Transient Elastography in HIV Infected Patients with Liver Steatosis Identifies a High-Risk Group for Non-Alcoholic Steatohepatitis.

OBJECTIVE: The study aimed to assess the role of TE in HIV-infected patients with NAFLD. METHODS: HIV-infected patients undergoing ART were enrolled between August 2016 and February 2017, following the inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria included pregnancy, alcohol intake ≥20g/day and co-infection with hepatitis B or C. Patients underwent an abdominal US to diagnose liver steatosis. Significant fibrosis (≥F2) was considered when APRI>1.0, FIB4>3 and liver stiffness ≥7.1kPa. Subjects with TE ≥7.1kPa were prescribed a liver biopsy and the NAFLD Scoring System ≥3 was considered as a diagnosis of NASH. The poisson regression model was used to identify factors associated with liver steatosis. RESULTS: 98 patients were included. The mean age of the subjects was 49±11 years and 53 (54.1%) were males. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male sex (PR= 2.18) and higher BMI (PR=1.08). Among the 31 patients with NAFLD, 26 showed results for TE, APRI and FIB4. The prevalence of significant fibrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients (26.9%) had a TE result ≥7.1kPa, which was associated with higher triglyceride levels, FIB4 score and CAP values. Liver biopsy was perfomed on six of those with TE ≥7.1kPa and NASH was found in 5 (83.3%) and liver fibrosis without NASH in one. CONCLUSION: NAFLD prevalence in HIV-infected patients is higher than the general population. TE ≥7.1kPa was not able to diagnose significant fibrosis but accurately detect a subgroup of patients at a high risk for NASH among HIV monoinfected individuals with steatosis.

Análise do perfil de doadores de sangue positivos para hemoglobina S em hemocentro do estado do Rio Grande do Sul / Profile assessment of blood donors with sickle cell trait in a public blood bank in Southern Brazil

Introdução: Portadores do traço falciforme podem doar sangue, porém requerem maior atenção ao direcionamento da sua transfusão. Considerando o perfil étnico- racial da região sul do Brasil, o presente artigo teve como objetivo analisar o perfil e a prevalência de Hemoglobina S em um hemocentro público de Porto Alegre. Métodos: Estudo transversal retrospectivo realizado através de uma pesquisa em banco de dados cadastrais e de resultados de testes imunológicos no período de janeiro de 2015 a dezembro de 2019. Resultados: Foram obtidos um total de 8.2363 registros cadastrais e 6.7184 testes imunológicos. Dos testes, 467 foram positivos para Hemoglobina S de 134 doadores distintos. O percentual de Hb S positiva apresentou uma média de 0,7% anual entre todos os doadores. Entre doadores autodeclarados "Negros" a prevalência é de 0,92% e "Caucasianos" é de 0,13%. Conclusão: Os dados corroboram com a literatura, porém o espectro social que abrange as denominações "Caucasiano Brasileiro" e "Mestiço" permanecem em questionamento dentro da relevância do marcador étnico da Hemoglobina S no Rio Grande do Sul. (AU)

Introduction: People with sickle cell trait can donate blood, but special attention should be paid to the transfusion recipient. Considering the ethnic-racial profile of Southern Brazil, this article aimed to analyze the profile and prevalence of hemoglobin S in a public blood bank in Porto Alegre. Methods: A quantitative, retrospective, and cross-sectional study was conducted to assess the profile of blood donors positively screened for hemoglobin S from January 2015 to December 2019 in a public blood bank in Southern Brazil. Results: A total of 82,363 records and 67,184 immunohematological tests were obtained. Regarding the tests, 467 were positive for hemoglobin S among 134 different donors. The percentage of positive hemoglobin S has remained stable over the years, with an annual average of 0.7%. The prevalence of self-reported "black" and "Brazilian Caucasian" blood donors was 0.92% and 0.13%, respectively. Conclusions: The data are in accordance with the literature; however, the social spectrum that comprises the terms "Brazilian Caucasian" and "mixed-race" remains in question regarding the relevance of the ethnic marker of hemoglobin S in Southern Brazil. (AU)

