How Cardiac Fibrosis Assessed via T1 Mapping Is Associated with Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease.

(1) Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. Although cardiovascular and NAFLD risk factors overlap, an independent association between these conditions may exist. Hepatic and cardiac fibrosis are important markers of mortality, but the correlation between these markers in patients with NAFLD has not been well studied. Our main objective was to determine the degree of myocardial fibrosis in patients with NAFLD and its correlation with the severity of liver fibrosis. (2) Methods: In this cross-sectional study, patients with NAFLD were allocated to two groups according to the stage of liver fibrosis assessed using MRI: no or mild fibrosis (F0-F1) and significant fibrosis (F2-F4). Framingham risk scores were calculated to evaluate cardiovascular risk factors, and patients underwent multiparametric cardiac and abdominal MRIs. (3) Results: The sample comprised 44 patients (28 with no or mild liver fibrosis and 16 with significant liver fibrosis). The mean age was 57.9 ± 12 years, and 41% were men. Most patients had high cardiac risk factors and carotid disease. Relative to patients with no or mild liver fibrosis, those with significant fibrosis had a higher median calcium score (p = 0.05) and increased myocardial extracellular volume (ECV; p = 0.02). Liver fibrosis correlated with cardiac fibrosis, represented by the ECV (r = 0.49, p < 0.001). The myocardial ECV differentiated patients with and without significant liver fibrosis (AUC = 0.78). (4) Conclusion: This study showed that diffuse myocardial fibrosis is associated with liver fibrosis in patients with NAFLD.

New Insights on the Mechanisms of Myocardial Injury in Hypertensive Patients With COVID-19.

PURPOSE: Myocardial injury is common in hypertensive patients with 2019 coronavirus disease (COVID-19). Immune dysregulation could be associated to cardiac injury in these patients, but the underlying mechanism has not been fully elucidated. METHODS: All patients were selected prospectively from a multicenter registry of adults hospitalized with confirmed COVID-19. Cases had hypertension and myocardial injury, defined by troponin levels above the 99th percentile upper reference limit, and controls were hypertensive patients with no myocardial injury. Biomarkers and immune cell subsets were quantified and compared between the two groups. A multiple logistic regression model was used to analyze the associations of clinical and immune variables with myocardial injury. RESULTS: The sample comprised 193 patients divided into two groups: 47 cases and 146 controls. Relative to controls, cases had lower total lymphocyte count, percentage of T lymphocytes, CD8+CD38+ mean fluorescence intensity (MFI), and percentage of CD8+ human leukocyte antigen DR isotope (HLA-DR)+ CD38-cells and higher percentage of natural killer lymphocytes, natural killer group 2A (NKG2A)+ MFI, percentage of CD8+CD38+cells, CD8+HLA-DR+MFI, CD8+NKG2A+MFI, and percentage of CD8+HLA-DR-CD38+cells. On multivariate regression, the CD8+HLA-DR+MFI, CD8+CD38+MFI, and total lymphocyte count were associated significantly with myocardial injury. CONCLUSION: Our findings suggest that lymphopenia, CD8+CD38+MFI, and CD8+HLA-DR+MFI are immune biomarkers of myocardial injury in hypertensive patients with COVID-19. The immune signature described here may aid in understanding the mechanisms underlying myocardial injury in these patients. The study data might open a new window for improvement in the treatment of hypertensive patients with COVID-19 and myocardial injury.

Efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 lineages circulating in Brazil.

Several COVID-19 vaccines have shown good efficacy in clinical trials, but there remains uncertainty about the efficacy of vaccines against different variants. Here, we investigate the efficacy of ChAdOx1 nCoV-19 (AZD1222) against symptomatic COVID-19 in a post-hoc exploratory analysis of a Phase 3 randomised trial in Brazil (trial registration ISRCTN89951424). Nose and throat swabs were tested by PCR in symptomatic participants. Sequencing and genotyping of swabs were performed to determine the lineages of SARS-CoV-2 circulating during the study. Protection against any symptomatic COVID-19 caused by the Zeta (P.2) variant was assessed in 153 cases with vaccine efficacy (VE) of 69% (95% CI 55, 78). 49 cases of B.1.1.28 occurred and VE was 73% (46, 86). The Gamma (P.1) variant arose later in the trial and fewer cases (N = 18) were available for analysis. VE was 64% (-2, 87). ChAdOx1 nCoV-19 provided 95% protection (95% CI 61%, 99%) against hospitalisation due to COVID-19. In summary, we report that ChAdOx1 nCoV-19 protects against emerging variants in Brazil despite the presence of the spike protein mutation E484K.

