This study involved the analysis of 112 patients with autoimmune hepatitis (AIH), during which process several specific issues or problems were identified. One subgroup included pregnant patients, and another patients diagnosed at an older age (>65 years). The diagnosis of AIH is not always easy, and the investigations revealed that some patients diagnosed with AIH had features of an overlap syndrome (with primary sclerosing cholangitis) or in fact never had AIH, but as retrospectively diagnosed, had toxic hepatitis masquerading as AIH. Some patients who were initially documented as clearly having chronic hepatitis C, also had autoantibodies in their serum and were (or could have been) incorrectly diagnosed as AIH. The results showed a large variability in symptoms and complaints at the time of diagnosis of AIH. The disorder can present as an acute or chronic disease. In some patients only vague symptoms are reported and in others, the diagnosis is an incidental discovery because of abnormal liver enzymes. In contrast, other patients present with acute liver failure. The diagnosis must be considered in patients with non-viral liver disease with significantly raised ANA and SMA and high serum gammaglobulin concentrations. No fixed age predisposition was found, but rather an even spread over various age groups. The male:female ratio is 1:2.5. This disorder can for the most part be well treated with a combination therapy of corticosteroids and azathioprine. Experience shows that high doses of corticosteroids can cause serious complications, particularly in older patients. A lower dose is mostly adequate, although biochemical normalisation may take longer. In approximately half of the patients, corticosteroid-therapy was discontinued, with azathioprine as the only treatment. The long-term survival of adequately treated patients is almost equal to that of the control group. In the cohort, ten patients died: three who had presented with acute liver failure, two who later developed a hepatocellular carcinoma and one who died because of cerebral lymphoma. Three older patients died of sepsis, possibly co-induced by high doses of steroids. Five patients underwent liver transplantation, of which one died of aspergillosis. / Dissertation (MD)--University of Pretoria, 2011. / Internal Medicine / unrestricted

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, 2014. / Submitted by Ana Cristina Barbosa da Silva (annabds@hotmail.com) on 2015-02-20T15:58:21Z No. of bitstreams: 1 2014_CarolinaDantasRochaXavierdeLucena_Parcial.pdf: 239046 bytes, checksum: 24343f3229bd87027b7fa4c2be8aad64 (MD5) / Approved for entry into archive by Raquel Viana(raquelviana@bce.unb.br) on 2016-03-22T18:48:33Z (GMT) No. of bitstreams: 1 2014_CarolinaDantasRochaXavierdeLucena_Parcial.pdf: 239046 bytes, checksum: 24343f3229bd87027b7fa4c2be8aad64 (MD5) / Made available in DSpace on 2016-03-22T18:48:33Z (GMT). No. of bitstreams: 1 2014_CarolinaDantasRochaXavierdeLucena_Parcial.pdf: 239046 bytes, checksum: 24343f3229bd87027b7fa4c2be8aad64 (MD5) / Em 2011, o Ministério da Saúde publicou uma portaria tornando o preenchimento do Cartão Nacional de Saúde (CNS) obrigatório em 2012. O objetivo deste trabalho é descrever o perfil epidemiológico das Autorizações de Internações Hospitalares (AIH) eletivas de 2012 e analisar descritivamente se a obrigatoriedade do CNS permite uma qualidade da informação do Sistema de Informação Hospitalar (SIH). Trata-se de um estudo de natureza descritiva de delineamento transversal, desenvolvido com incorporação de método quantitativo de pesquisa, em que foram analisadas as AIH eletivas aprovadas de 2012. Para análise dos dados, utilizou-se o software Statistical Package for the Social Sciences (SPSS), através do qual se realizaram análises descritivas de distribuições de frequências e desenvolveu-se um software através do Java para que fosse possível a análise através do CNS de duplicidades de AIH para uma mesma internação. De acordo com este estudo, 54% das AIH eletivas no Brasil em 2012 foram causadas por Doenças do aparelho digestivo, geniturinário, circulatório e neoplasias. Observou-se que mais de 50 mil AIH iniciaram no ano de 2008, resultando em um tempo de permanência de 1.460 a 1.827 dias. Mais de 180 mil foram informadas com motivo de apresentação PERMANÊNCIA, portanto, nestes casos foram geradas mais de uma AIH para uma mesma internação, ocorrendo superestimação do número de internações eletivas no país já que se utiliza o dado de número de internação como sendo o nº de AIH. Conclui-se com este estudo a necessidade de implementação de regras no SIH que permita o registro fidedigno e real de uma internação, qualificando a informação, sendo imprescindível para a epidemiologia, planejamento e gestão. Faz-se necessário ainda, tornar o CNS uma fonte mais segura e fidedigna já que foram encontradas situações de duplicação e erros. Contudo, a implantação da obrigatoriedade do CNS nas AIH no ano de 2012 foi positiva para a qualificação da informação já que permitiu análises que podem ser utilizadas para a tomada de decisão dos gestores dos sistemas estudados. / In 2011 the Brazilian Ministry of Health published a directive that included a filling of the National Health Card (CNS) in 2012. The goal of this study is to describe the epidemiological profile of elective Authorize Hospital Admittance (AIH) and descriptively analyze the requirement of CNS enables quality of information from the Hospital Information System (SIH). This is a descriptive cross-sectional study, developed with the incorporation of the quantitative research method, where we analyzed the AIH approved in 2012. The analysis was performed by SPSS software, through which it conducted descriptive analyzes of frequency distributions and developed a software using Java to make possible the analysis of CNS through the duplicates of AIH for the same hospitalization. According to this study, 54% of elective AIH in Brazil in 2012 were caused by the digestive, genitourinary, circulatory diseases and neoplasms appliance. It was observed that more than 50 000 AIH began in 2008, resulting in a residence time 1460-1827 days. Over 180000 were informed on the occasion of presentation STAY therefore these cases were generated over an AIH for the same hospitalization, occurring overestimation of the number of elective admissions in the country since it uses the given number of hospitalization as the number AIH. The conclusion to this study the need to implement rules in SIH enabling the trusted and true record of a hospital, qualifying information, and essential for epidemiology, planning and management. It is still necessary to make the CNS safer and reliable source since duplication and errors were found. However, the implementation of mandatory CNS in AIH in 2012 was positive for the classification of the information as allowed analyzes that can be used for decision making of managers of the systems studied.

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal