Prevalence of Hepatitis C Virus Infection in Patients With Renal-Cell Carcinoma.

BACKGROUND: Some studies have demonstrated that the prevalence of chronic hepatitis C virus (HCV) infection is increased in patients with renal-cell carcinoma (RCC). Brazil is considered a low prevalence area for HCV (1.38%). The aim of this study was to evaluate the prevalence of HCV infection in patients with RCC. PATIENTS AND METHODS: A cross-sectional study with retrospective data collection was carried out. Patients more than 18 years old with a histopathologic diagnosis of RCC and who underwent HCV serology were included. Sociodemographic, pathologic, and clinical characteristics were evaluated at the time of patient admission. A descriptive analysis of the data was performed using means accompanied by their respective standard deviations for the continuous variables, and absolute number and frequency for the categorical variables. Comparisons between means were performed by analysis of variance. A chi-square test was used to compare the frequency of categorical variables. P < .05 was considered statistically significant. RESULTS: The prevalence of HCV infection was 4.1% (95% confidence interval, 1.7-8.3). No significant differences in age, sex, ethnicity, schooling, and alcohol or tobacco consumption among HCV- and HCV-negative patients with RCC were observed. CONCLUSIONS: A 3-fold higher prevalence of HCV infection was identified among patients with RCC than in the general Brazilian population. Further studies are required to confirm these data.

Prevalence of hepatitis C virus infection and its impact on the prognosis of head and neck cancer patients.

OBJECTIVE: Several studies have shown a higher prevalence of hepatitis C virus (HCV) infection among patients with head and neck cancer (HNC) compared to the general population. In Brazil, the prevalence of HCV infection is considered low (1.38%). The aim of this study was to determine HCV prevalence and how this can modify outcomes of patients with HNC. STUDY DESIGN: Retrospective cohort. METHODS: Patients with a diagnosis of malignant neoplasm in the head and neck (HN) region and who had serology performed for HCV were included. Patients were classified into two groups: head and neck squamous cell carcinoma (HNSCC) and other head and neck malignant neoplasms (OHNMN). Descriptive statistics were performed for all variables of interest. Means were compared using ANOVA and proportions using chi-square tests. Survival data were compared by Kaplan-Meier curves and log-rank test. RESULTS: Global HCV prevalence in patients with HNC was 7.8%, reaching 12.8% in HNSCC and 3.4% in OHNMN (p = 0.003). There was a higher risk of developing a second primary neoplasm in HNSCC compared to OHNMN patients (20.6% versus 4.6%; p = 0.001). The mean survival was not different between HCV-positive and HCV-negative patients (6.0 years versus 6.6 years, respectively, p = 0.516). CONCLUSION: The prevalence of HCV infection was higher in HNC patients compared to the general Brazilian population. It seems reasonable to consider that HCV infection is associated with an increased risk of HNC, but HCV infection does not worsens the prognosis of HNC patients.

Conventional and liquid-based cytology (Liqui-PREP™) anal findings in male HIV anoreceptive patients in a referral University hospital in Rio de Janeiro, Brazil / Achados de citologia convencional e de citologia em base líquida (Liqui-PREP®) anal em pacientes masculinos HIV soropositivos anorreceptivos, em um hospital universitário de referência do Rio de Janeiro, Brasil

Introduction: The anal lesions seem to have a natural history that closely resembles cervical lesions, with signs that precede the invasion. Cytological changes of anal epithelium induced by HPV can be detected through cytology, as it is considered an effective screening method. Objective: To identify the frequency of atypical epithelial conventional cytology results by comparing anal samples through Liqui-PREPTM technology in HIV-positive men. Methods: Cross-sectional descriptive and analytical study of 33 men who have sex with men (MSM), HIV-positive and anoreceptive attended at the Gaffrèe and Guinle University Hospital (HUGG), Rio de Janeiro, from June to July, 2016. Collection of anal samples for the conventional cytology and Liqui-PREPTM cytology was carried out. For significance of findings, Fisher exact test with 95% confidence interval was used and cytological Kappa index was employed for concordance between the two cytological methods. Results: The age ranged from 23 to 60 years (mean=39.06). The CD4 cell count was between 200 to 500/mm3 on 16 (48.5%) and 13 (39.4%), and 50% was diagnosed with HIV for more than 6 years. In conventional cytology one case was considered unsatisfactory (3%). Among the cases considered satisfactory, 9 (28.1%) were diagnosed with ASC-US; 4 (12.5%) LSIL; 2 (6.3%) ASC-H, and 2 (6.3%) HSIL. Through Liqui-PREPTM method, 7 cases were considered unsatisfactory (21.2%). Among the satisfactory cases, 7 showed ASC-US (26.9%); 4 (15.4%) ASC-H; 2 (7.7%) LSIL; and 2 (7.7%) HSIL. The difference of unsatisfactory cases between both methods, although higher for Liqui-PREPTM, was not statistically significant (p=0.054). The correlation was moderate (0503; p<0.006 [0.1765­0.8298]). Conclusion: The cytologic atypia is common among MSM HIV (+), and the anal conventional cytology and liquid by Liqui-PREPTM cytology are equivalent, although they are more unsatisfactory in the latter technique.

