The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing worldwide. Cirrhotic patients are recommended by the American Association for the Study of Liver Disease (AASLD) to receive HCC screening and surveillance every 6 months to a year. The purpose of this study was to identify the current screening and surveillance patterns for cirrhotic patients with HCC in clinical practice. Hepatocellular carcinoma can be detected by radiological studies in addition to laboratory testing. It is important to implement the AASLD screening guidelines, as early identification might decrease the mortality rate of patients with cirrhosis and HCC. The research question guiding this study was: What are the screening patterns of cirrhotic patients diagnosed with cirrhosis and HCC that have been referred to the Hepatology Division? A retrospective, descriptive, cross-sectional design was used for this study. Data were collected from subjects who were referred to a Specialty Hepatology Division for evaluation and treatment. Approval was obtained from the IRB. Cirrhotic patients diagnosed with HCC meeting the inclusion and exclusion criteria were used in this study. The aim of the study was to identify the clinical patterns of practitioners screening for HCC in cirrhotic patients. Validity and reliability for the data collection tool was not established. Variables that were studied included demographic data, etiology of cirrhosis, type of HCC screening, time increments of screening, and size of tumor at the time of diagnosis. The data were analyzed with the use of crosstabs, frequency, and correlation statistics. Despite the recommended HCC screening and surveillance guidelines cirrhotic patients were not screened. The different screening patterns that were identified were none, sporadic, and annual (every 6 months to 1 year). The patterns differed by the practitioner managing the patient. Also, cirrhosis was diagnosed late in the disease process, although many of the patients are followed by gastroenterologists. It can be assumed that the late diagnosis of cirrhosis was another factor that was preventing the implementation of HCC screening and surveillance. Implications for practice were identified. Practitioners are responsible for performing HCC screening and surveillance of cirrhotic patients based on the recommended guidelines of the AASLD for the management of cirrhotic patients and the detection of small lesions. Only 33% of the patients were screened with the use of ultrasound, and 43% were screened with alpha-fetoprotein. The lesions that were diagnosed were larger in the non-screened patients than the screened patients. The Hepatology Division was the only setting that was screening the patients based on the recommended guidelines. The recommendation based on the results of this study is for all cirrhotic patients to be managed by hepatology services if one is available.

Pacientes no pré-transplante de fígado podem apresentar diversas complicações da cirrose. Uma importante complicação é o hiperesplenismo, que pode resultar no sequestro de leucócitos e na consequente diminuição de neutrófilos e linfócitos, tornando o paciente, teoricamente, mais suscetível a infecções pelos vírus BKV e JCV. Por outro lado, esses pacientes também podem apresentar comprometimento renal (síndrome hepatorrenal) e de sistema nervoso central (encefalopatia hepática). Com complicações como essas e como esses pacientes apresentam-se com a resposta celular imune circulante comprometida, pode ser interessante investigar a presença dos poliomavirus nesses pacientes. O objetivo deste trabalho foi identificar e quantificar os poliomavirus BKV e JCV em saliva, lavado bucal, sangue e urina, de pacientes no pré-transplante de fígado. Para o grupo de estudo foram selecionados, 21, pacientes cirróticos, em fila de transplante de fígado, de ambos os sexos, com idade superior a 18 anos e para o grupo controle foram selecionados 20 pacientes normorreativos, de ambos os sexos, maiores de 18 anos. Nesses pacientes foram realizadas coletas de fluídos, urina, saliva, lavado bucal, e sangue. Após a coleta e congelamento das amostras, foram realizadas pesquisas de detecção e quantificação do poliomavírus humano dos subtipos BK e JC através do método de PCR em tempo real. Quinze pacientes (71,42%) do GE apresentaram-se positivos para o BKV em pelo menos uma amostra, mas nenhum dos pacientes desse grupo