Biomarcadores no líquido cefalorraquidiano no desenvolvimento da doença de alzheimer: uma revisão sistemática / Biomarkers in cerebrospinal fluid in development alzheimer's disease: a systematic review / Biomarcadores en el líquido cefalorraquídeo en el desarrollo de la enfermedad de alzheimer: una revisión sistemática

Objetivou-se identificar os artigos que analisam os biomarcadores tau total (T-tau), tau fosforilada (P-tau) e beta-amiloide (Aβ) no líquido cefalorraquidiano (LCR) para o desenvolvimento da doença de Alzheimer (DA). Foi realizada uma revisão sistemática aplicando-se uma lógica de pesquisa nas bases de dados PubMed, SciELO e Medline, selecionando artigos conforme os critérios de inclusão e exclusão. Foram avaliados oito estudos clínicos, os quais demonstraram níveis de T-tau e P-tau elevados e níveis diminuídos de Aβ, entretanto nem todos encontraram significância estatística nesses achados. As dosagens dos biomarcadores Aβ, T-tau e P-tau em conjunto apresentam grande potencial diagnóstico no desenvolvimento da DA, contudo mais estudos são necessários para estabelecer valores de corte dos biomarcadores na evolução da doença.

This study aimed to identify studies that analyzed the total tau (T-tau), phosphorylated tau (P-tau) and beta-amyloid (Aβ) biomarkers in the cerebrospinal fluid (CSF) to the development of Alzheimer's disease (AD). The study is characterized as a systematic review, that was applied a search logic in PubMed, SciELO e Medline, selecting studies according to inclusion and exclusion criteria. Eight clinical studies were evaluated, and all of these found elevated levels of T-tau and P-tau and decreased levels of Aβ, but not all studies found statistical significance in these findings. The dosage of the biomarkers Aβ, T-tau, and P-tau together present a great diagnostic potential of AD; however, more studies are needed to establish cutoff values of these biomarkers in disease progression.

Se objetivó identificar los artículos que analizaran los biomarcadores tau total (T-tau), tau fosforilada (P-tau) y beta-amiloide (Aβ) en el líquido cefalorraquídeo (LCR) para el desarrollo de la enfermedad de Alzheimer (DA). Se realizó una revisión sistemática aplicando una lógica de investigación en las bases de datos PubMed, SciELO y Medline, seleccionando artículos conforme a los criterios de inclusión y exclusión. Se evaluaron ocho estudios clínicos, los cuales se encontraron niveles de T-tau y P-tau elevados y niveles disminuidos de Aβ, pero no todos encontraron significación estadística en estos hallazgos. Las dosificaciones de los biomarcadores Aβ, T-tau y P-tau en conjunto presentan un gran potencial diagnóstico en el desarrollo de la DA, pero más estudios son necesarios para establecer valores de corte de los biomarcadores en la evolución de la enfermedad.

Hepatic steatosis among people living with HIV in Southern Brazil: prevalence and risk factors.

Chronic liver disease is an important cause of morbidity and mortality among people living with human immunodeficiency virus (HIV) and is frequently related to non-alcoholic fatty liver disease (NAFLD). The objective is to estimate the prevalence and risk factors of hepatic steatosis among consecutive patients with stable HIV infection on antiretroviral therapy (ART). Also, the use of transient elastography (TE) as a mean to identify a subgroup at risk for non-alcoholic steatohepatitis (NASH) and/or liver fibrosis. HIV infected patients were enrolled between August2016 and February2017. Inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria: pregnancy; alcohol intake ≥20 g/day and co-infection B or C viruses. Patients underwent ultrasound (US) to diagnose liver steatosis. Significant fibrosis (≥F2) was estimated if at least one of the following were present: APRI > 1.0, FIB4 > 3 and/or liver stiffness ≥7.1kPa. Subjects with TE ≥ 7.1kPa were proposed a liver biopsy and NAFLD Scoring System (NAS) ≥ 3 was considered as diagnosis of NASH. A total of 98 patients were included. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male gender, BMI, ALT and total bilirubin levels. The prevalence of significant fibrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients had a TE result ≥7.1kPa. NASH was found in 5 (83.3%). Among HIV infected patients undergoing ART, almost one third have NAFLD. Neither TE, APRI or FIB4 were able to act as surrogates for significant liver fibrosis. Nevertheless, TE ≥ 7.1kPa was able to accurately select a subgroup of patients at risk for NASH.

