Endothelial biomarkers as predictors for haemodialysis need in severe leptospirosis patients (Weil's disease).

OBJECTIVE: To investigate the prediction ability of vascular injury biomarkers for haemodialysis requirement in patients with severe leptospirosis. METHODS: Prospective study with severe leptospirosis patients hospitalised in Fortaleza, Brazil. Blood samples were collected hospital admission to quantify vascular injury biomarkers: syndecan-1, ICAM-1, VCAM-1, angiopoietin-2 and FGF-23. Two groups were evaluated according to haemodialysis requirement during hospital stay. RESULTS: Twenty-seven patients were included, with a mean age of 39 ± 18 years. 88.9% were males. 53.8% needed haemodialysis and presented higher levels on hospital admission of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/ml; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/ml; p = 0.01), and FGF-23 (291 [56-2031] vs. 10 [10-806] pg/ml; p = 0.021). Syndecan-1 showed significant correlation with creatinine (r = 0.546; p = 0.05) and total bilirubin levels (r = 0.534; p = 0.013) on hospital admission. Angiopoietin-2 showed significant correlation with creatinine levels (r = 0.513; p = 0.009) on hospital admission and with number of haemodialysis sessions (r = 0.406; p = 0.049). No significant correlation was found with FGF-23. Regarding prognostic performance, combined syndecan-1 and angiopoietin-2 levels had a better ability to predict haemodialysis need in patients with severe leptospirosis (AUC-ROC = 0.744 [95% CI: 0.545-0.943] p = 0.035). CONCLUSION: Syndecan-1 and angiopoietin-2 were associated with haemodialysis need in patients with severe leptospirosis and may be useful to improve therapeutic approach and reduce mortality.

Prevalence and factors associated with depression in people living with HIV/AIDS in a Brazilian metropolitan region.

The frequent association between mental disorders and HIV infection may be related to several risk factors. The present study aims to determine the prevalence of depression and its associated factors in people living with HIV/AIDS (PLWHA) who attended four outpatient clinics in Fortaleza, Brazil, between September 2014 and April 2015. In addition to the Mini International Neuropsychiatric Interview questionnaire, which was used to identify the prevalence of depressive disorder, the researchers applied a sociodemographic questionnaire, and the Hamilton Depression Scale to classify the severity of depression. In all, 257 participants were included in the analyses. The overall lifetime prevalence of depression was identified to be 29.2% (19.5% in men and 44.9% in women). The prevalence of a current depressive episode was 18.7%. Mild, moderate, and severe depression was identified in 2.1%, 12.5%, and 85.4%, respectively. The factors related to depression were: gender, marital status, income, educational level, current employment status, and family history of depression. This study highlights the importance of lifetime depression as a disorder of high prevalence in PLWHA, and associated with risk factors that are difficult or impossible to be modified. Early diagnosis and treatment of depression may improve quality of life in PLWHA.

Long-term follow-up of patients with chronic chagas disease and implantable cardioverter-defibrillator.

BACKGROUND/OBJECTIVES: Chronic Chagas heart disease (ChHD) is associated with ventricular tachyarrhythmias and an increased risk of sudden cardiac death. Little is known about the effectiveness of implantable cardioverter-defibrillator (ICD) therapy in this population. The objective of this study was to evaluate the efficacy of ICD in patients with ChHD and to identify predictors of mortality and appropriate ICD shocks. METHODS: The cohort study included 65 patients with ChHD and ICD for primary and secondary prevention of sudden death. The Cox model was applied to evaluate the predictors of mortality, and survival was assessed by Kaplan-Meier analysis. RESULTS: The median age was 56 ± 11.9 years. The median follow-up was 40 ± 26.8 months. Among the patients 23 (36.5%) had appropriate shocks. A total of 13 (20%) patients died (6.1% of annual mortality rate), and there was no sudden death. In univariate Cox model, functional class IV (hazard ratio [HR] = 1.99; 95% confidence interval [CI], 1.05-3.76; P = 0.034), primary prevention (HR = 0.29; 95% CI, 0.09-0.99; P = 0.048), lower education (HR = 2.51; 95% CI, 1.05-5.99; P = 0.038), and ejection fraction <30% (HR = 2.80; 95% CI, 1.09-7.18; P = 0.032) were predictors of worse prognosis (death). In the multivariate Cox model, an ejection fraction <30% and the low education remained predictors of poor prognosis. Predictors of appropriate shocks were not found. CONCLUSIONS: The ICD was effective for the prevention of sudden cardiac death in patients with chronic ChHD. An ejection fraction <30% and low education were predictors of poor prognosis.

