Dendritic Cell-Based Immunotherapies to Fight HIV: How Far from a Success Story? A Systematic Review and Meta-Analysis.

The scientific community still faces the challenge of developing strategies to cure HIV-1. One of these pursued strategies is the development of immunotherapeutic vaccines based on dendritic cells (DCs), pulsed with the virus, that aim to boost HIV-1 specific immune response. We aimed to review DCs-based therapeutic vaccines reports and critically assess evidence to gain insights for the improvement of these strategies. We performed a systematic review, followed by meta-analysis and meta-regression, of clinical trial reports. Twelve studies were selected for meta-analysis. The experimental vaccines had low efficiency, with an overall success rate around 38% (95% confidence interval = 26.7%-51.3%). Protocols differed according to antigen choice, DC culture method, and doses, although multivariate analysis did not show an influence of any of them on overall success rate. The DC-based vaccines elicited at least some immunogenicity, that was sometimes associated with plasmatic viral load transient control. The protocols included both naïve and antiretroviral therapy (ART)-experienced individuals, and used different criteria for assessing vaccine efficacy. Although the vaccines did not work as expected, they are proof of concept that immune responses can be boosted against HIV-1. Protocol standardization and use of auxiliary approaches, such as latent HIV-1 reservoir activation and patient genomics are paramount for fine-tuning future HIV-1 cure strategies.

Mannose binding lectin and mannose binding lectin-associated serine protease-2 genes polymorphisms in human T-lymphotropic virus infection.

Variations in genes involved in the immune response pathways may influence the interaction between viruses (such as Human T-lymphotropic virus, HTLV-1) and the host. The mannose binding lectin (MBL) and its associated serine protease type 2 (MASP-2) promote the activation of the lectin pathway of the complement system. As the interaction of complement system with HTLV-1 is not well understood, the MBL2 promoter/exon 1 polymorphisms and a MASP2 missense polymorphism were examined in a Northeast Brazilian population, looking for a possible relationship between these variations and the susceptibility to HTLV-1 infection. The present study describes an association between a polymorphism in the MASP2 gene and susceptibility to HTLV-1 infection, and provides further evidence of an association between the MBL2 gene and HTLV-1 infection. These findings suggest an important role of the complement system activation, via the lectin pathway, in the susceptibility to HTLV-1 infection.

Gain-of-function STAT1 mutation and visceral leishmaniasis.

Gain-of-function mutations in the STAT1 gene have been initially associated with chronic mucocutaneous candidiasis. However, further research has shown that STAT1 GOF variants may increase susceptibility to infection by other intracellular pathogens. This report describes the first case of disseminated leishmaniasis associated with a STAT1 GOF mutation in a pediatric patient who did not have chronic mucocutaneous candidiasis. The patient was a four-year-old boy presenting with fever, severe asthenia, hepatosplenomegaly, pancytopenia, and liver failure. Bone marrow aspirate revealed hemophagocytosis and Leishmania parasites. Treatment consisted primarily of liposomal amphotericin B, as per the Hemophagocytic Lymphohistiocytosis 2004 protocol. After eight weeks of treatment, the patient did not improve and was submitted to diagnostic splenectomy. Activated macrophages and nodular spleen necrosis secondary to the visceral leishmaniasis were detected. Unfortunately, the patient died in the second week after splenectomy due to overwhelming systemic infection. DNA sequencing revealed a pathogenic (p. R274Q) GOF mutation in STAT1.

Prevalence of Guillain-Barré syndrome among Zika virus infected cases: a systematic review and meta-analysis.