Avanços no tratamento da esclerose múltipla através do anticorpo monoclonal Ocrelizumabe / Advances in the treatment of multiple sclerosis through monoclonal antibody Ocrelizumab

RESUMO: Objetivos: Avaliar a efetividade e os riscos associados ao tratamento da esclerose múltipla com o anticorpo monoclonal Ocrelizumabe. Métodos: O estudo consiste em uma revisão da literatura objetivando a busca de artigos que evidenciassem de forma quantitativa os efeitos do fármaco Ocrelizumabe para as formas remitente-recorrente e primariamente progressiva da esclerose múltipla. A busca ocorreu nas bases de dados PubMed, BVS, Cochrane Librarye ScienceDirecta partir de 2011. Os artigos foram pré-selecionados através do título e resumo para leitura integral e de acordo com os critérios de inclusão e exclusão. Resultados: No total, foram recuperados 743 artigos, sendo considerados elegíveis 23 estudos para análise integral e destes, 20 foram excluídos por não se enquadrarem nos desfechos propostos, sendo incluídos três estudos. Todos os estudos comprovaram uma alta eficácia de Ocrelizumabelivre de infecções oportunistas. Conclusão: apesar da natureza degenerativa da esclerose múltipla, os avanços tecnológicos na terapêutica através de fármacos como o Ocrelizumabe têm trazido resultados promissores, como a diminuição da taxa anual de surtos, do número de lesões por RM e da progressão da incapacidade. No entanto, devido a sua recente aprovação, não é possível avaliar os efeitos da utilização do anticorpo monoclonal a longo prazo. (AU)

ABSTRACT: Objective: Evaluating the effectiveness and risks associated with the treatment of multiple sclerosis with the monoclonal antibody Ocrelizumab. Methods: The study consists of a narrative review that aimed to search articles evidencing the effects of the Ocrelizumab drug for the recurrent and primary progressive forms of multiple sclerosis. The search was carried out in PubMed, BVS, Cochrane Library, and ScienceDirect databases from 2011. The articles were pre-selected through the title and abstract for full reading and included or excluded in the study according to predetermined criteria. Results: A total of 743 articles were retrieved, 23 of which were consideredeligible for comprehensive analysis and 20 were excluded because they did not fit into the outcomes proposed.Three studies were included. All studies have demonstrated the high efficacy of Ocrelizumab free of opportunisticinfections. Conclusion: Despite the degenerative nature of MS, technological advances in therapy through drugs such as Ocrelizumab bring promising results, such as reduced annual outbreak rates, the number of MRI injuries, and the progress of the disability. However, due to its recent approval, it is not possible to evaluate the long-termeffects of monoclonal antibody use. (AU)

Inclusões semelhantes aos corpúsculos de Russell em blastos mieloides / Inclusions similar to Russell bodies in myeloblasts

Alterações nos mecanismos celulares resultam no aparecimento de corpúsculos de Russel, que são inclusões intracitoplasmáticas basofílicas. Estas inclusões ocorrem devido a uma indigestão celular de proteínas e podem ser observadas em diversas condições patológicas como leucemias, mieloma múltiplo, linfoma de Burkitt e gastrite com corpúsculos de Russell, sendo raramente observadas em leucemias mieloides agudas. O presente estudo relata a presença de inclusões semelhantes aos corpúsculos de Russell em blastos no sangue periférico de uma paciente de 51 anos com leucemia mieloide aguda.

Changes in cell mechanisms result in the appearance of Russel bodies, which are basophilic intracytoplasmic inclusions. These inclusions occur due to cellular indigestion of proteins, and can be observed in several pathological conditions such as leukemias, multiple myeloma, Burkitt's lymphoma, and gastritis with Russell bodies, but rarely observed in acute myeloid leukemias. The present study reports the presence of inclusions similar to Russell bodies in peripheral blood blasts in a 51-year-old female patient with acute myeloid leukemia.