apresentou síndrome hepatorrenal. Por outro lado, 66,66% desses pacientes apresentaram encefalopatia hepática, mas, apesar de 10 pacientes serem positivos para o JCV, em nenhum deles foi possível quantificar a carga viral ou associar a presença do vírus com a doença clínica. Quanto às amostras, no GE, 21 (25%) foram positivas para BKV e 10 (11,90%) para JCV e no GC 27 (34,61%) foram positivas para BKV e 6 (7,69%) para JCV. Não houve diferença estatisticamente significante entre os grupos (p=0,52 e p=0,25). No GE encontramos um panorama semelhante ao GC, referente a presença do vírus em lavado, sangue e urina. A maior diferença entre as amostras apresentou-se na identificação do BKV em saliva. Assim foi possível concluir que pacientes cirróticos em fila de transplante hepático não apresentam maior prevalência de BKV ou JCV do que pacientes normorreativos e as complicações da cirrose (encefalopatia hepática e síndrome hepatorrenal) não estão associadas à presença desses vírus. Em pacientes normorreativos os fluídos bucais são equivalentes a urina na detecção do BKV, mas a saliva não é um bom fluido para detecção do BKV em pacientes cirróticos / Patients in the liver pre-transplantation can present several complications of cirrhosis. A major complication is hypersplenism, which can result in sequestration of leukocytes and the consequent decrease of neutrophils and lymphocytes, making the patient theoretically more susceptible to infection by BKV and JCV virus. Furthermore, these patients may also have renal impairment (hepatorenal syndrome) and central nervous system (hepatic encephalopathy). With complications like these and how these patients present with impaired current cellular immune response, it may be interesting to investigate the presence of polyomavirus in these patients. The objective of this study was to identify and quantify BKV and JCV polyomavirus in saliva, oral lavage, blood and urine of patients before liver transplantation. For the study group were selected, 21 cirrhotic patients, liver transplant waiting list, of both sexes, aged over 18 and for the control group were selected 20 normorreativos patients of both sexes, older than 18 years. In these patients fluid collections were performed, urine, saliva, oral lavage and blood. After collecting and freezing the samples were carried out research of detection and quantification of human polyomavirus BK and JC subtypes using the PCR method in real time. Fifteen patients (71.42%) of GE were positive for BKV in at least one sample, but none of the patients in this group had hepatorenal syndrome. Moreover, 66.66% of patients had hepatic encephalopathy, but while 10 patients were positive for JCV, none of them has been able to quantify the viral load or the presence of virus associated with clinical disease. As regards the samples, the GE 21 (25%) were positive for BKV and 10 (11.90%) for JCV and CG 27 (34.61%) were positive for BKV and 6 (7.69%) for JCV . There was no statistically significant difference between groups (p = 0.52 and p = 0.25). The GE find an overview similar to GC concerning the presence of the virus in washed blood and urine. The major difference between samples submitted to the BKV ID saliva. Thus it was concluded that patients with cirrhosis on liver transplant waiting list do not have a higher prevalence of BKV and JCV than normorreativos patients and complications of cirrhosis (hepatic encephalopathy and hepatorenal syndrome) are not associated with the presence of these viruses. In the oral fluid normorreativos patients are equivalent to detection of BKV urine, saliva but is not a good fluid for detection of BKV in cirrhotics

Pacientes no pré-transplante de fígado podem apresentar diversas complicações da cirrose. Uma importante complicação é o hiperesplenismo, que pode resultar no sequestro de leucócitos e na consequente diminuição de neutrófilos e linfócitos, tornando o paciente, teoricamente, mais suscetível a infecções pelos vírus BKV e JCV. Por outro lado, esses pacientes também podem apresentar comprometimento renal (síndrome hepatorrenal) e de sistema nervoso central (encefalopatia hepática). Com complicações como essas e como esses pacientes apresentam-se com a resposta celular imune circulante comprometida, pode ser interessante investigar a presença dos poliomavirus nesses pacientes. O objetivo deste trabalho foi identificar e quantificar os poliomavirus BKV e