Zika virus (ZIKV) is an emergent flavivirus transmitted mainly through Aedes spp. mosquitoes that is posing challenge to healthcare services in countries experiencing an outbreak. Usually ZIKV infection is mild, but in some cases it has been reported to progress into neurological diseases such as microcephaly in infants and Guillain-Barré syndrome (GBS) in adults. GBS is a debilitating autoimmune disorder that affects peripheral nerves. Since ZIKV caused massive outbreaks in South America in the past few years, we aimed to systematically review the literature and perform a meta-analysis to estimate the prevalence of GBS among ZIKV-infected individuals. We searched PubMed and Cochrane databases and selected three studies for a meta-analysis. We estimated the prevalence of ZIKV-associated GBS to be 1.23% (95% CI=1.17-1.29%). Limitations include paucity of data regarding previous flavivirus infections and ZIKV-infection confirmation issues. Our estimate seems to be low, but cannot be ignored, since ZIKV outbreaks affects an overwhelming number of individuals and GBS is a life-threatening debilitating condition, especially in pregnant women. ZIKV infection cases must be closely followed to assure prompt care to reduce the impact of GBS associated-sequelae on the quality of life of those affected.

HIV and syphilis co-infection in northeast Brazil: a gender assessment / Coinfecção HIV e sífilis no Nordeste do Brasil: uma avaliação de gênero

Objective: this study aimed to determine the frequency and the clinical-epidemiological profile of the human immunodeficiency virus (HIV) and syphilis co-infection between genders in specialized care services in Northeast Brazil. Methods: an analytical cross-sectional study was conducted with secondary data from 171 individuals with HIV and syphilis co-infection. Data were collected in a reference center for acquired immunodeficiency syndrome (AIDS) in Northeast Brazil from 2015 to 2020. Welch's test compared the means of independent samples; the chi-square and Fisher's exact test assessed the association between categoric variables. The significance level was set at 5%. This study has ethical approval. Results: the HIV and syphilis co-infection frequency was 15.4%. Individuals with co-infection had a mean age of 34.2 (± 11.0) years and were predominantly men. The women sample started their sex life earlier, had a lower education level and per capita family income, used more illicit drugs, and were mostly heterosexual, married or in a stable union, and unemployed. Men had more anal sex. Moreover, most individuals had syphilis in the asymptomatic phase and HIV with undetectable viral load; CD4 T cells were greater than 350 cells/mm³. Conclusion: the high prevalence of HIV and syphilis co-infection in specialized care services, especially in men who have sex with men (MSM), highlights the need to improve counseling to reduce sexual risk behavior and improve prevention and care strategies to control these diseases.

Objetivo: este estudo teve como objetivo determinar a frequência e o perfil clínico-epidemiológico da coinfecção pelo vírus da imunodeficiência humana (HIV) e sífilis em ambos os gêneros num serviço de atenção especializada no Nordeste do Brasil. Métodos: trata-se de um estudo transversal, analítico, com dados secundários de 171 pacientes com coinfecção por HIV e sífilis de um centro de referência para síndrome da imunodeficiência adquirida (SIDA) de 2015 a 2020. O teste de Welch foi utilizado para comparar as médias de amostras independentes; os testes qui-quadrado e exato de Fisher avaliaram a associação entre variáveis categóricas. O nível de significância adotado foi de 5%. Este estudo obteve aprovação ética. Resultados: a frequência da coinfecção por HIV e sífilis foi de 15,4%. Os indivíduos tinham idade média de 34,2 (± 11,0) anos e eram predominantemente homens. As mulheres iniciaram a vida sexual mais cedo, tinham menor escolaridade e renda familiar per capita, usavam mais drogas ilícitas e eram, em sua maioria, heterossexuais, casadas ou em união estável, e desempregadas. Os homens praticavam mais sexo anal. A maioria dos indivíduos apresentava sífilis na fase assintomática e HIV com carga viral indetectável, além de células T CD4 superiores a 350 células/mm³. Conclusão: a alta prevalência de coinfecção por HIV e sífilis em serviços de atenção especializada, principalmente em homens que fazem sexo com homens (HSH), evidencia a necessidade de aprimorar o aconselhamento a fim de reduzir comportamentos sexuais de risco e melhorar as estratégias de prevenção e cuidado para o controle dessas doenças.

Gain-of-function STAT1 mutation and visceral leishmaniasis

ABSTRACT Gain-of-function mutations in the STAT1 gene have been initially associated with chronic mucocutaneous candidiasis. However, further research has shown that STAT1 GOF variants may increase susceptibility to infection by other intracellular pathogens. This report describes the first case of disseminated leishmaniasis associated with a STAT1 GOF mutation in a pediatric patient who did not have chronic mucocutaneous candidiasis. The patient was a four-year-old boy presenting with fever, severe asthenia, hepatosplenomegaly, pancytopenia, and liver failure. Bone marrow aspirate revealed hemophagocytosis and Leishmania parasites. Treatment consisted primarily of liposomal amphotericin B, as per the Hemophagocytic Lymphohistiocytosis 2004 protocol. After eight weeks of treatment, the patient did not improve and was submitted to diagnostic splenectomy. Activated macrophages and nodular spleen necrosis secondary to the visceral leishmaniasis were detected. Unfortunately, the patient died in the second week after splenectomy due to overwhelming systemic infection. DNA sequencing revealed a pathogenic (p. R274Q) GOF mutation in STAT1.

Effectiveness of the First Dose of BCG against Tuberculosis among HIV-Infected, Predominantly Immunodeficient Children.

The objective of this study was to estimate the protective effect of Bacille Calmette-Guérin (BCG) vaccine against tuberculosis among (predominantly immunodeficient) HIV-infected children in Angola. A hospital-based case-control study was conducted with 230 cases, children coinfected with tuberculosis, and 672 controls, HIV-infected children from the same hospital, aged 18 months to 13 years. The presence of a vaccination scar was taken as a proxy marker for BCG vaccination. The crude effectiveness was 8% (95% CI: -26 to 32) and the adjusted effectiveness was 30% (95% CI: -75 to 72). The present study suggests that BCG does not have a protective effect against tuberculosis among immunodeficient HIV-infected children. Since BCG is no longer given to HIV-infected children, the study may not be replicated. Accepting that these findings should be considered with caution, they are nonetheless likely to be the last estimate of BCG efficacy in a sufficiently powered study.

Prevalence of Guillain-Barré syndrome among Zika virus infected cases: a systematic review and meta-analysis

ABSTRACT Zika virus (ZIKV) is an emergent flavivirus transmitted mainly through Aedes spp. mosquitoes that is posing challenge to healthcare services in countries experiencing an outbreak. Usually ZIKV infection is mild, but in some cases it has been reported to progress into neurological diseases such as microcephaly in infants and Guillain-Barré syndrome (GBS) in adults. GBS is a debilitating autoimmune disorder that affects peripheral nerves. Since ZIKV caused massive outbreaks in South America in the past few years, we aimed to systematically review the literature and perform a meta-analysis to estimate the prevalence of GBS among ZIKV-infected individuals. We searched PubMed and Cochrane databases and selected three studies for a meta-analysis. We estimated the prevalence of ZIKV-associated GBS to be 1.23% (95% CI = 1.17-1.29%). Limitations include paucity of data regarding previous flavivirus infections and ZIKV-infection confirmation issues. Our estimate seems to be low, but cannot be ignored, since ZIKV outbreaks affects an overwhelming number of individuals and GBS is a life-threatening debilitating condition, especially in pregnant women. ZIKV infection cases must be closely followed to assure prompt care to reduce the impact of GBS associated-sequelae on the quality of life of those affected.

O Paciente e a Vivência da Visita Médica à Beira do Leito / The Patient and the Experience of Bedside Teaching

RESUMO Objetivo Analisar os significados atribuídos pelos pacientes à vivência das visitas médicas realizadas em grupo à beira do leito na enfermaria de Clínica Médica. Método Utilizou-se o método qualitativo, por meio da técnica de entrevistas semiestruturadas. Foram entrevistados 11 pacientes, internados em um hospital-escola localizado no Recife. As entrevistas foram submetidas à técnica de análise de conteúdo, e as categorias analíticas foram embasadas na psicologia da saúde, com enfoque biopsicossocial. Resultados e discussão Os entrevistados perceberam a visita como algo bom, que auxilia na aprendizagem dos estudantes, porém alguns a consideraram algo negativo e desconhecido. Os participantes interpretaram a visita como um espaço dos médicos, do qual eles não devem participar, sendo a comunicação centrada nos médicos e estudantes. Essa postura pode desfavorecer a construção do vínculo médico-paciente e contribuir para um sentimento de passividade dos pacientes. Conclusão Embora a maioria dos pacientes tenha avaliado a visita médica de forma positiva, como a comunicação está centrada nos médicos-estudantes, limita-se a participação do paciente durante a visita médica.

