This study aims to evaluate the accuracy of the PAGE-B and REACH-B scores in predicting the risk of developing HCC in patients with chronic hepatitis B regularly followed up at a reference service in the State of Maranhão. A historical, longitudinal, retrospective cohort study, carried out from the review of medical records of patients with chronic Hepatitis B. PAGE-B and REACH-B scores were calculated and the accuracy of the scores in predicting the risk of HCC in the studied population was evaluated. A total of 978 patients were included, with a median age of around 47 years, most of them female and not cirrhotic. HCC was identified in 34 patients. Thrombocytopenia, high viral load, male gender and age were associated with the occurrence of HCC. The ROC curve for the PAGE-B score showed a value of 0.78 and for the REACH-B score of 0.79. The cutoff point for PAGE-B was 11 points for greater sensitivity and for REACH-B 7.5 points considering greater sensitivity and 9.5 points considering greater specificity. PAGE-B and REACH-B scores were able to predict the risk of developing HCC in the studied population. The use of risk stratification scores is useful to reduce costs associated with HCC screening.

Background/Objectives: Approximately 25% of the world’s population and more than 60% of patients with type 2 diabetes (T2D) have metabolic-dysfunction-associated steatotic liver disease (MASLD). The association between these pathologies is an important cause of morbidity and mortality in Brazil and worldwide due to the high frequency of advanced fibrosis and cirrhosis. The objective of this study was to determine the epidemiologic and clinical-laboratory profile of patients with T2D and MASLD treated at an endocrinology reference service in a state in northeastern Brazil, and to investigate the association of liver fibrosis with anthropometric and laboratory measurements. Methods: A cross-sectional study was performed in a specialized outpatient clinic with 240 patients evaluated from July 2022 to February 2024, using a questionnaire, physical examination, laboratory tests, and liver elastography with FibroScan^®. Results: Estimates showed that women (adjusted OR = 2.69, 95% CI = 1.35–5.35, p = 0.005), obesity (adjusted OR = 2.23, 95% CI = 1.22–4.07, p = 0.009), high GGT (adjusted OR = 3.78, 95% CI = 2.01–7.14, p < 0. 001), high AST (adjusted OR = 6.07, 95% CI = 2.27–16.2, p < 0.001), and high ALT (adjusted OR = 3.83, 95% CI = 1.80–8.11, p < 0.001) were associated with the risk of liver fibrosis even after adjusted analysis. Conclusions: The study findings suggested that female sex and BMI were associated with an increased risk of liver fibrosis, highlighting the importance of comprehensive evaluation of these patients. In addition, FIB-4 and MAF-5 provided a good estimate of liver fibrosis in our population and may serve as a useful tool in a public health setting with limited resources.

Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson’s regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.

O crescente uso dos análogos do receptor do peptídeo semelhante ao glucagon-1 (GLP-1RAs) no tratamento de obesidade e comorbidades associadas tem gerado interesse na avaliação de seus efeitos adversos, especialmente os gastrointestinais. Nesta perspectiva, o presente estudo tem como objetivo analisar os efeitos adversos associados ao uso dos análogos do receptor do peptídeo semelhante ao glucagon-1 (GLP-1RAs), com base em uma revisão sistemática de estudos clínicos. Tratou-se de uma revisão sistemática da literatura, cuja busca de dados foi realizada nas bases PUBMED, LILACS e SCIELO. Inicialmente, foram identificados 1.696 artigos na busca inicial, e após a avaliação dos títulos e resumos, seguida pela seleção e análise detalhada dos artigos, 11 estudos foram considerados elegíveis para compor esta revisão sistemática. A amostra total compreendeu aproximadamente 23.596 indivíduos. Verificou-se uma predominância de participantes do sexo feminino na maioria dos estudos, e a faixa etária dos envolvidos variou, em média, de 14,6 a 69 anos. Os efeitos adversos mais comuns e frequentes são, em sua maioria, leves a moderados, como sintomas gastrointestinais, incluindo náuseas, vômitos, diarreia, constipação, entre outros. Contudo, alguns estudos também identificaram efeitos adversos graves em determinados pacientes, ressaltando a necessidade de monitoramento clínico durante o tratamento. Em conclusão, embora os análogos do GLP-1 apresentem benefícios clínicos significativos, é essencial o acompanhamento contínuo dos pacientes para gerenciar os efeitos adversos, garantindo a segurança e a adesão ao tratamento a longo prazo.

