Hepatitis A in Latin America: The current scenario.

This review aims to gather and disseminate updated information regarding hepatitis A virus (HAV) in Latin America (LA) in the last 11 years, including seroprevalence, post-vaccination studies, virus detection in aqueous matrices and food samples, and outbreak reports. Only 24 seroprevalence studies were published between 2012 and 2023 with 55%-100% reported prevalences of anti-HAV IgG. Among the 25 LA countries, only eight of them have introduced HAV vaccines into their immunisation programs. Outbreaks of hepatitis A occurred between 2017-2019, mainly affecting men who have sex with men in Argentina, Brazil and Chile, probably as a consequence of the abrupt decline of young adults' immunity. This could be due to that young adult have never been infected in childhood (due to socio-health improvements) and are above the cut-off ages to be included when the vaccination programs were introduced. Although scarce, studies focused on environmental and food HAV surveillance have shown viral presence in these samples. Surface waters presented HAV detections between 1.2% and 86.7%, and untreated wastewaters between 2.8% and 70.9%. Genotypes found in all cases were IA and IC. The only wastewater-based epidemiology study showed to be a useful tool as a complement of traditional epidemiological surveillance. Only four LA countries have looked for HAV in food samples, with genome detection rates between 9% and 33%. Latin American HAV circulation scenario is changing. In countries where socioeconomic and sanitary conditions have not improved, the virus persists with high endemicity and the access to the vaccine should be re-evaluated by local governments. In countries where access to clean water, better sanitary conditions and HAV immunisation programs have been implemented, the number of cases among young adults seems to be increasing, alerting health authorities.

Expression of MicroRNAs in Adults with Celiac Disease: A Narrative Review.

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of proline- and glutamine-rich proteins, widely termed "gluten", in genetically susceptible individuals. CD induces an altered immune response that leads to chronic inflammation and duodenal mucosal damage. Currently, there are no specific tests for the accurate diagnosis of CD, and no drugs are available to treat this condition. The only available treatment strategy is lifelong adherence to a gluten-free diet. However, some studies have investigated the involvement of microRNAs (miRNAs) in CD pathogenesis. miRNAs are small noncoding ribonucleic acid molecules that regulate gene expression. Despite the growing number of studies on the role of miRNAs in autoimmune disorders, data on miRNAs and CD are scarce. Therefore, this study aimed to perform a literature review to summarize CD, miRNAs, and the potential interactions between miRNAs and CD in adults. This review shows that miRNA expression can suppress or stimulate pathways related to CD pathogenesis by regulating cell proliferation and differentiation, regulatory T-cell development, innate immune response, activation of the inflammatory cascade, focal adhesion, T-cell commitment, tissue transglutaminase synthesis, and cell cycle. Thus, identifying miRNAs and their related effects on CD could open new possibilities for diagnosis, prognosis, and follow-up of biomarkers.

Implementation of a re-linkage to care strategy in patients with chronic hepatitis C who were lost to follow-up in Latin America.

To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.

Immunosuppression and Malignant Neoplasms: Risk-Benefit Assessment in Patients with Inflammatory Bowel Disease.

BACKGROUND The treatment of inflammatory bowel disease aims to induce and maintain disease remission, avoid complications, and restore quality of life. The treatments include the use of immunosuppressants and biological therapy. Despite the effectiveness of these treatments in controlling disease activity and in limiting complications, there remains an increased risk of developing malignancies. CASE REPORT A 70-year-old male patient with ulcerative colitis who had pancolitis was initially treated with mesalazine. In 2010, the medication was changed to azathioprine due to clinical disease activity. The patient demonstrated clinical and endoscopic response to the medication, but presented recurrent facial lesions identified as non-melanoma skin cancer in 2014, 2015, and 2016. Azathioprine was discontinued and anti-TNF therapy was started, but no satisfactory clinical or endoscopic response was observed. The patient developed hematuria and a ureter tumor was found with subsequent ureteronephrectomy. Moreover, the patient underwent total colectomy with ileostomy as a treatment for refractory ulcerative colitis. CONCLUSIONS Immunosuppressive therapy can facilitate the development of malignant neoplasms, accelerate tumor growth, and favor the onset of metastases. The types of tumors most associated with its use are lymphoproliferative tumors and non-melanoma skin cancer. The benefits of adequate control of inflammatory bowel disease are clear and the use of immunosuppressants should not be limited by these potential adverse outcomes; however, the risk-benefit profile of immunosuppression should always be assessed on a case-by-case basis.

Recovery from COVID-19 Pneumonia in a Patient with Acute Severe Colitis.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has increased concern regarding SARS-CoV-2 infection in inflammatory bowel disease (IBD) patients, especially those on immunosuppressive therapies or with active disease. There are limited reports describing the clinical features of COVID-19 in an IBD population, and the impact of immunosuppression on the severity of the infection remains unclear. CASE REPORT: A 33-year-old female patient with a long history of ulcerative colitis, poorly controlled, was admitted with COVID-19 a few days after being discharged from the hospital for treatment of acute severe ulcerative colitis. High-risk factors for COVID-19 complications, i.e., high-dose steroids (40 mg prednisone) and severe active disease, were present at admission. Despite the development of extensive pulmonary involvement, the patient had a favorable outcome. DISCUSSION: Management of IBD patients during the COVID-19 pandemic has been challenging. Measures to minimize the potential risk of SARS-CoV-2 infection, including strict social distancing and self-isolation, in the IBD population have been recommended, especially for high-risk patients. Although steroid tapering and persistence of biologics are advised by professional groups, the best treatment strategy for IBD patients presenting a flare during the outbreak has yet to be defined.