ABSTRACT Objective To analyze the meanings attributed to the experience of bedside teaching in groups on hospital wards. Methods This research used a qualitative method with semi-structured interviews. The sample was composed of eleven patients hospitalized in a hospital in Recife. The interviews were subjected to content analysis and the formation of the categories was based on health psychology, employing a biopsychosocial approach. Results and discussion The participants perceived the bedside teaching as a good thing, which helps the students’ learning, but some considered it as negative and unfamiliar. Furthermore, the participants interpreted the bedside teaching as a space for physicians, in which they should not participate, where communication is centered on the student doctors. This attitude may not favor the construction of the doctor-patient relationship and, thus, contribute to a feeling of passivity among patients. Conclusion Although most the patients evaluated the bedside teaching positively, since communication was focused on the student doctors, it limited the patients’ participation during the activity.

High polymorphism of the MBL2 gene in patients with atopic dermatitis.

BACKGROUND: Low serum levels of mannose-binding lectin (MBL) are determined mainly by variant alleles of the MBL2 gene and it has been suggested that MBL may play a role in the susceptibility to atopic dermatitis (AD). OBJECTIVE: The aim was to investigate the difference of the frequency of MBL2 variant alleles in AD patients and in a group of individuals without AD, and associate the MBL2 alleles with AD severity. METHODS: MBL2 variant allele's frequency was investigated in 131 children with AD and 165 healthy children/adolescents matched by convenience. The severity of disease was graded according to the SCORing Atopic Dermatitis (SCORAD) index. The first exon variants were called "O" and the wild type "A". The variants in the promoter were H/L at -550 and X/Y at -221, determined by Real Time PCR. RESULTS: Children with AD had higher frequency of allele O and the genotypes related to low or deficient levels of MBL, when compared to the healthy group (p = 0.0012 and p < 0.001, respectively), but not with AD severity. CONCLUSION: Low or deficient MBL serum levels determined genetically may contribute to the predisposition for AD, but not for disease severity.

Frequency of primary resistance to antiretroviral drugs and genetic variability of HIV-1 among infected pregnant women recently diagnosed in Luanda-Angola.

The determination of the prevalence of primary resistance to antiretroviral therapy in different places of the world is of extreme importance in molecular epidemiology monitoring, and it can guide the initial patient therapy in a given geographical area. The frequency of drug resistance mutations (DRM) and the genetic variability of HIV-1 isolates from newly diagnosed HIV-infected pregnant women attending the antenatal clinics of the Lucrecia Paim and Augusto N'Gangula maternities, Luanda-Angola, were determined. Thirty five out of 57 samples (61.4%) were sequenced and one mutation associated with resistance to nucleoside reverse transcriptase inhibitors was detected. Additionally, two mutations associated with resistance to non-nucleoside reverse transcriptase inhibitors were also detected. No primary mutations associated with protease inhibitors (PI) were found. Subtypes A1, C, D, F1, G, H, CRF 13, CRF 37, and other mosaics were detected.

[Human papillomavirus cervical infection: viral genotyping and risk factors for high-grade squamous intraepithelial lesion and cervix cancer]. / Infecção cervical por papilomavírus humano: genotipagem viral e fatores de risco para lesão intraepitelial de alto grau e câncer de colo do útero.

