Hepatitis B virus reactivation in patients treated with monoclonal antibodies.

Hepatitis B virus (HBV) reactivation poses a significant clinical challenge, especially in patients undergoing immunosuppressive therapies, including monoclonal antibody treatments. This manuscript briefly explores the complex relationship between monoclonal antibody therapy and HBV reactivation, drawing upon current literature and clinical case studies. It delves into the mechanisms underlying this phenomenon, highlighting the importance of risk assessment, monitoring, and prophylactic measures for patients at risk. The manuscript aims to enhance the understanding of HBV reactivation in the context of monoclonal antibody therapy, ultimately facilitating informed clinical decision-making and improved patient care. This paper will also briefly review the definition of HBV activation, assess the risks of reactivation, especially in patients treated with monoclonal antibodies, and consider management for patients with regard to screening, prophylaxis, and treatment. A better understanding of patients at risk can help clinicians provide optimum management to ensure successful patient outcomes and prevent morbidity.

Adult eosinophilic esophagitis and advances in its treatment.

Eosinophilic esophagitis (EoE) is a chronic eosinophil inflammation that seems to be T helper type 2 antigen-driven. The disease is one of several eosinophilic gastrointestinal disorders in which there appears to be inflammation of the gastrointestinal tract without any apparent underlying causes. Differential diagnosis needs to be made with gastroesophageal reflux, which is characterized by chronic inflammation due to gastric refluxate from disorders related to motility. EoE, however, is considered a chronic allergic inflammatory disorder related to destructive tissue remodeling. There seems to be a higher prevalence of EoE in Western countries. It is typically found in atopic male individuals. Physiopathological risk factors include atopy, environmental factors, esophageal epithelial barrier dysfunctions, etc. EoE can cause several symptoms that include retrosternal burning sensation, dysphagia, food impaction, chronic reflux symptoms, nausea, and vomiting. Early diagnosis, which requires a biopsy to assess for esophageal inflammation, is essential for proper treatment. The aim of our brief overview is to summarize the current literature regarding the characteristics, diagnosis, complications, mechanisms of pathology, clinical features, influence of comorbidities, and treatment in patients with EoE.

Sexual practices and HPV infection in unvaccinated young adults.

The present study aimed to evaluate the association of genital and oral HPV infection among different sexual practices in both sexes. In total, 6388 unvaccinated men and women aged 16-25 years from all state capitals of Brazil were enrolled in through primary care services between September 2016 and November 2017. Genital and oral HPV genotyping was performed using the Roche Linear Array. Poisson regression analysis with robust variance was conducted to examine factors associated with overall HPV infection. A higher prevalence of genital HPV was found in women who practiced oral sex (57.85%) and in men who practiced all types of sex (65.87%). However, having more sexual partners and being younger were more important than the type of sex practiced. HPV 6 (7.1%) and 16 (10.5%) were significantly more prevalent in women who practiced oral sex, while HPV 6 (23.96%) and 11 (21.49%) were more prevalent in men who practiced anal sex. The type of sex was not associated with oral HPV prevalence. Genital and oral HPV infection were not associated by different sexual practices in the studied population.

[Self-reported prevalence of hypertension and associated factors in quilombola communities in the State of Rio Grande do Sul, Brazil]. / Prevalência autorreferida de hipertensão e fatores associados em comunidades quilombolas do Rio Grande do Sul, Brasil.

The study sought to identify the prevalence of arterial hypertension (AH) and possible associated factors in adults residing in quilombola communities in the State of Rio Grande do Sul (RS). A transversal population-based study, carried out in 2011, included 589 adult households in quilombola communities in the State of RS, by sampling proportional to the size. The outcome was obtained by the question: "Has a doctor ever told you that you have hypertension?" Poisson regression with robust variance and hierarchical input variables were used. Finally, the population attributable fractions per component (PAFC) were calculated for modifiable factors associated to AH. The self-reported prevalence of AH was 38.3% (CI95% 31.4%-45.1%). Adjusted analysis revealed an association of the outcome with age group, education, excessive alcohol consumption, waist circumference and the presence of diabetes. PAFC analysis revealed that if the individuals had greater schooling, the prevalence of AH would be reduced. Given the high prevalence of AH and the extreme social vulnerability of this population, public policies that guarantee their access to fundamental rights (health, income and schooling) could have a significant impact in reducing this outcome.