Apesar de que a biópsia hépatica, seja considerada padrão-ouro no estadiamento e diagnostico da fibrose hepática, podemos também utilizar outros mecanismos menos invasivos e de menor custo para conseguir estimativas para tal. Dentre eles podemos citar o APRI e o FIB-4, metodos que utilizam apenas a coleta sanguinea e com dados de laboratorio hepatico e hemograma conseguimos aplicar em escores sensiveis, porem pouco especificos para o estadiamento da fibrose. Objetivo avaliar a acuracia de ambos escores com a biópsia hepática atraves de um estudo restrospectivo, onde 74 pacientes submetidos a fibrose, tiveram seus escores APRI e FIB-4 calculados, após isso seus valores de acuracia foram comparados com os valores da biopsia hepática. Com isso constatamos uma acuracia de 85% no APRI P<0,05 e aproximadamente 88% no FIB-4 P<0,05). Portanto os scores podem ser utilizados, mas devido a baixa especificidade, não podem ser utilizados de forma isolada, devendo ser associado a historia clinica, uma boa anamnese, exame clinico, complementares e em ultima instância, a propria biópsia hepática.

Background and Aim: Liver fibrosis is an important factor affecting organ survival in transplanted patients, but liver biopsy is an invasive technique to use in children without clinical or serological signs of graft damage. Transient elastography (TE) is a new noninvasive technique, validated in adults, that estimates the liver stiffness of a cylindrical section that is 100 fold that of a standard bioptic specimen. We evaluated the feasibility of TE in children after liver transplantation (LT) and we compared it with liver biopsy. Methods: 24 HCV/HBV negative paediatric liver transplant recipients with reliable TE (IQR 60%) were enrolled in the study. All patients had TE and biopsy within a 1 year interval. Bioptic specimens (length range: 1-4.2 cm, at least 4 portal spaces) were evaluated according to the METAVIR score. The cutoff value to use for the identification of significant fibrosis (F ≥ 2) was obtained by the ROC curve analysis. Results: The METAVIR fibrosis stages were: F0 = 7, F1 = 9, F2 = 6, F3 = 1, F4 = 1; the average stiffness was calculated for all the histological fibrosis stages (F0 = 4.72±1.12 kPa, F1 = 4.4±0.64 kPa, F2 = 5.7±2.31 kPa, F3 = 6.8 kPa, F4 = 10.1 kPa). There was a statistically significant correlation between TE and METAVIR (R = 0.571, p = 0.004). The diagnostic accuracy of TE for the diagnosis of fibrosis (F ≥ 2), which was calculated by a comparison between the liver stiffness and METAVIR as gold standard, measured as an area under the curve (AUROC), gave a result equal to 0.715, showing that the method had a good diagnostic performance. A stiffness cutoff of 6.6 kPa was identified as the best value associated with significant fibrosis (F ≥ 2) (sensitivity 62.5%, specificity 100%, PPV 100% and NPV 84.21%). Conclusions: TE is a simple, non-invasive, reliable tool to assess and monitor the progression of liver fibrosis in paediatric transplanted liver patients. If liver stiffness is <6.6 kPa a significant fibrosis can be excluded. Therefore, these results suggest that follow-up liver fibrosis biopsy could be reserved to selected cases with a liver stiffness of ≥6.6 kPa. Further studies are ongoing on larger cohorts.