PURPOSE: to analyze the characteristics of viral infection and the risk factors for high-grade squamous intraepithelial lesion and cervical carcinoma in women with cervical HPV infection. METHODS: a case-control study was conducted on women with cervical HPV at a Gynecology reference service enrolled at the Public Health System, located in Recife, Northeastern Brazil. The groups of cases (72 women with high-grade squamous intraepithelial lesion or cervical cancer) and controls (176 women with normal Pap smear or benign alterations) were investigated for six viral genotypes (HPV 16, 18, 31, 33, 6, 11) in ecto- and endocervical material using MY09/MY11 primers. The independent variables were ranked in three levels of determination: distal (sociodemographic), intermediate (behavioral) and proximal (previous Pap smear). The homogeneity of proportions was tested (χ2), unadjusted Odds Ratios (OR) were obtained and hierarchical logistic regression was applied to the final model, with adjustment of the effect of each variable to the outcome based on the variables in the same and previous levels of causality. RESULTS: the viral genotype of cervical infection was identified in 76.6% of the 248 women participating in the study. High-risk HPV genotypes (83.4% of cases and 67.1% of controls) were predominant, especially HPV 16 and 31. The distal risk factors identified were: living in a rural area (OR=2.71, 95%CI: 1.18-6.23), less than three years of study (OR=3.97, 95%CI: 2.09-7.54) and family income below two minimum wages (OR=3.30, 95%CI: 1.04-10.51); intermediate: four or more pregnancies (OR=2.00, 95%CI: 1.06-3.76); and proximal: absence of a previous Pap smear (OR=9.74, 95%CI: 2.48-38.28). CONCLUSIONS: genotypes 16 and 31 of cervical HPV infection are predominant among women assisted by the Public Health System in Northeastern Brazil. Socioeconomic and reproductive factors, as well as the absence of cytological screening, represent risk factors for the progression of infection to high-grade squamous intraepithelial lesion and cervical cancer.

Sensitivity and specificity of BCG scar reading among HIV-infected children.

BCG scar has been used as an indicator of vaccination with BCG in the past, but the validity of scar among HIV-positive children is still unknown. The validity of BCG scar reading among such children was estimated, using three different gold standards. The sensitivity ranged from 81.3% (95%-CI: 78.0-84.2) to 91.6% (95%-CI: 88.4-94.0), when the gold standards were, respectively, information from the adult responsible for the child and the vaccination card. The specificity ranged from 90.5% (95% CI: 81.6-95.5) to 94.1% (95% CI: 87.7-97.4), when the gold standards were, respectively, the vaccination card and information from the adult responsible for the child. Reading of BCG scar was shown to be a good indicator for vaccination in the past, among HIV-infected children.

Multilevel analysis of hepatitis A infection in children and adolescents: a household survey in the Northeast and Central-west regions of Brazil.

BACKGROUND: The objectives were to estimate the prevalence of hepatitis A among children and adolescents from the Northeast and Midwest regions and the Federal District of Brazil and to identify individual-, household- and area-levels factors associated with hepatitis A infection. METHODS: This population-based survey was conducted in 2004-2005 and covered individuals aged between 5 and 19 years. A stratified multistage cluster sampling technique with probability proportional to size was used to select 1937 individuals aged between 5 and 19 years living in the Federal capital and in the State capitals of 12 states in the study regions. The sample was stratified according to age (5-9 and 10- to 19-years-old) and capital within each region. Individual- and household-level data were collected by interview at the home of the individual. Variables related to the area were retrieved from census tract data. The outcome was total antibodies to hepatitis A virus detected using commercial EIA. The age distribution of the susceptible population was estimated using a simple catalytic model. The associations between HAV infection and independent variables were assessed using the odds ratio and corrected for the random design effect and sampling weight. Multilevel analysis was performed by GLLAMM using Stata 9.2. RESULTS: The prevalence of hepatitis A infection in the 5-9 and 10-19 age-group was 41.5 and 57.4%, respectively for the Northeast, 32.3 and 56.0%, respectively for the Midwest and 33.8 and 65.1% for the Federal District. A trend for the prevalence of HAV infection to increase according to age was detected in all sites. By the age of 5, 31.5% of the children had already been infected with HAV in the Northeast region compared with 20.0% in the other sites. By the age of 19 years, seropositivity was approximately 70% in all areas. The curves of susceptible populations differed from one area to another. Multilevel modeling showed that variables relating to different levels of education were associated with HAV infection in all sites. CONCLUSION: The study sites were classified as areas with intermediate endemicity area for hepatitis A infection. Differences in age trends of infection were detected among settings. This multilevel model allowed for quantification of contextual predictors of hepatitis A infection in urban areas.