Two cases of testicular tuberculosis in HIV patients with distinct clinical presentations.

Genito-urinary tuberculosis (TB) corresponds to the second most common cause of extrapulmonary tuberculosis EPTB worldwide. It is however rare and is often clinically indistinguishable from testicular malignancy and infarction. HIV hugely increases the risk of TB in unusual sites; we present two such cases of testicular tuberculosis. The diagnosis was based respectively on histopathological findings, acid-bacilli smear of biopsy, semen, and culture.

Use of insect repellent as personal protection among women of childbearing age in an arbovirus endemic area in Northeastern Brazil.

OBJECTIVE: To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. METHODS: This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. RESULTS: Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44-4.51); who are employed (OR=1.51; 95%CI 1.12-2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28-2.36) and the media (OR=1.43; 95%CI 1.01-2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29-5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83-4.30) had increased odds for continued use of insect repellent. CONCLUSION: The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period.

[Hypertension in female prisoners in Brazil: far beyond the biological aspects]. / Hipertensão em mulheres presas no Brasil: muito além do biológico.

The scope was to estimate the prevalence of arterial hypertension (AHT) and associated risk factors among female prisoners. Data from the National Health Survey of the Female Prison Population and Prison Guards were used, investigating sociodemographic variables, prison characteristics, health behaviors and conditions. Information was collected through a self-administered questionnaire, and the magnitude of the association was estimated by the odds ratio and 95% confidence interval. Of the 1,327 prisoner participants, 24.4% were hypertensive, the majority were 31 years of age or older (54.6%), and 51.5% self-reported mixed race. After adjustment for associated risk factors in the bivariate analysis, a direct relationship between age and AHT was observed, in which age equal to/over 41 years was independently associated with a 7-fold greater chance of having AHT, compared to those under 25 years of age. Those who self-reported mixed race, had high cholesterol, were obese and were also independently associated with a higher prevalence of AHT. The greater the number of people with whom the inmate shares a cell was associated with a higher prevalence of AHT, but without a dose-response relationship. The conclusion drawn is that age, race, obesity, physical inactivity and stress are risk factors for AHT in female prisoners.

Objetivou-se estimar a prevalência de hipertensão arterial (HA) e os fatores de risco associados em mulheres presas. Utilizou-se dados do Inquérito Nacional de Saúde na População Penitenciária Feminina e em Servidoras Prisionais, investigando-se características sociodemográficas, fatores das prisões, comportamentos e condições de saúde. As informações foram coletadas por meio de questionário autoaplicado, sendo a magnitude da associação estimada por odds ratio e intervalo de confiança de 95%. Das 1.327 participantes, 24,4% eram hipertensas, a maioria tinha 31 anos ou mais (54,6%), 51,5% autorreferiram etnia/cor parda. Após mutual ajustamento pelos fatores de risco associados na análise bivariada, observou-se relação direta e com gradiente entre idade e HA, em que idade igual/maior a 41 anos foi associada independentemente com uma chance sete vezes maior de ter HA, se comparado a quem tem menos de 25 anos. Aquelas que autorreferiram etnia/cor negra apresentaram colesterol alto e estavam obesas, também foram associadas de forma independente com maior prevalência de HA. O maior número de pessoas com que a presa divide cela esteve associado à maior prevalência de há, sem uma relação dose-resposta. Conclui-se que idade, etnia/cor, obesidade, inatividade física e estresse são fatores de risco para HA em mulheres presas.

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007-2021.

BACKGROUND: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. METHODS: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. RESULTS: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). CONCLUSIONS: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control.

Prevalence of trachoma in the non-indigenous Baixo Jaguaribe micro-region, Ceará State, Northeast Brazil.

BACKGROUND: The aim of the current study was to estimate the population prevalence of trachoma in non-indigenous populations in the Baixo Jaguaribe micro-region, in the state of Ceará, northeast region of Brazil, 2021-2022. METHODS: A population-based prevalence survey focusing on detecting cases of trachomatous inflammation-follicular (TF) in children aged 1-9 y and trachomatous trichiasis (TT) 'unknown to the health system' in people aged ≥15 y, was conducted in rural areas of the Baixo Jaguaribe micro-region in the state of Ceará. Indigenous populations will be further researched. RESULTS: There was no detection of cases of TF and TT. In 900 households, 2234 people were examined. In the Baixo Jaguaribe micro-region, females (54.6%; 1219/2234) and the mixed/Pardo-Brazilian ethnicity (68.1%; 1521/2234) predominated. The most commonly reported educational level was elementary and middle school (41.8%; 702/1679). In 56.2% (506/900) of households, there was a source of water within the household. The monthly income range of 50%-100% of the minimum wage predominated in the families of the Baixo Jaguaribe micro-region (43.1%; 388/900). CONCLUSIONS: Although no cases of TF and TT were detected in the Baixo Jaguaribe micro-region in the state of Ceará during the study period, considering the historical endemicity, we emphasise the need for monitoring and sustainability of surveillance actions in areas at risk for trachoma, common contexts for neglected populations.