Estudantes de medicina sabem cuidar da própria saúde? / Do medical students know how to care for their own health?

Vários estudos mundiais mostram que estudantes de medicina têm adotado um estilo de vida pouco saudável, apesar dos conhecimentos adquiridos durante a graduação. Em nosso estudo utilizamos questionário da National College Health Risk Behavior Survey ­ Estados Unidos da América, 1995, validado, desenvolvido pelo Centers for Disease Control and Prevention. Aplicamos os questionários em quatro turmas totalizando amostra de 324 estudantes (estudo observacional transversal). 9% dos acadêmicos já pensaram em suicídio; 96% já experimentaram bebida alcoólica; 25% já experimentaram droga ilícita, sendo 64% antes de ingressar na faculdade; 21% não usaram ou usaram raramente preservativo no último mês; 51% consideraram que sua alimentação piorou após ingresso na faculdade; 43% não realizaram qualquer atividade física no último mês. Assim, são necessárias medidas de intervenção no transcorrer da graduação que melhorem substancialmente a compreensão das boas práticas de saúde.

Paracoccidioidomicose subaguda abdominal em paciente adulto imunocompetente: relato de caso / Abdominal subacute paracoccidioidomycosis in an immunocompetent adult patient: case report

JUSTIFICATIVA E OBJETIVOS: A paracoccidioidomicose é uma doença fúngica, granulomatosa crônica, que acomete principalmente os pulmões, o sistema linfático e a pele. Pode ser dividida nas formas aguda e subaguda, que ocorre principalmente em crianças e acomete preferencialmente pele e sistema linfático e, crônica que ocorre principalmente em adultos, particularmente no pulmão. O objetivo deste estudo foi apresentar a manifestação da paracoccidioidomicose subaguda em adulto jovem imunocompetente.RELATO DO CASO: Paciente do sexo feminino, 29 anos, internada para investigação de dor abdominal, sendo diagnosticada paracoccidioidomicose subaguda. Apresentou colestase intra-hepática, devido à linfoadenomegalia intra-abdominal. Evoluiu sem complicações após tratamento instituído.CONCLUSÃO: O caso relatado reflete uma manifestação incomum,em adulto jovem, residente em zona urbana, das formas aguda e subaguda de paracoccidioidomicose, com acometimento linfonodal profundo intra-abdominal causando colestase intra-hepática, icterícia e anemia.

BACKGROUND AND OBJECTIVES: Paracoccidioidomycosis is a chronic, fungal, granulomatous disease, which mainly affects the lungs, lymphatic system and skin. It can be divided into acute and subacute, occurring primarily in children and affecting mainly the skin and lymphatic system, and chronic, occurring primarily in adults and affecting mainly the lungs. This report describes the manifestation of subacute paracoccidioidomycosis in an immunocompetent young adult.CASE REPORT: Female patient, 29 year-old, imunocompetent, hospitalized with abdominal pain, was diagnosed with subacute paracoccidioidomycosis. She showed intrahepatic cholestasis due to intra-abdominal lymphadenopathy. She presented uneventful recovery after treatment.CONCLUSION: This case reflects an unusual manifestation in young adults living in urban areas of the subacute/acute paracoccidioidomycosis, with deep intra-abdominal lymphadenopathy causing intrahepatic cholestasis, jaundice and anemia. There was improvement after treatment

Diabetes mellitus tipo 1 de curta duração e suas implicações sobre a qualidade de vida / Type 1 diabetes mellitus short term and its implications on the quality of life

Objetivo: O diabetes mellitus tipo 1 representa condição crônica de saúde frequente na população pediátrica e possui impacto significativo sobre qualidade de vida destes indivíduos. O objetivo do presente estudo é avaliar a qualidade de vida em indivíduos com diabetes mellitus tipo 1 de curta duração, sob a ótica dos pacientes e dos seus cuidadores. Métodos: Aplicação dos questionários PedsQL 4.0 e Instrumento de Qualidade de Vida para Jovens com Diabetes. Resultados: Dentre os 15 pacientes (e seus cuidadores) avaliados, observou-se que a maior parte dos indivíduos entrevistados considerou sua saúde como boa, em relação à das demais pessoas e a autopercepção da qualidade de vida não se mostrou, de forma geral, prejudicada pelo diabetes. Conclusão: Tendo em vista que a ausência de complicações crônicas e a percepção de boa saúde estão intimamente relacionadas, destaca-se a importância da intervenção precoce, por parte da equipe de saúde, com objetivo de promover atividades de educação em saúde, voltadas às necessidades desse grupo de indivíduos.