OBJECTIVES: To determine the frequency of the antineutrophil cytoplasmic antibodies (ANCA), antiproteinase-3 and antimyeloperoxidase, in primary sclerosing cholangitis (PSC) with or without inflammatory bowel disease (IBD+ or IBD-) and in different types of autoimmune hepatitis (AIH). Additionally, to verify the agreement between ANCA patterns by indirect immunofluorescence and their antigenic specificities by ELISA. METHODS: For this study, 249 patients were enrolled (42 PSC/IBD+; 33 PSC/IBD-; 31 AIH type-1; 30 AIH type-2; 31 AIH type-3; 52 primary biliary cirrhosis; 30 healthy controls) whose serum samples were tested for ANCA autoantibodies. RESULTS: There were fewer female subjects in the PSC/IBD- group (p=0.034). Atypical perinuclear-ANCA was detected more frequently in PSC/IBD+ patients than in PSC/IBD- patients (p=0.005), and was significantly more frequent in type-1 (p<0.001) and type-3 AIH (p=0.012) than in type-2 AIH. Proteinase-3-ANCA was detected in 25 samples (only one with cytoplasmic-ANCA pattern), and more frequently in PSC/IBD+ than in PSC/IBD- patients (p=0.025). Myeloperoxidase-ANCA was identified in eight samples (none with the perinuclear-ANCA pattern). Among the 62 reactive samples for atypical perinuclear-ANCA, 13 had antigenic specific reactions for proteinase-3 and myeloperoxidase. CONCLUSIONS: PSC/IBD+ differed from PSC/IBD- in terms of sex and proteinase 3-ANCA and atypical perinuclear-ANCA reactivity, the latter of which was more frequently detected in type-1 and type-3 AIH than in type-2 AIH. There was no agreement between ANCA patterns and antigenic specificities in IBD and autoimmune liver diseases, which reinforces the need for proteinase-3 and myeloperoxidase antibody testing.

ABSTRACT Objective: To compare the relief of symptoms provided by palliative care consultation team (PCCT) compared to the traditional care team (TC), in patients with advanced cancer in the first 48 hours of hospitalization. Method: Allocated to PCCT Group and TC Group, this study assessed 290 patients according to the Edmonton Symptom Assessment System (ESAS) within the first 48 hours of hospitalization. The main outcome was a minimum 2-point reduction in symptom intensity. Results: At 48 hours, the PCCT Group had a 2-point reduction in the mean differences (p <0.001) in pain, nausea, dyspnea, and depression; and TC Group, on nausea and sleep impairment (p <0.001). Multiple Logistic Regression found for the PCCT Group a greater chance of pain relief (OR 2.34; CI 1.01-5.43; p = 0.049). Conclusion: There was superiority of the PCCT Group for pain relief, dyspnea and depression. There is a need for more studies that broaden the understanding of team modalities.

RESUMEN Objetivo: Comparar el alivio de síntomas obtenido por equipo interconsultor en cuidados paliativos (ICP) al obtenido por equipo de cuidado tradicional (CT), en enfermos con cáncer avanzado en las primeras 48 horas de hospitalización. Método: Alocados en los Equipos ICP y Equipo CT, 290 pacientes han sido evaluados por la Escala de Síntomas de Edmonton (ESAS) en las primeras 48 horas de la hospitalización. El desenlace principal ha sido la reducción mínima de 2 puntos en la intensidad de síntomas. Resultados: En 48 horas, el Equipo ICP tuvo reducción de 2 puntos en las medias de las diferencias (p < 0,001) del dolor, náusea, disnea y depresión; y el Equipo CT, en la náusea y perjuicio del sueño (p < 0,001). Regresión Logística Múltiple mostró para el Equipo ICP mayor oportunidad de alivio del dolor (RC 2,34; CI 1,01-5,43; p = 0,049). Conclusión: Hubo superioridad del Equipo ICP para alivio del dolor, disnea y depresión. Estudios que amplíen la comprensión acerca de las modalidades de equipo son necesarios.

RESUMO Objetivo: Comparar o alívio de sintomas obtido por equipe interconsultora em cuidados paliativos (ICP) ao obtido por equipe de cuidado tradicional (CT), em doentes com câncer avançado nas primeiras 48 horas de hospitalização. Método: Alocados nos Grupos ICP e Grupo CT, 290 pacientes foram avaliados pela Escala de Sintomas de Edmonton (ESAS) nas primeiras 48 horas da hospitalização. O desfecho principal foi a redução mínima de 2 pontos na intensidade de sintomas. Resultados: Em 48 horas, o Grupo ICP teve redução de 2 pontos nas médias das diferenças (p < 0,001) da dor, náusea, dispneia e depressão; e o Grupo CT, na náusea e prejuízo do sono (p < 0,001). Regressão Logística Múltipla mostrou para o Grupo ICP maior chance de alívio da dor (RC 2,34; CI 1,01-5,43; p = 0,049). Conclusão: Houve superioridade do Grupo ICP para alívio da dor, dispneia e depressão. Estudos que ampliem a compreensão sobre modalidades de equipe são necessários.