Introdução: As lesões anais parecem ter uma história natural, que se assemelha às de lesões de colo uterino, com sinais que precedem a invasão. As alterações citológicas do epitélio anal induzidas pelo HPV podem ser detectadas por citologia, um método de rastreio considerado efetivo. Objetivo: Identificar a frequência de atipias epiteliais nos resultados da citologia convencional comparando amostras anais pela tecnologia Liqui-PREP® em homens HIV positivos. Métodos: Estudo transversal, descritivo e analítico de 33 homens que fazem sexo com homens (HSH), HIV positivos e anorreceptivos atendidos no Hospital Universitário Gaffrèe e Guinle (HUGG), Rio de Janeiro, no período de junho a julho de 2016. Os pacientes foram submetidos à coleta de amostras anais para citologia convencional e citologia Liqui-PREP®. Para significância de achados, foi usado o teste exato de Fisher com intervalo de confiança de 95%, e para concordância entre os dois métodos citológicos, foi utilizado o índice de Kappa. Resultados: A idade variou de 23 a 60 anos (média=39,06). A contagem de células CD4 foi entre 200 e 500/mm3 para 16 (48,5%) e 13 (39,4%) dos casos analisados, e 50% tinham o diagnóstico de HIV há mais de seis anos. Na citologia convencional, um caso foi considerado insatisfatório (3%). Entre os casos considerados satisfatórios, 9 (28,1%) foram diagnosticados como células escamosas atípicas de significado indeterminado possivelmente não neoplásicas (ASC-US); 4 (12,5%) como lesão intraepitelial de baixo grau (LSIL); 2 (6,3%) como células escamosas atípicas não sendo possível excluir lesão intraepitelial de alto grau (ASC-H) e 2 (6,3%) como lesão intraepitelial de alto grau (HSIL). Pelo método Liqui-PREP®, 7 casos foram considerados insatisfatórios (21,2%). Entre os casos satisfatórios, 7 como ASC-US (26,9%); 4 (15,4%) como ASC-H; 2 (7,7%) como LSIL e 2 (7,7%) como HSIL. A diferença de insatisfatório entre os métodos, embora maior para Liqui-PREP®, não foi estatisticamente significativa (p=0,054). A concordância foi moderada (0,503; p<0,006 [0,1765­0,8298]). Conclusão: É frequente a atipia citológica entre HSH HIV (+), e as citologias anal convencional e em meio líquido pela técnica Liqui-PREPTM se equivalem, embora sejam mais insatisfatórias na técnica citológica Liqui-PREP®.

An unusual case of bacillary angiomatosis in the oral cavity of an AIDS patient who had no concomitant tegumentary lesions - case report and review.

Bacillary angiomatosis (BA) is an angioproliferative disease of immunocompromised patients that usually presents as vascular tumors in the skin and subcutaneous tissues. It is caused by chronic infections with either Bartonella henselae or B. quintana. Oral cavity BA is exceedingly rare and even rarer without simultaneous cutaneous disease. We report herein the case of a 51-year-old HIV-infected man who presented severe odynophagia and an eroded lesion on the hard palate that progressed to an oronasal fistula. No cutaneous lesions were recorded. Doxycycline led to complete resolution. To the best of our knowledge, only six previous cases of oral BA without tegumentary disease have been previously reported and none of them progressed to fistula.

Facial botryomycosis-like pyoderma in an HIV-infected patient: remission after initiation of darunavir and raltegravir

Abstract Botryomycosis is an uncommon, chronic, suppurative, bacterial infection that primarily affects the skin and subcutaneous tissues. It has long been associated with defects of cellular immunity. We report a 28-year-old woman who presented with a chronic, ulcerated lesion with draining sinuses in the right malar region. Predisposing factors were HIV infection with poor immunological control, alcoholism, and a previous trauma to the right cheek. Several courses of antimicrobial therapy provided only partial and temporary remission. Complete clinical remission was only achieved 5 years later when a novel antiretroviral regimen composed of darunavir and raltegravir was initiated.

