Aécio Flávio Meirelles de Souza

Oral refeeding in patients with mild acute pancreatitis: prevalence and risk factors of relapsing abdominal pain.

Background and Aim:  In acute pancreatitis (AP), oral refeeding may stimulate pancreatic secretion, increasing the inflammation of the glandular tissue causing relapse of abdominal pain or even exacerbation of the disease. This study aimed to assess the prevalence and risk factors of abdominal pain relapse over oral refeeding in patients convalescing with AP as well as the impact of pain recurrence on the hospital stay.

Long‐term results with azathioprine therapy in patients with corticosteroid‐dependent Crohn’s disease: Open‐label prospective study

Background:  A substantial number of patients with Crohn’s disease (CD) become dependent on steroids after induction therapy. Treatment with azathioprine (AZA) may be beneficial in such patients. The present open‐label study evaluated the long‐term safety and efficacy of AZA in steroid‐dependent CD patients.

Insulin resistance in non-diabetic patients with chronic hepatitis C: what does it mean?

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.

Idiopathic acute pancreatitis due to biliary sludge: prevention of relapses by endoscopic biliary sphincterotomy in high-risk patients.

“idiopathic” acute pancreatitis due to biliary sludge: prevention of relapses by endoscopic biliary sphincterotomy in high-risk patients

Fatal evolution of systemic lupus erythematosus associated with Crohn's disease

The authors describe the case of a young Brazilian woman who was treated of ileocolonic Crohns disease sparing rectum, as confirmed by colonoscopy and histopathological examination. After a 4-year course of sulfasalazine treatment, she presented with skin facial lesions in vespertilio, fever, arthralgias and high titers of anti-ANA and LE cells. A sulfasalazine-induced lupus syndrome was diagnosed, because after sulfasalazine withdrawal and a short course of prednisone, the clinical symptoms disappeared and the laboratory tests returned to normal. Mesalazine 3 g/day was started and the patient remained well for the next 3 years, when she was again admitted with fever, weakness, arthralgias, diplopy, strabismus and hypoaesthesia in both hands and feet, microhematuria, haematic casts, hypocomplementemia and high titers of autoimmune antibodies. A diagnosis of associated systemic lupus erythematosus was made. Although a pulsotherapy with methylprednisolone was started, no improvement was noticed. A cyclophosphamide trial was tried and again no positive results occurred. The patient evolved to severe clinical manifestations of general vasculitis affecting the central and peripheral nervous system and lungs, having a fatal evolution after 2 weeks. Although uncommon, the association of both disease may occur, and the authors call attention to this possibility, making a brief review of literature.

Phenotypic features of innate and adaptive immunity in patients with chronic hepatitis C and end-stage renal disease

The knowledge of the immunological profile of patients with chronic hepatitis C (CHC) and end‐stage renal disease (ESRD) on haemodialysis (HD) is still limited.

Alterações no teste ultra-rápido da urease e no exame anatomopatológico para Helicobacter pylori induzidas por drogas anti-secretoras

Background - One of the major problems when evaluating dyspeptic patients at public hospitals is the large interval between the consultation and the endoscopy, leading to the prescription of antisecretory drugs, what can be responsible for false results on examinations. Aim - To evaluate changes in ultrarapid urease test and histopathological examination for Helicobacter pylori by antisecretory drugs. Methods - In a prospective double-blind study, 50 patients with dyspeptic complaints and endoscopic diagnosis of peptic ulcer, erosive gastritis, esophagitis or duodenitis, with a positive urease test, were randomized to a 7-day course of treatment with either omeprazole 20 mg or ranitidine 300 mg a day. Before and after treatment, two biopsy specimens each were obtained from the antrum and corpus and an ultrarapid urease test and a histopathological examination for Helicobacter pylori were performed. Results - There were no significant changes in the results of ultrarapid urease test and histopathological examination for Helicobacter pylori after treatment with ranitidine. With omeprazole, we observed a decrease in positive results in ultrarapid urease test and histopathological examination for Helicobacter pylori in the antrum, but not in the corpus. Conclusion - Omeprazole, used for 7 days, can lead to negative results in ultrarapid urease test and histopathological examination for Helicobacter pylori in the antrum, and should not be employed in patients before the endoscopy is performed.

Reply to: insulin resistance and chronic hepatitis C in non-diabetic patients

We appreciate the interest of Dr. Wiwanitkit in our article recently published in Journal of the Brazilian Society of Endocrinology and Metabology. According to the study results, chronic hepatitis C patients with insulin resistance (HOMA IR> 2.5) had more advanced HCV – related liver fibrosis (1). One of the issues considered by Dr. Wiwanitkit is that our results may have been influenced by the other liver diseases. However, as described in the methods section, previous antiviral treatment, co-infection with HBV or HIV, chronic renal disease, DM2, decompensated liver cirrhosis, hepatocellular carcinoma, and alcohol intake above 20 g ethanol/d were exclusion criteria. The second question issue raised by him, is that although theon the fact that it was an observational study, data were submitted to statistical analysis (univariate analysis) and results were considered statistically significant when p < 0.05. Therefore, we found possible to conclude that there was an association between IR and HCV-induced liver fibrosis. We did not analyze in our study whether insulin resistance was independently associated with HCV-induced liver fibrosis.