RESUMO Objetivo: Comparar o alívio de sintomas obtido por equipe interconsultora em cuidados paliativos (ICP) ao obtido por equipe de cuidado tradicional (CT), em doentes com câncer avançado nas primeiras 48 horas de hospitalização. Método: Alocados nos Grupos ICP e Grupo CT, 290 pacientes foram avaliados pela Escala de Sintomas de Edmonton (ESAS) nas primeiras 48 horas da hospitalização. O desfecho principal foi a redução mínima de 2 pontos na intensidade de sintomas. Resultados: Em 48 horas, o Grupo ICP teve redução de 2 pontos nas médias das diferenças (p < 0,001) da dor, náusea, dispneia e depressão; e o Grupo CT, na náusea e prejuízo do sono (p < 0,001). Regressão Logística Múltipla mostrou para o Grupo ICP maior chance de alívio da dor (RC 2,34; CI 1,01-5,43; p = 0,049). Conclusão: Houve superioridade do Grupo ICP para alívio da dor, dispneia e depressão. Estudos que ampliem a compreensão sobre modalidades de equipe são necessários.

ABSTRACT Objective: To compare the relief of symptoms provided by palliative care consultation team (PCCT) compared to the traditional care team (TC), in patients with advanced cancer in the first 48 hours of hospitalization. Method: Allocated to PCCT Group and TC Group, this study assessed 290 patients according to the Edmonton Symptom Assessment System (ESAS) within the first 48 hours of hospitalization. The main outcome was a minimum 2-point reduction in symptom intensity. Results: At 48 hours, the PCCT Group had a 2-point reduction in the mean differences (p <0.001) in pain, nausea, dyspnea, and depression; and TC Group, on nausea and sleep impairment (p <0.001). Multiple Logistic Regression found for the PCCT Group a greater chance of pain relief (OR 2.34; CI 1.01-5.43; p = 0.049). Conclusion: There was superiority of the PCCT Group for pain relief, dyspnea and depression. There is a need for more studies that broaden the understanding of team modalities.

RESUMEN Objetivo: Comparar el alivio de síntomas obtenido por equipo interconsultor en cuidados paliativos (ICP) al obtenido por equipo de cuidado tradicional (CT), en enfermos con cáncer avanzado en las primeras 48 horas de hospitalización. Método: Alocados en los Equipos ICP y Equipo CT, 290 pacientes han sido evaluados por la Escala de Síntomas de Edmonton (ESAS) en las primeras 48 horas de la hospitalización. El desenlace principal ha sido la reducción mínima de 2 puntos en la intensidad de síntomas. Resultados: En 48 horas, el Equipo ICP tuvo reducción de 2 puntos en las medias de las diferencias (p < 0,001) del dolor, náusea, disnea y depresión; y el Equipo CT, en la náusea y perjuicio del sueño (p < 0,001). Regresión Logística Múltiple mostró para el Equipo ICP mayor oportunidad de alivio del dolor (RC 2,34; CI 1,01-5,43; p = 0,049). Conclusión: Hubo superioridad del Equipo ICP para alivio del dolor, disnea y depresión. Estudios que amplíen la comprensión acerca de las modalidades de equipo son necesarios.

RESUMO CONTEXTO: O período pré-transplante é complexo e inclui grande quantidade de procedimentos. A gravidade da doença hepática predispõe a um alto número de internações e procedimentos de alto custo. Estudos em avaliação econômica são uma importante ferramenta para o manejo dos custos em lista de espera para o transplante hepático. OBJETIVO: O objetivo do presente estudo foi avaliar o custo total do paciente em lista de espera para o transplante hepático e os principais recursos relacionados ao alto custo. MÉTODOS: Foi realizado um estudo de coorte em 482 pacientes registrados em lista de espera para o transplante hepático. Os pacientes foram acompanhados por um período de 24 meses, no qual foram avaliados todos os custos de materiais, medicamentos, consultas, procedimentos internações, exames laboratoriais e de imagem, reposição de hemocomponentes e nutrição recebida. A quantidade total de cada recurso e componente utilizado foi obtida e multiplicada pelo seu valor unitário e, desta maneira, o custo individual de cada paciente foi obtido. RESULTADOS: O total gasto pelos 482 pacientes foi de US$ 6.064.986,51. Os custos ambulatoriais corresponderam a 32,4% do total (US$ 1.965.045,52) e os custos em internação corresponderam a 67,6% do total (US$ 4.099.940,99). Os principais determinantes do custo em ambulatório foram: medicamentos (44,31%) e exames laboratoriais e de imagem (31,68%). Os principais determinantes de custo em internações foram: medicamentos (35,20%), utilização do leito em enfermaria e em UTI (26,38%) e exames laboratoriais (13,72%) Pacientes com valores de MELD entre 25-30 foram os de maiores custos em lista de espera (US$ 16.686,74 ± 16,105.02) e os de menor custo foram os pacientes com MELD abaixo de 17 (US$ 5.703,22 ± 9.318,68). CONCLUSÃO: O custo total em lista de espera para o transplante hepático aumenta de acordo com a gravidade do paciente. Individualmente, internações, reposição de hemocomponentes e o tratamento do paciente com carcinoma hepatocelular são os principais determinantes de custo para os pacientes em lista de espera para o transplante hepático. Quanto maior o tempo de espera, maiores serão os custos em lista, causando maior impacto nos sistemas de saúde.