Positivity of dengue, chikungunya, and Zika infections in women in Northeast Brazil post-Zika epidemic.

The state of Ceará, in the Northeast Region of Brazil, presents the simultaneous circulation of Zika (ZIKV), dengue (DENV) and chikungunya (CHIKV) viruses. In 2017 there were a high number of cases of these three arboviruses, especially CHIKV. Here, we detected the presence of arboviruses ZIKV, DENV and CHIKV and their coinfections in women in endemic regions of the city of Fortaleza, Ceará in a post-Zika epidemic year. Sociodemographic and environmental characteristics associated with arbovirus positivity were also analyzed. Women (n = 1289) between 15 and 39 years old were included. RT-qPCR was performed for virus detection and IgM antibody positivity was also analyzed. One hundred and six (8.3%) participants were positive for one or more arboviruses. Monoinfections (76; 5.9%) were distributed between 22 (1.7%) for ZIKV, 39 (3.1%) for DENV and 15 (1.2%) for CHIKV. Co-infections were detected in 30 (2.3%) of the positive participants and one case with triple infection was found. IgM positivity was found in 2.4% of ZIKV RT-qPCR, 9.6% of DENV and 16.3% of CHIKV. RT-qPCR positivity for arboviruses was associated with low socioeconomic class and presence of a water box sealing in the household. A higher positivity to the three viruses occurred in the month with the lowest wind velocity, which was also preceded by the highest peak of rain and humidity. We identified the simultaneous circulation and co-infection of ZIKV, DENV and CHIKV in Fortaleza in a post-Zika epidemic year. We also highlight the need for continuous epidemiological surveillance combined with molecular diagnostic tools.

Leprosy among female prisoners in Brazil.

To estimate the prevalence of leprosy among Brazilian female prisoners and identify factors associated with the disease. Cross-sectional study conducted between 2014 and 2015 in 15 Brazilian female prisons. The data of 1,327 women were collected using Audio Computer-Assisted Self-Interviewing and dermatological and neurological examination to identify suspicious lesions of leprosy. The average age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and lifetime self-reported prevalence was 7.5%. The variables that were associated with lifetime self-reported leprosy were: women in prison once being twice as likely to have leprosy; white women were 1.4 time more likely to have leprosy than non-white women; women who knew someone with leprosy was 1.9 time more likely to have leprosy; and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people. The leprosy prevalence among female prisoners in Brazil were greater than that found in a Brazilian woman of the general population and show the extremely high vulnerability of this population generated through pre-incarceration poverty, as well as potential transmission in prison.

Health of female prisoners in Brazil.

The majority of the women in prisons comes from the poorest strata of society with limited access to education, income and health services. This contributes to the fact that female prisoners have a higher burden of adverse health events than both male prisoners and women in general population We objectived to estimate the prevalence of different morbidities and risk factors among female prisoners in Brazil. A total of 1,327 women were recruited in this cross-sectional study. Data were collected using a using audio computer-assisted self-interviewing questionnaire, rapid antibody tests and physical examination. The higher prevalences was of syphilis, infection sexually disease, arterial hypertense, asthma, common mental disorders and severe physical violence. Regarding risk factors, 36.3% have good knowledge about HIV, 55.8% were smokers, 72.3% had ever used any illicit drug, 92.1% are sedentary and 92.1% maintained an unhealthy diet. Female prisoners are disproportionately affected by various adverse health conditions. There is a need for an effective surveillance system inside prisons for early diagnosis and treatment.

LIVER TRANSPLANTATION IN HIV PATIENTS: A CASE SERIES FROM THE NORTHEAST REGION OF BRAZIL.