Evolução clínica de indivíduos com antígeno de superfície do vírus da hepatite B reagente, atendidos em um laboratório clínico de Caxias do Sul - RS, entre os anos de 2010 a 2015 / Clinical course of individuals with B hepatitis surface antigen attended in a clinical laboratory in Caxias do Sul - RS between the years of 2010 to 2015

Objetivo: A hepatite B é uma doença infecciosa que atinge, aproximadamente, 2 bilhões de pessoas. Apresenta fase aguda que pode evoluir para a cura ou cronificar. O quadro da doença é avaliado por meio de enzimas hepáticas e marcadores sorológicos, que detectam anticorpos e antígenos produzidos pelo vírus. Esse trabalho teve como objetivo avaliar os diferentes marcadores da hepatite B através de exames laboratoriais de indivíduos infectados, correlacionando testes de função hepática com a evolução da doença. Métodos: Trata-se de estudo transversal retrospectivo realizado de 2010 a 2015, utilizando banco de dados de um laboratório de Caxias do Sul-RS. As variáveis estão apresentadas em média e desvio-padrão e foram comparadas utilizando o teste t Student para amostras dependentes e as variáveis entre os grupos pelo teste t Student para amostras pareadas. Resultados: Um total de noventa indivíduos foi incluído, com média de idade de 46,0±13,5 anos (51% homens). Quanto à evolução, 31% dos pacientes evoluíram para a cura e 69% para a crônica. Encontramos significância entre as enzimas ALT e GGT, no momento do diagnóstico, com as últimas dosadas pelo laboratório (p < 0,008 e p< 0,007, respectivamente). Entre os grupos, houve diferença entre ALT (inicial e final) do grupo cura (p = 0,012), o que não ocorreu no grupo que cronificou (p= 0,848). Conclusão: O estudo pôde revelar o comportamento das transaminases e GGT frente à contaminação pelo vírus da hepatite B, ficando evidente a importância do correto acompanhamento da hepatite B através desses exames laboratoriais para se conhecer a noção real do estado da patologia.

Mãe, obrigada pelos microRNAs / Mom, thanks for the microRNAs

Os microRNAs (miRNAs) são pequenas moléculas de RNA não codificante que têm grande importância nos mais diversos processos celulares, pois atuam na regulação da expressão gênica pós-transcricional. Estima-se que estes RNAs tenham controle de, em média, 30% da regulação de genes codificantes de proteínas em mamíferos. Da mesma forma, na fase zigótica do desenvolvimento embrionário, os miRNAs maternos desempenham funções notáveis e são fundamentais para a degradação dos próprios transcritos maternos. Este evento é determinante para a transição materno­zigótica, momento onde o zigoto passa a expressar completamente e de maneira independente seus próprios mRNAs, e; portanto, são vitais para o desenvolvimento inicial do embrião. O presente estudo, através de uma revisão narrativa de literatura, busca descrever os mecanismos de ação de miRNAs maternos presentes em zigotos de diversas espécies durante o desenvolvimento embrionário. Foram selecionados estudos disponíveis na base de dados PubMed através da busca utilizando palavras­chave descritas pelos Descritores em Ciências da Saúde (DeCS). (AU)

MicroRNAs (miRNAs) are small molecules of non-coding RNA that have great importance in the most diverse cellular processes, since they act in the post-transcriptional regulation of gene expression. It is estimated that these RNAs have a control of, on average, 30% of the regulation of protein-encoding genes in mammals. Likewise, in the zygotic phase of embryonic development, maternal miRNAs perform remarkable functions and are fundamental for the degradation of the maternal transcripts themselves. This event is determinant for the maternal-to-zygotic transition, at which moment the zygote begins to express completely and independently its own miRNAs, and is therefore vital for the initial development of the embryo. The present study, through a review of the literature, aims to describe the mechanisms of action of maternal miRNAs present in zygotes of different species during embryonic development. We selected only the studies listed in the PubMed database through the search using keywords described by the Health Sciences Descriptors (DeCS). (AU)

Associação entre interleucina-6 e doença renal crônica: uma revisão sistemática / Association between interleukin-6 and chronic renal disease: a systematic review