ABSTRACT BACKGROUND: The pre-transplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. OBJECTIVE: The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. METHODS: A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months follow-up, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. RESULTS: The total expenditure of the 482 patients was US$ 6,064,986.51. Outpatient and impatient costs correspond to 32.4% of total cost (US$ 1,965,045.52) and 67.6% (US$ 4,099,940.99) respectively. Main cost drivers in outpatient were: medicines (44.31%), laboratorial tests and image exams (31.68%). Main cost drivers regarding hospitalizations were: medicines (35.20%), bed use in ward and ICU (26.38%) and laboratorial tests (13.72%). Patients with MELD score between 25-30 were the most expensive on the waiting list (US$ 16,686.74 ± 16,105.02) and the less expensive were those with MELD below 17 (US$ 5,703.22 ± 9,318.68). CONCLUSION: Total costs on the waiting list for liver transplantation increased according to the patient’s severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems.

OBJECTIVES: This study used autopsy to evaluate the prevalence of cholelithiasis and its associated risk factors in a population of healthy, young subjects who suffered a violent or natural death. METHODS: This study is a prospective evaluation of autopsies of 446 individuals from 2011 to 2013 in Brazil. Of that sample, 330 (74%) subjects died from violent deaths and 116 (26%) died naturally. The presence of biliary calculi, previous cholecystectomy, gender, age, ethnicity, body mass index (BMI) and alcohol use were evaluated. RESULTS: In the natural death group, 6.9% (95% CI 3.39 to 13.28) (3.08% of the male subjects and 11.76% of the female subjects) exhibited evidence of gallbladder disease. In the violent death group, only 2.12% (95% CI 0.96 to 4.43) (2.17% of the male subjects and 1.85% of the female subjects) of the subjects exhibited evidence of gallbladder disease. Age was correlated with the prevalence of gallbladder disease, but BMI was correlated with only gallbladder disease in the natural death group. CONCLUSIONS: This population has the lowest prevalence of cholelithiasis in the Americas. Dietary habits, physical activity, ethnicity, alcohol consumption and genetic factors may be responsible for this low prevalence.

OBJECTIVES:Orthotopic liver transplantation has improved survival in patients with end-stage liver disease; however, therapeutic strategies that achieve ideal immunosuppression and avoid early complications are lacking. To correlate the dose and level of Tacrolimus with early complications, e.g., rejection, infection and renal impairment, after liver transplantation. From November 2011 to May 2013, 44 adult liver transplant recipients were studied in this retrospective comparative study.RESULTS:The most frequent indication for liver transplantation was hepatitis C cirrhosis (47.7%), with a higher prevalence observed in male patients (68.18%). The ages of the subjects ranged from 19-71 and the median age was 55.5 years. The mean length of the hospital stay was 16.1±9.32 days and the mean Model for End-stage Liver Disease score was 26.18±4.28. There were five cases of acute cellular rejection (11.37%) and 16 cases of infection (36.37%). The blood samples that were collected and analyzed over time showed a significant correlation between the Tacrolimus blood level and the deterioration of glomerular filtration rate and serum creatinine (p<0.05). Patients with infections had a higher serum level of Tacrolimus (p= 0.012). The dose and presence of rejection were significantly different (p= 0.048) and the mean glomerular filtration rate was impaired in patients who underwent rejection compared with patients who did not undergo rejection (p= 0.0084).CONCLUSION:Blood Tacrolimus levels greater than 10 ng/ml were correlated with impaired renal function. Doses greater than 0.15 mg/kg/day were associated with the prevention of acute cellular rejection but predisposed patients to infectious disease.