Este estudo teve como objetivo identificar a prevalência e fatores associados à hipertensão arterial (HA) em adultos quilombolas do Rio Grande do Sul (RS). Trata-se de um estudo transversal de base populacional, realizado em 2011, com 589 adultos responsáveis por domicílios e amostragem proporcional ao tamanho. O desfecho foi obtido com a pergunta: "Algum médico já lhe disse que você tem hipertensão?". Foi empregada regressão de Poisson, com variância robusta e entrada hierarquizada das variáveis. Por fim, foram calculadas as frações atribuíveis populacionais por componente (FAPC) para fatores modificáveis associados à HA. A prevalência autorreferida de HA foi de 38,3% (IC95% 31,4%-45,1%). A análise ajustada revelou associação do desfecho com faixa etária, escolaridade, consumo excessivo de álcool, circunferência da cintura acima do adequado e presença de diabetes. A análise dos FAPC revelou que, se os indivíduos tivessem maior escolaridade, a prevalência de HA seria reduzida. Diante da elevada prevalência de HA e da extrema vulnerabilidade social dessa população, políticas públicas que garantam seu acesso a direitos fundamentais (saúde, renda e escolaridade) poderiam ter impacto importante na diminuição desse desfecho.

Prevalência autorreferida de hipertensão e fatores associados em comunidades quilombolas do Rio Grande do Sul, Brasil / Self-reported prevalence of hypertension and associated factors in quilombola communities in the State of Rio Grande do Sul, Brazil

Resumo Este estudo teve como objetivo identificar a prevalência e fatores associados à hipertensão arterial (HA) em adultos quilombolas do Rio Grande do Sul (RS). Trata-se de um estudo transversal de base populacional, realizado em 2011, com 589 adultos responsáveis por domicílios e amostragem proporcional ao tamanho. O desfecho foi obtido com a pergunta: "Algum médico já lhe disse que você tem hipertensão?". Foi empregada regressão de Poisson, com variância robusta e entrada hierarquizada das variáveis. Por fim, foram calculadas as frações atribuíveis populacionais por componente (FAPC) para fatores modificáveis associados à HA. A prevalência autorreferida de HA foi de 38,3% (IC95% 31,4%-45,1%). A análise ajustada revelou associação do desfecho com faixa etária, escolaridade, consumo excessivo de álcool, circunferência da cintura acima do adequado e presença de diabetes. A análise dos FAPC revelou que, se os indivíduos tivessem maior escolaridade, a prevalência de HA seria reduzida. Diante da elevada prevalência de HA e da extrema vulnerabilidade social dessa população, políticas públicas que garantam seu acesso a direitos fundamentais (saúde, renda e escolaridade) poderiam ter impacto importante na diminuição desse desfecho.

Abstract The study sought to identify the prevalence of arterial hypertension (AH) and possible associated factors in adults residing in quilombola communities in the State of Rio Grande do Sul (RS). A transversal population-based study, carried out in 2011, included 589 adult households in quilombola communities in the State of RS, by sampling proportional to the size. The outcome was obtained by the question: "Has a doctor ever told you that you have hypertension?" Poisson regression with robust variance and hierarchical input variables were used. Finally, the population attributable fractions per component (PAFC) were calculated for modifiable factors associated to AH. The self-reported prevalence of AH was 38.3% (CI95% 31.4%-45.1%). Adjusted analysis revealed an association of the outcome with age group, education, excessive alcohol consumption, waist circumference and the presence of diabetes. PAFC analysis revealed that if the individuals had greater schooling, the prevalence of AH would be reduced. Given the high prevalence of AH and the extreme social vulnerability of this population, public policies that guarantee their access to fundamental rights (health, income and schooling) could have a significant impact in reducing this outcome.

Neither hereditary periodic fever nor periodic fever, aphthae, pharingitis, adenitis: Undifferentiated periodic fever in a tertiary pediatric center.

AIM: To describe the frequency and clinical characteristics of patients with undifferentiated periodic fever (UPF) and to investigate whether a clinical classification of UPF based on the PRINTO-Eurofever score can help predicting the response to treatment and the outcome at follow-up. METHODS: Clinical and therapeutic information of patients with recurrent fever who presented at a single pediatric rheumatology center from January 2006 through April 2016 were retrospectively collected. Patients with a clinical suspicion of hereditary periodic fever (HPF) syndrome and patients with clinical picture of periodic fever, aphthae, pharingitis, adenitis (PFAPA) who were refractory to tonsillectomy underwent molecular analysis of five HPF-related genes: MEFV (NM_000243.2), MVK (NM_000431.3), TNFRSF1A (NM_001065.3), NLRP3 (NM_001079821.2), NLRP12 (NM_001277126.1). All patients who had a negative genetic result were defined as UPF and further investigated. PRINTO-Eurofever score for clinical diagnosis of HPF was calculated in all cases. RESULTS: Of the 221 patients evaluated for periodic fever, twelve subjects with a clinical picture of PFAPA who were refractory to tonsillectomy and 22 subjects with a clinical suspicion of HPF underwent genetic analysis. Twenty-three patients (10.4%) resulted negative and were classified as UPF. The median age at presentation of patients with UPF was 9.5 mo (IQR 4-24). Patients with UPF had a higher frequency of aphthae (52.2% vs 0%, P = 0.0026) and musculoskeletal pain (65.2% vs 18.2%, P = 0.0255) than patients with genetic confirmed HPF. Also, patients with UPF had a higher frequency of aphthous stomatitis (52.2% vs 10.7%, P < 0.0001), musculoskeletal pain (65.2% vs 8,0%, P < 0.0001), and abdominal pain (52.2% vs 4.8%, P < 0.0001) and a lower frequency of pharyngitis (56.6% vs 81.3%, P = 0.0127) compared with typical PFAPA in the same cohort. Twenty-one of 23 patients with UPF (91.3%) received steroids, being effective in 16; 13 (56.2%) were given colchicine, which was effective in 6. Symptoms resolution occurred in 2 patients with UPF at last follow-up. Classification according to the PRINTO-Eurofever score did not correlate with treatment response and prognosis. CONCLUSION: UPF is not a rare diagnosis among patients with periodic fever. Clinical presentation place UPF half way on a clinical spectrum between PFAPA and HPF. The PRINTO-Eurofever score is not useful to predict clinical outcome and treatment response in these patients.