JCV em saliva, lavado bucal, sangue e urina, de pacientes no pré-transplante de fígado. Para o grupo de estudo foram selecionados, 21, pacientes cirróticos, em fila de transplante de fígado, de ambos os sexos, com idade superior a 18 anos e para o grupo controle foram selecionados 20 pacientes normorreativos, de ambos os sexos, maiores de 18 anos. Nesses pacientes foram realizadas coletas de fluídos, urina, saliva, lavado bucal, e sangue. Após a coleta e congelamento das amostras, foram realizadas pesquisas de detecção e quantificação do poliomavírus humano dos subtipos BK e JC através do método de PCR em tempo real. Quinze pacientes (71,42%) do GE apresentaram-se positivos para o BKV em pelo menos uma amostra, mas nenhum dos pacientes desse grupo apresentou síndrome hepatorrenal. Por outro lado, 66,66% desses pacientes apresentaram encefalopatia hepática, mas, apesar de 10 pacientes serem positivos para o JCV, em nenhum deles foi possível quantificar a carga viral ou associar a presença do vírus com a doença clínica. Quanto às amostras, no GE, 21 (25%) foram positivas para BKV e 10 (11,90%) para JCV e no GC 27 (34,61%) foram positivas para BKV e 6 (7,69%) para JCV. Não houve diferença estatisticamente significante entre os grupos (p=0,52 e p=0,25). No GE encontramos um panorama semelhante ao GC, referente a presença do vírus em lavado, sangue e urina. A maior diferença entre as amostras apresentou-se na identificação do BKV em saliva. Assim foi possível concluir que pacientes cirróticos em fila de transplante hepático não apresentam maior prevalência de BKV ou JCV do que pacientes normorreativos e as complicações da cirrose (encefalopatia hepática e síndrome hepatorrenal) não estão associadas à presença desses vírus. Em pacientes normorreativos os fluídos bucais são equivalentes a urina na detecção do BKV, mas a saliva não é um bom fluido para detecção do BKV em pacientes cirróticos / Patients in the liver pre-transplantation can present several complications of cirrhosis. A major complication is hypersplenism, which can result in sequestration of leukocytes and the consequent decrease of neutrophils and lymphocytes, making the patient theoretically more susceptible to infection by BKV and JCV virus. Furthermore, these patients may also have renal impairment (hepatorenal syndrome) and central nervous system (hepatic encephalopathy). With complications like these and how these patients present with impaired current cellular immune response, it may be interesting to investigate the presence of polyomavirus in these patients. The objective of this study was to identify and quantify BKV and JCV polyomavirus in saliva, oral lavage, blood and urine of patients before liver transplantation. For the study group were selected, 21 cirrhotic patients, liver transplant waiting list, of both sexes, aged over 18 and for the control group were selected 20 normorreativos patients of both sexes, older than 18 years. In these patients fluid collections were performed, urine, saliva, oral lavage and blood. After collecting and freezing the samples were carried out research of detection and quantification of human polyomavirus BK and JC subtypes using the PCR method in real time. Fifteen patients (71.42%) of GE were positive for BKV in at least one sample, but none of the patients in this group had hepatorenal syndrome. Moreover, 66.66% of patients had hepatic encephalopathy, but while 10 patients were positive for JCV, none of them has been able to quantify the viral load or the presence of virus associated with clinical disease. As regards the samples, the GE 21 (25%) were positive for BKV and 10 (11.90%) for JCV and CG 27 (34.61%) were positive for BKV and 6 (7.69%) for JCV . There was no statistically significant difference between groups (p = 0.52 and p = 0.25). The GE find an overview similar to GC concerning the presence of the virus in washed blood and urine. The major difference between samples submitted to the BKV ID saliva. Thus it was concluded that patients with cirrhosis on liver transplant waiting list do not have a higher prevalence of BKV and JCV than normorreativos patients and complications of cirrhosis (hepatic encephalopathy and hepatorenal syndrome) are not associated with the presence of these viruses. In the oral fluid normorreativos patients are equivalent to detection of BKV urine, saliva but is not a good fluid for detection of BKV in cirrhotics