Infecção cervical por papilomavírus humano: genotipagem viral e fatores de risco para lesão intraepitelial de alto grau e câncer de colo do útero / Human papillomavirus cervical infection: viral genotyping and risk factors for high-grade squamous intraepithelial lesion and cervix cancer

OBJETIVO: analisar, em mulheres com HPV em colo do útero, as características da infecção viral e os fatores de risco para lesão intraepitelial de alto grau e carcinoma cervical. MÉTODOS: realizou-se um estudo caso-controle com mulheres com HPV em colo do útero atendidas em serviço de Ginecologia de referência vinculado ao SUS, em Recife, Nordeste do Brasil. No grupo de casos (72 mulheres com lesão intraepitelial de alto grau ou carcinoma cervical) e de controles (176 mulheres com colpocitologia normal ou com alterações benignas), foram pesquisados seis genótipos virais (HPV 16, 18, 31, 33, 6 e 11) em material da ecto- e endocérvice com primers MY09/MY11. As variáveis independentes foram hierarquizadas em três níveis de determinação: distal (sociodemográficas), intermediário (comportamentais) e proximal (realização anterior de colpocitologia). A homogeneidade das proporções foi testada (χ2). Obtiveram-se ORs não ajustadas e, na modelagem final, realizou-se regressão logística hierarquizada com o ajuste do efeito de cada variável sobre o desfecho pelas variáveis do mesmo nível e de níveis anteriores de causalidade. RESULTADOS: em 76,6 por cento das 248 mulheres participantes do estudo, o genótipo viral da infecção cervical foi identificado. Predominaram genótipos de alto risco oncogênico (83,4 por cento nos casos e 67,1 por cento nos controles), principalmente HPV 16 e 31. Foram identificados como fatores de risco (a) distais: residir em zona rural (OR=2,7; IC95 por cento: 1,1-6,2), menos de três anos de estudo (OR=3,9; IC95 por cento: 2,0-7,5) e renda familiar inferior a dois salários mínimos (OR=3,3; IC95 por cento: 1,0-10,5); (b) intermediário: número de gestações igual ou superior a quatro (OR=2,0; IC95 por cento: 1,0-3,7); (c) proximal: ausência de colpocitologia anterior (OR=9,7; IC95 por cento: 2,4-38,2). CONCLUSÕES: em mulheres usuárias do SUS do Nordeste do Brasil predominam os genótipos virais 16 e 31 em infecções cervicais ...

PURPOSE: to analyze the characteristics of viral infection and the risk factors for high-grade squamous intraepithelial lesion and cervical carcinoma in women with cervical HPV infection. METHODS: a case-control study was conducted on women with cervical HPV at a Gynecology reference service enrolled at the Public Health System, located in Recife, Northeastern Brazil. The groups of cases (72 women with high-grade squamous intraepithelial lesion or cervical cancer) and controls (176 women with normal Pap smear or benign alterations) were investigated for six viral genotypes (HPV 16, 18, 31, 33, 6, 11) in ecto- and endocervical material using MY09/MY11 primers. The independent variables were ranked in three levels of determination: distal (sociodemographic), intermediate (behavioral) and proximal (previous Pap smear). The homogeneity of proportions was tested (χ2), unadjusted Odds Ratios (OR) were obtained and hierarchical logistic regression was applied to the final model, with adjustment of the effect of each variable to the outcome based on the variables in the same and previous levels of causality. RESULTS: the viral genotype of cervical infection was identified in 76.6 percent of the 248 women participating in the study. High-risk HPV genotypes (83.4 percent of cases and 67.1 percent of controls) were predominant, especially HPV 16 and 31. The distal risk factors identified were: living in a rural area (OR=2.71, 95 percentCI: 1.18-6.23), less than three years of study (OR=3.97, 95 percentCI: 2.09-7.54) and family income below two minimum wages (OR=3.30, 95 percentCI: 1.04-10.51); intermediate: four or more pregnancies (OR=2.00, 95 percentCI: 1.06-3.76); and proximal: absence of a previous Pap smear (OR=9.74, 95 percentCI: 2.48-38.28). CONCLUSIONS: genotypes 16 and 31 of cervical HPV infection are predominant among women assisted by the Public Health System in Northeastern Brazil. Socioeconomic and reproductive factors, as well ...