BACKGROUND: The emergence of potent combined highly active antiretroviral therapy (ART) in 1996 changed the natural history of HIV infection, with a significant reduction in mortality due to opportunistic infections but increased morbidity due to chronic cardiovascular, hepatic, and renal diseases. In May 2016, a reference center for liver transplantation in the Northeast of Brazil performed the first liver transplantations (LT) in HIV patients, with five others until 2021. METHODS: The criteria for selection of LT were good adherence and absence of resistance to ART, HIV viral load maximum suppression, T-CD4+ lymphocyte count of more than 100 cells/mm3, and absence of opportunistic infections in the last 6 months. RESULTS: Six liver transplants were performed between May 2016 and May 2021, five men, with a mean age of 53.2 years, and one was a diabetic patient. All patients had access to grafts with short cold ischemia with a mean time of 5 hours and 39 minutes. The 4-month survival rate was 100%, with a range time of follow-up of 4-63 months (mean time of 31 months). The mean pre-transplant T-CD4+ lymphocyte count was 436 cells/mm3. The mean length of hospital stay after transplantation was 16.8 days. One patient presented precocious vena cava thrombosis; another had stenosis of cavocaval anastomosis leading to refractory ascites, renal failure and post-transplant graft dysfunction, and another presented stenosis of choledochal anastomosis. Immunosuppression and prophylaxis were used according to standard protocols, and there were no differences in the profile of infections or rejection after liver transplantation. CONCLUSION: This case series documents good survival and usual transplant procedures for confirmed HIV cases.

Scientometric analysis of research on trachoma in Brazil, 2000-2020.

OBJECTIVE: To analyze the scientometric profile of research on trachoma in Brazil. METHODS: Bibliographic research of publications on trachoma in Brazil indexed by the Scopus database from 2000 to 2020, based on specific criteria. Data on authorship, country of origin, institutions, and keywords were collected and analyzed with analysis of time trends. Bibliographic networks were constructed via a scientometric visualization software-VOSviewer® 1.6.16. RESULTS: We analyzed 42 publications on trachoma in Brazil. The annual average was two articles, with an increase of about 50% during the period. The average number of authors was three per document and school surveys were the most common subject category. Most published articles came from Brazilian institutions (95.2%), mainly those based in Southeast and North Brazil. Of the most productive authors, 10 were mentioned as first author in 26.2% of publications (11/42) and the predominant institutions are based in the state of São Paulo. The term "trachoma" (n = 18) was the most recurrent keyword. CONCLUSION: This first scientometric analysis of research on trachoma in Brazil showed a limited number of studies on this disease. The scientific production slightly increased, although the origin of many studies is geographical areas with lower endemicity of this disease. Greater investments are needed for a better understanding and control of this neglected tropical disease. The analysis of bibliographic production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.

Hypertension among women experiencing incarceration: A comparison with the general female population.

To compare the prevalence and characteristics of hypertension in women experiencing incarceration (WEI) to the general population in Brazil: (1) a prison survey conducted from January 2014 to December 2015 in 15 states, with 1,327 WEI; and (2) a household survey in the 26 states and the Federal District of Brazil administered to women in the general population (WGP). Data analysis used SPSS® version 20.0. The point estimates and the prevalence ratio with their respective confidence intervals were calculated using Poisson regression. Ages in the two populations differed, 27.9% of WGP were over 50, while 7.3% of WEI were. The overall prevalence of arterial hypertension was 31.3% (95% CI: 28.6-34.0) in the WEI and 38.9% (95% CI: 37.8-39.9) for WGP. For individuals under 30, hypertension was found in 22.4% of WEI and 13.4% of WGP. WEI have a higher prevalence of hypertension at an earlier age than the GP. Less education, obesity, using illegal drugs, previous pregnancy, and not using contraceptives were more frequent in this group, revealing the need to implement policies aimed at treating both their hypertension and other health issues in prison.

Impact of a computer system as a triage tool in the management of pulmonary tuberculosis in a HIV reference center in Brazil.

BACKGROUND: The Neural Clinical Score for tuberculosis (NCS-TB) is a computer system developed to improve the triage of presumed pulmonary TB (pPTB). METHODS: A study was performed with cohorts of pPTB patients cared for at a reference hospital in Northeast Brazil. RESULTS: The NCS-TB sensitivity was 76.5% for TB diagnosis, which shortened the time from triage to smear microscopy results (3.3 to 2.5 days; p<0.001) and therapy initiation (6.7 to 4.1 days; p=0.045). CONCLUSIONS: Although the NCS-TB was not suitable as a screening tool, it was able to optimize laboratory diagnosis and shorten the time to treatment initiation.