Resistance Mutations A30K and Y93N Associated with Treatment Failure with Sofosbuvir and Daclatasvir for Hepatitis C Virus Infection Non-Responder Patients: Case Reports.

In Brazil, hepatitis C treatment has been evolving significantly with the licensing of direct-acting antivirals (DAAs). However, viral determinants (amino acid substitutions in hepatitis C virus (HCV) genome and infective genotype) associated with host factors (hepatic condition and prior HCV therapy) might limit the achievement of sustained virologic response (SVR). Here, we described two case reports in which the occurrence of HCV NS5A mutations A30K (subtype 3a) and Y93N (subtype 1a) might have influenced daclatasvir (DCV)/sofosbuvir (SOF) combined therapy non-response. Despite high response rates for DAA combined therapies in Brazil, these case reports stated the importance of an investigation about how to manage a DAA treatment failure since a combination of factors, especially the occurrence of resistance substitutions, could impact a rescue therapy with new available antivirals in clinical routine.

Análise da soropositividade do anti-HBs em profiss ionais de saúde / Analysis of the seropositivity of the anti-HBs in health professionals

O risco de se contrair a hepatite B entre os profissionais de saúde é maior do que o da população geral adulta. Os objetivos do estudo foram analisar a soropositividade do anti-HBs em profissionais de saúde, analisar o perfil dos que responderam à vacinação, definir o esquema vacinal recebido e identificar condições que reduziram a resposta vacinal. O estudo foi um inquérito soro-epidemiológico transversal. Entre 1/1/2004 e 31/07/2006,foram realizadas 111 5 sorologias para a titulação do anti-HBs em profissionais de saúde de um hospital privado do município do Rio de Janeiro, de risco baixo ou alto para a ocorrência de acidentes pérfuro-cortantes. Dos exames realizados, 729 foram reagentes e 386 não reagentes, caracterizando uma soropositividade de 65,4% (IC 95%: 62,6 ? 68,2). As idades foram mais elevadas no grupo não reagente (p<0,001). Em ambos os grupos predominaram as mulheres, porém a maior proporção do sexo feminino ocorreu no grupo reagente (p=0,009). Verificamos um maior número de profissionais de alto risco no grupo reagente (p<0,001) e um maior número de vacinados contra a hepatite B (p<0,001) e com o esquema completo (p<0,001) no grupo reagente. Com relação à história de transfusão ou doação de sangue, história de tabagismo, índice de massa corporal, prática de atividade física, uso de álcool e acidentes de trabalho, não se observou diferença entre os grupos. Os profissionais da área de saúde deveriam ser vacinados com o esquema proposto pela Organização Mundial de Saúde. Avaliação da soropositividade deveria ser realizada periodicamente.

The risk of acquiring hepatitis B is higher among health professionals than in the rest of the general adult population. The objectives of the present study were to analyze the seropositivity of the anti-HBs in health professionals, to analyze the profile of the health professionals that responded to the vaccination, to characterize the vaccination scheme received, and to identify the conditions that reduced the response to the vaccine. The study was a sero-epidemiologic transversal survey. From 1/1/2004 to 31/07/2006, 1115 serologic tests were utilized for detection of the anti-HBs in the serum of the health professionals from a private general hospital in the municipality of Rio de Janeiro, with low or high risk of occurrence of perforate-cutting accidents. From the tests carried out, 729 were reactive and 386 non-reactive, characterizing a seropositivity in 65.4% of the tested professionals (IC 95%: 62.6 ? 68.2). The subjects in the non-reactive group (p<0.001) were older, and in both groups the large majority was female, though among reactive group the proportion was higher (p= 0.009). In the reactive group (p<0.001) a greater number of high risk health professionals were found, as well as a greater number of health professionals who had been vaccinated against hepatitis B (p<0.001) with the complete scheme (p<0.001). No difference between reactive and non-reactive groups was observed regarding blood transfusion or donation, history of smoking, body mass index, physical activity, alcohol consumption, and occupational accidents. It is known that professionals of the health area must be vaccinated according to the scheme proposed by the World Health Organization, therefore. seropositivity should be evaluated periodically.

Porfiria cutânea tarda, esclerodermia e vírus da hepatite C: revisão da literatura a propósito de um caso / Porphyria cutanea tarda, scleroderma and hepatitis C virus: literature review based on a case

Embora a associação de PCT, esclerodermia e HCV seja uma ocorrência rara, é importante conhecer as particularidades dessa condição. O presente artigo discute a patogênese, os resultados clínicos e o tratamento