Freqüência de testagem rápida para o HIV durante a admissão para o parto em puérperas no Instituto Materno Infantil Prof. Fernando Figueira, IMIP / HIV testing prevalence during antenatal care in women admitted for delivery at the Instituto Materno Infantil Professor Fernando Figueira, IMIP

OBJETIVOS: determinar a prevalência da testagem anti-HIV no pré-natal e internamento para o parto e identificar fatores associados à realização e recebimento do resultado dos testes em parturientes. MÉTODOS: estudo descritivo, com 400 puérperas atendidas no Centro de Atenção à Mulher do IMIP Instituto Materno Infantil Prof. Fernando Figueira, IMIP. RESULTADOS: chegaram à admissão para o parto sem o resultado do teste anti-HIV, 154 (38,5 por cento) mulheres. Dessas, foi solicitado teste rápido em 134 (87,0 por cento), porém só foram colhidos em 130 (84,5 por cento). Observou-se que: o número de consultas realizadas no pré-natal, (p=0,001) o número de profissionais que atenderam a mulher no pré-natal e a escolaridade (p=0,006) tiveram associação significativa com a realização do exame anti-HIV no pré-natal, mas não com o recebimento do mesmo. O aconselhamento e oferecimento do teste tanto no pré-natal como na admissão para o parto também apresentaram associação significativa com a realização do anti-HIV durante o pré-natal. CONCLUSÕES: a prevalência de testagem anti-HIV no pré-natal e/ou na triagem foi satisfatório no aspecto quantitativo, porém o recebimento do resultado tanto no pré-natal quanto na admissão para o parto , bem como o aconselhamento pós-teste, foi aquém do recomendado.

OBJECTIVES: to determine HIV testing prevalence during antenatal care and hospital admission for delivery and identify factors associated to pregnant women testing and results delivery. METHODS: a descriptive study comprised of 400 puerperal women seen at the Women Care Center of Instituto Materno Infantil Professor Fernando Figueira, IMIP. RESULTS: one hundred and fifty four (38.5 percent) women were admitted for delivery without having received the results of the anti-HIV test. One hundred and thirty four women (87.0 percent) had been prescribed a fast HIV test but only 130 were tested (84.5 percent). The following was determined: the number of antenatal medical visits ((p<0,001), the number of professionals providing antenatal care and education level (p=0,006) were significantly associated to anti-HIV testing during antenatal care, but not with results delivery. Counseling and test access during antenatal care and hospital admission for delivery were significantly associated to anti-HIV testing during antenatal care as well. CONCLUSIONS: anti-HIV testing prevalence during antenatal care and/or screening was satisfactory in quantitative terms, however, results delivery during antenatal care, admission for delivery, and post-test counseling fell short of recommendations.

Mortalidade por causas externas de mulheres em idade fértil na cidade do Recife / Mortality due to external causes of woman at childbearing-age, Recife-Brazil

Determinar a prevalencia de morte de mulheres em idade fértil por causas externas na cidade do Recife nos anos de 2001 e 2002. Estudo de corte transversal que analisou 211 mulheres em idade fértil que morreram por causas externas na cidade de Recife-PE, nos anos de 2001 e 2002. Um banco de dados secundário foi construido apartir de informações contidas no Sistema de Informação de Mortalidade (SIM) e no Sistema de Informação de Nascidos Vivos (SINASC) da Diretoria de Epidemiologia e Vigilância a Saúde (DIEVS) da Secretaria Municipal de Saúde. No intuito de caracterizar estas mulheres segundo algumas variáveis contidas na Declaração de Óbito(DO), determinar a freqüencia destes óbitos em relação à gestação, parto e puerpério, verificar se ha influência das causas externas nos calculos dos coeficiêntes de mortalidade materna tardia e calcular o coeficiente de mortalidade por causas externas nas mulheres em idade reprodutiva no período do estudo. As causas externas ocuparam a terceira posição na mortalidade geral feminina em idade rereprodutiva, mas foram a principal causa de morte nas faixas etárias que vão de 10 a 29 anos. Quando analisados os óbitos por tipos de causas externas, observou-se que os homicídios foram os mais freqüentes, com 102 (48.3) óbitos e entre estes os provocados por armas de fogo ocuparam o primeiro lugar com 76 (74.5) dos casos. Os óbitos no período gravídico puerperal foram oito, representando 3.8 da população estudada. Evidenciando a importância das causas externas, para a composição, de um coeficiente maior de mortalidade materna tardia. Os coeficientes de mortalidade por causas externas das mulheres em idade fértil em 2001 e 2002 foram respectivamente 21.1 e 21.0/100.000. Apesar de manter a sua posição relativa no quadro geral da mortalidade, as causas externas, em números absolutos aumentaram, provocando um aumento no coeficiente de mortalidade das mulheres em idade fértil na cidade do Recife na ultima década.