Association between antiretrovirals and thyroid diseases: a cross-sectional study

Objective This study aims to estimate the prevalence of thyroid diseases and anti-TPO status. We searched for an association among presence of immune reconstitution and use of stavudine, didanosine and protease inhibitors with thyroid diseases. Materials and methods A cross-sectional study was performed to analyze the records of 117 HIV-infected patients who had their CD4+ cell count, viral load, anti-TPO, TSH and free T4 levels collected on the same day. Immune reconstitution was considered in those whose T CD4+ count was below 200 cells/mm3, but these values increased above 200 cells/mm3 after the use of antiretrovirals. The odds ratio obtained by a 2x2 contingency table and a chi-square test were used to measure the association between categorical variables. Results The prevalence of thyroid disease was 34.18%; of these, 4.34% were positive for anti-TPO. There was an association of risk between stavudine use and subclinical hypothyroidism (OR = 4.19, 95% CI: 1.29 to 13.59, X2 = 6.37, p = 0.01). Immune reconstitution achieved protection associated with thyroid disease that was near statistical significance OR = 0.45, 95% CI: 0.19 to 1.04, X2 = 3.55, p = 0.059. Conclusion The prevalence of thyroid disease in the sample studied was higher than what had been found in the literature, with a low positive anti-TPO frequency. The historical use of stavudine has an association of risk for the presence of subclinical hypothyroidism, and immune reconstitution has trends towards protection for the presence of thyroid diseases. .

Pyoderma Gangrenosum Simulating Necrotizing Fasciitis.

Pyoderma gangrenosum received this name due to the notion that this disease was related to infections caused by bacteria in the genus Streptococcus. In contrast to this initial assumption, today the disease is thought to have an autoimmune origin. Necrotizing fasciitis was first mentioned around the fifth century AD, being referred to as a complication of erysipelas. It is a disease characterized by severe, rapidly progressing soft tissue infection, which causes necrosis of the subcutaneous tissue and the fascia. On the third day of hospitalization after antecubital venipuncture, a 59-year-old woman presented an erythematous and painful pustular lesion that quickly evolved into extensive ulceration circumvented by an erythematous halo and accompanied by toxemia. One of the proposed etiologies was necrotizing fasciitis. The microbiological results were all negative, while the histopathological analysis showed epidermal necrosis and inflammatory infiltrate composed predominantly of dermal neutrophils. Pyoderma gangrenosum was considered as a diagnosis. After 30 days, the patient was discharged with oral prednisone (60 mg/day), and the patient had complete healing of the initial injury in less than two months. This case was an unexpected event in the course of the hospitalization which was diagnosed as pyoderma gangrenosum associated with myelodysplastic syndrome.

First case of attochthonous human visceral leismaniasis in the urban center off rio de janeiro: caserreport / Primeiro caso de leishmaniose visceral humana de transmissao autoctone no centro urbano do Rio de Janeiro: relato de caso

Visceral leishmaniasis is an anthropozoonosis that is caused by protozoa of the genus Leishmania, especially Leishmania (Leishmania) infantum, and is transmitted to humans by the bite of sandflies of the genus Lutzomyia, such as Lutzomyia longipalpis. There are many reservoirs, including Canis familiaris. It is a chronic infectious disease with systemic involvement that is characterized by three phases: the initial period, the state period and the final period. The main symptoms are fever, malnutrition, hepatosplenomegaly, and pancytopenia. This article reports a case of a patient diagnosed with visceral leishmaniasis in the final period following autochthonous transmission in the urban area of Rio de Janeiro. The case reported here is considered by the Municipal Civil Defense and Health Surveillance of Rio de Janeiro to be the first instance of autochthonous visceral leishmaniasis in humans in the urban area of this city. The patient was discharged and is undergoing a follow-up at the outpatient clinic, demonstrating clinical improvement.

A leishmaniose visceral é uma antropozoonose causada por protozoários do gênero Leishmania, principalmente Leishmania (Leishmania) infantum e transmitida ao homem pela picada do flebotomíneo do gênero Lutzomyia, destacando-se no Brasil a Lutzomyia longipalpis. Os animais reservatórios são muitos, tendo o cão doméstico (Canis familiaris) como principal reservatório. Trata-se de uma doença infecciosa crônica, de envolvimento sistêmico e caracterizado por três fases: período inicial, período de estado e período final. As principais manifestações são febre, hepatoesplenomegalia, desnutrição e pancitopenia. Este artigo tem como objetivo relatar o caso de paciente diagnosticada com leishmaniose visceral em período final, de transmissão autóctone na área urbana da cidade do Rio de Janeiro. O caso relatado neste artigo é considerado, após investigação, pela Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro como o primeiro caso autóctone de leishmaniose visceral em humanos na área urbana da cidade do Rio de Janeiro. O tratamento oferecido foi eficaz e a paciente encontra-se em acompanhamento ambulatorial.