Este artigo tem como objetivo realizar uma revisão sistemática relacionando os principais estudos que associam a interleucina-6 à doença renal crônica, na tentativa de verifi car as possíveis causas dessa associação. Foi aplicada uma lógica de pesquisa nas bases de dados PubMed, SciELO e ScienceDirect. Para seleção dos artigos, dois pesquisadores analisaram de forma independente os critérios de inclusão e exclusão, com posterior revisão por um terceiro pesquisador, na condição de árbitro. Os achados demonstram que a interleucina-6 está diretamente ligada à progressão da doença renal, pois todos os estudos encontraram seus níveis elevados, servindo como marcador para identifi cação e quantificação da inflamação do paciente. O artigo conclui que a interleucina-6 pode ser utilizada como um possível marcador de lesão renal para o diagnóstico e manutenção da doença, visto que também pode dar indícios de piora clínica dos pacientes renais crônicos.

The aim of this study was to perform a systematic review listing the key studies linking interleukin-6 to chronic kidney disease in an attempt to verify the possible causes of this association. A search logic was applied in the databases PubMed, SciELO and ScienceDirect. To select the articles, two researchers independently analyzed the inclusion and exclusion criteria, and analyzed by a third researcher (referee). The findings demonstrate that interleukin-6 is directly linked to the progression of kidney disease, as all studies have found their high levels, serving as a marker for identification and quantification of inflammation of the patient. The article concludes that interleukin-6 can be used as a marker of renal injury for the diagnosis and maintenance of disease, since clinical deterioration can also give indications of chronic renal failure.

Prevalência de câncer colorretal associado ao papilomavírus humano: uma revisão sistemática com metanálise / Colorectal cancer prevalence linked to human papillomavirus: a systematic review with meta-analysis

RESUMO: Introdução: O câncer colorretal é um dos tipos de tumor mais prevalentes na população mundial. A mortalidade causada por esses tumores malignos continua elevada e mantém-se praticamente no mesmo nível nas últimas décadas. Entre os fatores de risco já estabelecidos para o desenvolvimento do câncer estão as infecções por patógenos ou vírus. Entre os vírus, o papilomavírus humano (HPV) é o mais prevalente, tendo mais de 180 cepas, das quais 40 estão diretamente relacionadas com infecções anogenitais. Objetivo: Avaliar de forma sistemática, com metanálise, os principais estudos que associam o HPV ao câncer colorretal. Métodos: Como estratégia de busca foi adotada a lógica baseada em descritores específicos (idioma inglês), vinculados aos operadores booleanos (AND/OR). As buscas foram aplicadas nas bases de dados PubMed, ScienceDirect e Scientific Electronic Library Online (SciELO), no período de abril e maio de 2015. Resultados: Foram avaliadas 1.549 amostras, sendo 956 (61,7%) do sexo masculino. Foram diagnosticados 630/1.358 casos de câncer colorretal por HPV (51,9%). Destes, 408/767 (51,9%) eram do sexo masculino e 404/598 (67,5%) foram associados aos HPVs 16 e 18, com prevalência tumoral na região do colo (253/411; 61,3%). Do total de 598 amostras para estimativa das prevalências de HPV-16 e HPV-18, a quantidade de casos com valores muito semelhantes foi de 204 (31,7%) e 200 (35,8%), respectivamente. Foram verificados valores relativamente expressivos na região do colo, 253 (61,3%), e na região retal, 158 (38,7%). Conclusão: Após a realização do presente estudo, a associação entre HPV e câncer colorretal ficou evidente, não havendo distinção entre gêneros, com valores muito semelhantes entre o HPV-16 e o HPV-18.