Testagem anti-HIV em parturientes admitidas em uma maternidade-escola na cidade do Recife: Um estudo transversal / HIV Testing in pregnant women on admission for delivery in a teaching-maternity hospital of Recife: A cross-sectional study

RESUMO: O objetivo do estudo foi determinar a prevalência da testage anti-HIV durante o pré-natal e internamente para o parto e identificar fatores associados à realização e recebimento do resultado dos testes em parturientes admitidas numa maternidade de um hospital-escola. Métodos: Estudo tipo corte transversal envolvento 400 puérperas atendidas no Centro de Atenção à Mulher do IMIP. Foram excluídas as mulheres sabidamente HIV positivas antes da gestação. Resultados: Chegaram à admissão para o parto sem o resultado do teste anti-HIV, 154 (38,5por cento) mulheres. Destas, foram solicitadas "teste rápido" em 134 (87,0por cento), porém foram colhidos em 130(84,5por cento). Observou-se que: números de consultas realizadas no pré-natal, número de profissionais que atenderam a mulher no pré-natal, e a escolaridade tiveram associação significativa com a realização do exame anti-HIV no pré-natal mas não com o conhecimento do mesmo. O aconselhamento e oferecimento do teste tanto no pré-natal quanto na admissão para o parto também apresentaram associação significativa com a realização do anti-HIv durante o pré-natal. Conclusões: A prevalência de testagem anti-HIV no pré-natal e/ou na triagem foi satisfatório no aspecto quantitativo, porém o recebimento do resultado tanto no pré-natal quanto na admissão para o parto, bem como o aconselhamento pós-teste, foi aquém do recomendado

Vírus da hepatite G em doadores de sangue anti-vhc positivos do hemocentro de pernambuco / Viremia of hepatitis G virus in blood donors with positive anti-HCV hemocentro of the Pernambuco

O estudo realizado com o objetivo de verificar a ocorrência da viremia do vírus da hepatite G em doadores do sangue com os anticorpos contra o vírus do hepatitis C (anti-HCV), como também descrever fatores epidemiológicos relacionados. Cinquenta e nove doadores de sangue anti-HCV positivos da Fundaçäo de Hematologia e Hemoterapia de Pernambuco (HEMOPE) foram estudados entre 1996 e 1997.A informaçäo foi obtida com a entrevista médica, no momento em que a amostra do sangue era coletada para a detecçäo do HGV-RNA, com a reaçäo em cadeia da polimerase (PCR), e a mediçäo dos níveis do séricos do ALT E do AST. A ocorrência da viremia foi verificada para HGV em 3,4por cento da populaçäo estudada. dos 59 doadores anti-HCV positivos, 89,8por cento eram do sexo masculino e 84, 7 por cento pertenceu a uns grupos de idade mais novos (20-49 anos). A elevaçäo dos níveis do sérico de ALT foi observada em 44,1por cento e de AST em 37,3 por cento dos doadores anti-HCV positivos. Entre os dois doadores anti-HCV E RNA-HGV positivos, um apresentou o aumento dos enzimas hepáticas. os fatores epidemiológicos identificados podem näo estar envolvidos com a infecçäo por HGV, possivelmente por causa do pequeno tamanho da amostra