Gender differences in the prevalence of household food insecurity: a systematic review and meta-analysis.

OBJECTIVE: The present review aimed to identify and synthesize literature on household food insecurity with respect to whether the respondent was male or female. DESIGN: A systematic review of prevalence studies followed by a meta-analysis was conducted between 28 August 2014 and 19 October 2014 in seven electronic databases. The search was updated in April 2016. The included studies used experience-based measures to assess household food insecurity. Dichotomous measures of food insecurity were used. Pooled odds ratios of household food insecurity prevalence in women v. men were obtained through random-effect modelling. Quality assessment, publication bias diagnostics and subgroup analysis were also performed. SETTING: Population-based studies (i.e. non-clinical populations). SUBJECTS: Participants aged 18 years or over. RESULTS: Out of the 5145 articles initially identified, forty-two studies with a total population of 233 153 were included. In general, results showed that the odds for household food insecurity was 40 % higher in studies where women were the respondent (95 % CI 1·27, 1·54; P<0·001). Besides, subgroup analysis revealed that female-headed households were 75% (95 % CI 49-96%) more likely to be food insecure than male-headed households. CONCLUSIONS: Our results confirm the existence of gender differences in reporting household food insecurity. Furthermore, they indicate that households headed by women constitute a segment of the population that is particularly vulnerable to food insecurity.

Avaliação da concordância entre informações obtidas com questionário aplicado a usuários de uma Unidade de Saúde de Porto Alegre e as disponíveis nos prontuários

Analisar a concordância entre as informações obtidas a partir das respostas do questionário de uma pesquisa com informações disponíveis nos prontuários pode auxiliar na definição da confiabilidade dos resultados em que se baseiam suas conclusões. Técnicas estatísticas consideradas adequadas para verificar concordâncias são as fórmulas KAPPA e PABAK. Objetivo: Verificar a concordância das informações obtidas através do questionário de linha de base com as obtidas pela pesquisa nos prontuários dos pacientes. Método: Estudo de concordância. Foram analisadas 15 perguntas, das 93. As informações obtidas através das duas fontes foram comparadas para estimar a magnitude de concordância. Foi calculada a estatística kappa ou PABAK através do software Winpepi versão 11.25. Resultados: Foram analisados questionários de 149 indivíduos com média de idade de 62, 64 ± 13, 35 anos, sendo 69, 12% do sexo feminino. As concordâncias para a maioria das perguntas foram classificadas como substanciais. Conclusão: Os resultados sugerem que as informações obtidas com o questionário do estudo “Avaliação da Atenção à Saúde em Hipertensão e Diabete em Atenção Primária” estejam refletindo a realidade estudada.

Counterion exchange selectivity coefficients at water-in-oil microemulsion interface.

The counterion binding at a water/Aerosol-OT (AOT)/heptane microemulsion interface was treated in the context of the pseudo-phase ion exchange formalism. Two approaches were used to determine the selectivity coefficient for copper/sodium counterion binding at the AOT microemulsion interface: measurements of the Cu(II) concentration taken up by the reverse micelle in a Winsor II microemulsion system and steady-state emission quenching measurements of an anionic water-solubilized probe, the tris-(4,4'-dicarboxy-2,2'-bipyridine) ruthenium (II) ion. In addition, the selectivity coefficient for methyl viologen/sodium at the microemulsion surface was determined by the same photophysical technique. The value for copper (II)/sodium exchange (K(Cu/Na)) is 1.1+/-0.3 and that for methyl viologen/sodium (K(MV/Na)) is 0.9+/-0.3. The results show that the pseudo-phase ion exchange model can be used to obtain the selectivity coefficient in a microemulsion system.