Severe shoulder tendinopathy associated with levofloxacin

Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy / Gota aguda como manifestação da síndrome inflamatória de reconstituição imune após início de terapia antirretroviral

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

A síndrome inflamatória da reconstituição imune (IRIS) observada quando do início da terapia antirretroviral em indivíduos com infecção pelo HIV envolve mais comumente manifestações novas ou piora clínica de desordens infecciosas, previamente subclínicas ou não. Muito mais raras são as descrições de casos de IRIS de natureza não-infecciosa, embora representem importantes desafios ao diagnóstico e tratamento. Neste relato descrevemos um paciente HIV-positivo do sexo masculino, de 34 anos, sem antecedentes de gota e que desenvolveu monoartrite de gota um mês após início de terapia antirretroviral de alta atividade.

Effect of sociodemographic, clinical-prophylactic and therapeutic procedures on survival of AIDS patients assisted in a Brazilian outpatient clinic

The Brazilian AIDS Program offers free and universal access to antiretroviral therapy. This study investigates the influence of sociodemographic, clinical-prophylactic and therapeutic factors on survival, after AIDS diagnosis, in an open cohort of 1,420 patients assisted in a university hospital in the city of Rio de Janeiro (1995 _ 2002). Kaplan-Meier and Cox proportional hazards models were used to estimate the effect of variables in the three dimensions studied. The overall survival time of the upper quartile was 24 months (CI95 percent= 20.5-27.5), increasing from 14 months, in 1995, to 46 months, in 1998. We found a protective effect of heterosexual behavior against death that could be attributed to the increasing female-to-male sex ratio in the cohort, which coincided with the time of therapy introduction. Low schooling, hospital admission and lack of follow-up were identified as risk factors for death; PCP and Toxoplasmosis prophylaxis were protective. The number of attempts required to consolidate the antiretroviral therapy showed no significant effect on survival. The full model, which includes the number of antiretroviral drugs in the regimen, confirmed the triple therapy as the best regimen. This study brings important information for designing guidelines to deal with different aspects related to the practical management of patients and their behavior, thus contributing to the success of the program of free access to antiretroviral therapy implemented in Brazil.

Epidemiologia molecular do vírus da imunodeficiência humana do tipo I: métodos de inferência filogenética / Epidemiology molecular of the human immunodeficiency virus type I: approaches of inferring phylogenies

O crescimento das bases de dados moleculares referentes ao vírus da imunodeficiência humana do tipo I (HIV-1) aumentou progressivamente desde 1991. Pesquisadores do mundo inteiro têm se dedicado ao seqüenciamento de diferentes regiões do genoma do HIV visando elucidar o processo evolutivo viral. Supõe-se que este processo evolutivo esteja na base da pesquisa que determinará a produção de vacinas eficazes além de novas drogas para o combate da Aids. Neste trabalho, procuramos introduzir alguns aspectos da epidemiologia molecular do HIV-1 enfatizando a distribuição global dos seus subtipos e os métodos de inferência filogenética utilizados no estudo de sua evolução. Apresentamos, como aplicação dos métodos de inferência filogenética, um artigo intitulado (Epidemiologia Molecular do Sub-subtipo F1 do HIV-1), onde discutimos a epidemiologia molecular do sub-subtipo F1 buscando comparar as epidemias deste sub-subtipo no Brasil e na Romênia.

Fatores de integraçäo com a progressäo da infecçäo HIV / Integration factors with the progression of HIV infection

Fatores de interaçäo importantes, como resposta imune inicial, carga viral, virulência dos subtipos de HIV-1, componentes genéticos, ativaçäo inespecífica do sistema imune, aspectos biológicos e comportamentais, quanto dinâmica viral e alvos viscerais foram abordados. Discutiu-se ainda os principais fatores que podem influenciar o curso e a progressäo da infecçäo HIV.

Sindrome de imunodeficiencia adquirida: aspectos epidemiologicos e clinicos (estudo de 26 pacientes) / Acquired immunodeficiency syndrome: epidemiological and clinical aspects (study of 26 patients)

Os autores mostram o estudo de 26 pacientes portadores de SIDA, internados no Hospital Universitário Gaffree e Guinle durante os últimos anos. Apresentam dados epidemiológicos (sexo, cor, idade, proveniência, grupo de risco) e tambem duraçäo da doença, sinais e sintomas que motivaram a internaçäo, intercorrências observadas durante o período de doença e causa mortis. Fazem revisäo bibliográfica e procuram comparar os dados obtidos na literatura com os resultados encontrados em seu estudo. É evidenciada a importância das pneumopatias infecciosas como as complicaçöes fatais mais frequentes, e enfatizam sua profilaxia como condiçäo capital e indispensável ao controle desses pacientes