Clinical aspects of human rabies in the state of Ceará, Brazil: an overview of 63 cases.

INTRODUCTION: Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide. METHODS: We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019. RESULTS: Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%). CONCLUSIONS: Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early post-exposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Death-related factors in HIV/AIDS patients undergoing hemodialysis in an intensive care unit.

HIV-infected patients are at high risk for developing critical diseases, including opportunistic infections (OI), with consequent admission in intensive care units (ICU). Renal disfunctions are risk factors for death in HIV/AIDS patients, and survival rates in patients undergoing hemodialysis are smaller than the ones observed in the general population. In this context, this study aimed to investigate death-related factors in HIV/AIDS patients in an intensive care setting. This is a retrospective cross-sectional study performed through the analysis of medical records from 271 HIV/AIDS-diagnosed patients hospitalized in an intensive care unit of an infectious disease hospital, in Fortaleza, Ceara State, Brazil. Patients were divided into two groups: those who underwent dialysis during hospitalization and those who did not. Clinical and demographic parameters that could be associated with death were evaluated. Results indicated a prevalence of death of 19.1% (CI 95%: 14.8-24.3). The median age of patients was 47 years, with a male predominance (71.3%). The main causes of admission were pulmonary tuberculosis (16.9%), followed by neurotoxoplasmosis (14.9%). In the bivariate analysis, for those that did not undergo dialysis, age, fever, dyspnea, oliguria, disorientation, kidney injury, use of lamivudine and efavirenz, length of hospitalization, CD4 count, WBC count, platelet count, urea, sodium and LDH levels were the associated variables. In those who needed dialysis, the use of stavudine, abacavir and ritonavir, and the length of hospitalization were associated factors. Renal toxicity by the antiretroviral agents and length of hospitalization increased the risk of death among HIV patients under dialysis.

Epidemiology of human rabies in the state of Ceará, Brazil, 1970 to 2019. / Epidemiologia da raiva humana no estado do Ceará, 1970 a 2019.

OBJECTIVE: To describe cases of human rabies in Ceará State, Brazil between 1970 and 2019. METHODS: This was a descriptive study using secondary data from the Ceará State Department of Health and the state reference hospital. RESULTS: Of 171 cases, 75.7% occurred in males, 60.0% in <19-year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0% of cases, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (using the Joinpoint Regression Program, annual percentage change [APC] = 13.7 - 95%CI 4.6;41.5), while between 1978 and 2019 there was a decrease (APC = -6.7 - 95%CI -8.8;-5.9). There was a reduction in transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005). CONCLUSION: This study demonstrates changes in rabies transmission dynamics during the period studied, with a reduction in transmission by dogs and an increase of transmission by sylvatic animals.

Hepatitis B virus genotypes prevalence in patients from hepatology services in Ceará, Brazil.

INTRODUCTION: Hepatitis B virus (HBV) infection is a public health problem; therefore, we aimed to report HBV genotypes in Ceará, Brazil. METHODS: A total of 103 HBsAg-positive samples were subjected to HBV genotyping and subgenotyping. RESULTS: The following genetic compositions of samples were found: F-54% (F2-83.33%), A-40% (A1-65%), D-6%, C2-1%, E-1%, and G-1%. CONCLUSIONS: Some genotypes are only prevalent in certain parts of the world; however, the State of Ceará is a hub for migration and has one of the most important liver transplantation centers in Brazil, which can explain the prevalence of the F genotype.

Physical violence inside female prisons in Brazil: prevalence and related factors.

The present study aims to identify the prevalence of physical violence against female prisoners in Brazil, as well as related factors. This is a cross-sectional national survey conducted in 15 female prisons in five regions of Brazil selected in multiple stages. The following types of analysis were performed: univariate analysis; stratified analysis relating the outcome (suffer physical violence inside prison) to predictor variables, using the Pearson chi-square test; calculation of the Odds Ratio (O.R.); and multiple logistic regression. The Hosmer-Lemeshow test was used for analysis of goodness of fit and adequacy of the model. The prevalence of physical violence inside female prisons was 37.4%. There was a correlation between physical violence victimization in prison and the following variables: physical victimization prior to arrest (p = 0.013), solitary confinement (p = 0.000), mental suffering (p = 0.003), current or previous abusive intake of alcohol (p = 0.011), current or previous injection of cocaine (p = 0.002) and not performing prison labor (p = 0.003). Physical violence has become inherent in the Brazilian female prison system. Continued studies are needed to monitor the situation and to develop  interventions to prevent physical violence inside the facilities.