowth(SIBO).Individuals with SIBO may present gastrointestinal symptoms ranging from nausea,diarrhea and/or constipation,and flatulence to distension and abdominal pain,resulting from poor absorption of nutrients or changes in intestinal *** gold-standard treatment is based on the use of antibiotics to eradicate bacterial *** studies have evaluated diets in the treatment of SIBO;however,the studies are of low methodological quality,making extrapolation of the results to clinical practice ***,there is still not enough scientific evidence to support a specific type of diet for the treatment of SIBO.

关键词： Small intestinal bacterial overgrowth Treatment Diet Nutrition

Nonalcoholic fatty liver disease in asymptomatic Brazilian adolescents

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World Journal of Gastroenterology 2009年第4期15卷 473-477页

作者： Raquel Rocha helma pinchemel cotrim Almir Galvo Vieira Bitencourt Daniel Batista Valente Barbosa Adméia Souza Santos Alessandro de Moura Almeida Bruno Cunha Isabel Guimares postgraduate Course in Medicine and Health Federal University of BahiaSchool of Medicine Federal University of Bahia School of Medicine NASH project University Hospital Professor Edgard SantosFederal University of Bahia

AIM： To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease （NAFLD） among asymptomatic Brazilian adolescents. METHODS： Transversal observational study included asymptomatic adolescents with central obesity from private and public schools in Salvador-Bahia, northeastern Brazil. The children answered a questionnaire that in- cluded age, gender, race, and medical history, and were submitted to a complete physical exam and abdominal ultrasound. Biochemical exams included： ALT, AST, GGT, C reactive protein （CRp）, fasting glucose, insulin, cholesterol and triglycerides. Criteria for NAFLD included： the presence of steatosis in ultrasound and/or high level of ALT, negative or occasional historic of intake of alcohol （4 140 g/wk）, negative investigation for hepatitis A, B, C, auto-immune hepatitis, Wilson disease and ***： From October, 2005 to October, 2006, the study included 1801 subjects between 11 and 18 years of age and a mean age of 13.7± 2.0 years. One hun- dred ninety-nine had central obesity. The prevalence of NAFLD was 2.3%, most of whom were male and white. Insulin resistance （IR） was observed in 22.9% of them and had positive correlations with ALT and GGT （p 〈 0.05）. Elevated CRp was observed in 6.9% of the cases; however, it was not associated with WC, IR or liver enzymes. CONCLUSION： The prevalence of NAFLD in Brazilian adolescents was low. The ethnicity may have influence this frequency in the population studied, which had a large proportion of African descendents.

关键词： Nonalcoholic fatty liver disease Insulinresistance Central obesity Ethnicity Adolescents

Anthropometric indicators of visceral adiposity as predictors of non-alcoholic fatty liver disease: A review

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World Journal of Hepatology 2018年第10期10卷 695-701页

作者： Naiade Silveira Almeida Raquel Rocha helma pinchemel cotrim Carla Daltro Department of Sciences of Nutrition School of Nutrition Universidade Federal da Bahia Faculty of Medicine of Bahia Universidade Federal da Bahia

The objective was to critically analyze studies that evaluated the predictive capacity of indicators of visceral adiposity in non-alcoholic fatty liver disease(NAFLD). The bibliographic research was carried out using the electronic database pubMed, LILACS and SciELO, references of selected articles. Although we found few studies, they have already used several indicators of visceral adiposity as waist circumference, waist-to-hip ratio, waist-to-height ratio, Lipid accumulation product, Body Shape Index, Body Roundness Index and most them were good predictors of NAFLD. Thus, the anthropometric indicators may contribute for the diagnosis of NAFLD in a simple, low-cost and noninvasive way, allowing early therapeutic measures to prevent the evolution to non-alcoholic steatohepatitis.

关键词： Anthropometry Adiposity Non-alcoholic fatty liver disease Abdominal fat pediatrics predictive value

prevalence of sarcopenia using different methods in patients with non-alcoholic fatty liver disease

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World Journal of Hepatology 2022年第8期14卷 1643-1651页

作者： Naiade Silveira Almeida Raquel Rocha Claudineia Almeida de Souza Ana Carolina Sirelli da Cruz Bruna dos Reis Ribeiro Luiza Valois Vieira Carla Daltro Rafael Silva Manoel Sarno helma pinchemel cotrim programa de pós-Graduação em Medicina e Saúde Universidade Federal da BahiaSalvador 40110-060BABrazil Departamento de Ciência da Nutrição Escola de NutriçãoUniversidade Federal da BahiaSalvador 40110-060Brazil Caliper Clínica e Escola de Imagem Salvador 41810-012Brazil

BACKGROUND Sarcopenia is a clinical condition associated with several liver diseases and it includes non-alcoholic fatty liver disease(NAFLD)in its broad spectrum as steatosis,steatohepatitis and ***,the criteria to define sarcopenia are diverse,and even those established in consensus have been discussed regarding their performance in making an accurate *** To evaluate the prevalence of sarcopenia,using different methods,in patients with NAFLD,and its association with clinical-anthropometric *** This was an observational study of outpatients with *** was defined by the European Working Group Consensus on Sarcopenia in Older people of 2010(EWGSOp1)and 2018(EWGSOp2).The skeletal muscle index was used to estimate muscle mass,handgrip strength was assessed using the dynamometer and physical performance by walking a distance of four meters at usual walking *** non-invasive fibrosis scores,fibrosis-4(FIB-4)index and Aspartate aminotransferase to platelet ratio index(ApRI),were used to assess the absence and presence of *** Fifty-seven individuals with NAFLD were evaluated,the mean age(SD)was 52.7(11.3)years and 75.4%were *** assessed by FIB-4 and ApRI was observed in 3.7%and 16.6%of patients with NAFLD,*** diagnosis of sarcopenia was identified only by EWGSOp1 in 3.5%of NAFLD patients,and the prevalence of probable/pre-sarcopenia was higher using the EWGSOp2 consensus at 26.3%,when compared to 1.8%with *** defined by EWGSOp1,was associated with grade I steatosis,but without overweight(ppenia and fibrosis was not observed(p>0.05).EWGSOp2 showed a greater number of patients with probable sarcopenia,and who were overweight(12(80.0%)),with a higher degree of steatosis[11(73.3%)and presence of fibrosis(1(6.7%),FIB-4 and 3(20.0%),ApRI]compared to EWGSOp1[1(100%),0(0.0%),0(0.0%),FIB-4 and 0(0.0%),ApRI,respectively].CONCLUSION The presen

关键词： Non-alcoholic fatty liver disease Sarcopenia Muscle strength physical performance Liver fibrosis

Fatty liver disease in severe obese patients:Diagnostic value of abdominal ultrasound

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World Journal of Gastroenterology 2008年第9期14卷 1415-1418页

作者： Alessandro de Moura Almeida helma pinchemel cotrim Daniel Batista Valente Barbosa Luciana Gordilho Matteoni de Athayde Adimeia Souza Santos Almir Galvo Vieira Bitencourt Luiz Antonio Rodrigues de Freitas Adriano Rios Erivaldo Alves Faculdade de Medicina da Bahia Universidade Federal da Bahia SalvadorBahia 41830-020Brasil Faculdade de Medicina da Bahia Universidade Federal da BahiaSalvadorBahia 41830-020Brasil Faculdade de Medicina da Bahia Universidade Federal da Bahia SalvadorBahia 41830-020Brasil Faculdade de Medicina da Bahia Universidade Federal da BahiaSalvadorBahia 41830-020 Brasil Núcleo de Cirurgia da Obesidade SalvadorBahia 41830-020Brasil

AIM:To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis. METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard. RESULTS: The study included 105 patients. The mean age was 37.2 ± 10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis onUS was associated to advanced grades of steatosis on histology (p = 0.016). CONCLUSION: preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.

关键词： Bariatric surgery Obesity Hepatic steatosis Abdominal ultrasound diagnosis Fatty liver