ABSTRACT: Introduction: Colorectal cancer is one of the most prevalent types of tumors worldwide. Deaths caused by these malignant tumors remain high and have stayed practically at the same level for the last few decades. Among the established risk factors for the development of cancer are infections due to pathogens or viruses. Among the viruses, the human papillomavirus (HPV) is the most prevalent, with over 180 strains, 40 of which are directly related to anogenital infections. Objective: Systematically assess the main studies which link HPV to colorectal cancer with meta-analysis. Methods: The search strategy adopted was the logic based on specific descriptors (English language), in combination with the Boolean operators (AND/OR). The search was conducted in the following databases: PubMed, ScienceDirect, and Scientific Electronic Library Online (SciELO), between April and May 2015. Results: 1,549 samples were assessed, with 956 (61.7%) being males. Six hundred thirty out of 1,358 cases of colorectal cancer due to HPV were diagnosed (51.9%). From these, 408 of 767 (51.9%) were male and 404 of 598 (67.5%) were linked to HPV 16 and 18, with tumor prevalence in the area of the cervix (253 of 411; 61.3%). From the total of 598 samples for the prevalence estimate of HPV 16 and 18, the number of cases with similar numbers was 204 (31.7%) and 200 (35.8%), respectively. Relatively significant numbers were found in the area of the cervix, 253 (61.3%), and the area of the rectum, 158 (38.7%). Conclusion: After conducting the present study, the link between HPV and colorectal cancer was made evident, without a distinction between the sexes, with similar values between HPV 16 and HPV 18.

Prevalência de parasitoses intestinais e condições de saneamento básico das moradias em escolares da zona urbana de Caxias do Sul, Rio Grande do Sul / Prevalence of intestinal parasites among schoolchildren and household sanitation in the urban area of Caxias do Sul, State of Rio Grande do Sul, Brazil

Objetivos: Avaliar a prevalência de parasitas intestinais em escolares de Caxias do Sul, relacionando-a com as condições de saneamento das moradias e com o conhecimento sobre parasitoses autorrelatado pelos familiares. Métodos: Foram incluídas no estudo crianças com idade entre cinco e 13 anos, de escolas municipais de ensino fundamental localizadas em zona urbana de Caxias do Sul, Rio Grande do Sul, incluindo a periferia e as zonas centrais da cidade. As amostras foram processadas por sedimentação espontânea e analisadas microscopicamente. Os responsáveis pelos escolares responderam a um questionário elaborado para identificar condições socioeconômicas da família e de saneamento ambiental, assim como a impressão que os mesmos tinham sobre os seus conhecimentos acerca de parasitoses. Resultados: A amostra foi constituída por 257 escolares, com idade média de 8,7±1,3 anos, sendo 58% do sexo feminino. Das amostras de fezes analisadas, 5,8% foram positivas para parasitas, sendo 60% cistos de Endolimax nana, 26,7% de Entamoeba coli e 13,3% de Giardia lamblia. Com respeito às condições de vida dos escolares, 99,2% consumiam água potável, 94,6% afirmaram ter coleta e tratamento de esgoto e 99,2% contava com coleta pública de lixo na moradia. Sobre o conhecimento de parasitoses, 74,7% dos responsáveis sabiam o que são parasitas e 67,3% relataram que conheciam os meios de transmissão. No entanto, 49,8% consideravam as informações insuficientes para a prevenção de parasitoses. Conclusões: O estudo evidenciou uma baixa prevalência de parasitoses nos escolares e condições favoráveis de saneamento em suas moradias. Houve relato de grande frequência de uso de medicamentos antiparasitários sem diagnóstico prévio por exame de fezes.

Aims: To evaluate the prevalence of intestinal parasites among schoolchildren from Caxias do Sul, State of Rio Grande do Sul, southern Brazil, associating it with household sanitation and with family members' self-reported knowledge about parasites. Methods: Children aged 5 to 13 years attending local elementary schools in the urban area of Caxias do Sul, including the outskirts and downtown area, were included in the study. The samples were processed by spontaneous sedimentation and analyzed microscopically. The children's legal representatives answered a questionnaire on socioeconomic conditions and sanitation as well as on their knowledge about parasitic infections. Results: The sample included 257 schoolchildren with a mean age of 8.7±1.3 years, most of whom were female (58%). Of the analyzed stool samples, 5.8% were positive for parasitic cysts: Endolimax nana (60%), Entamoeba coli (26.7%), and Giardia lamblia (13.3%). Regarding living conditions, 99.2% of the schoolchildren had access to treated water, 94.6% said they had sewage collection and treatment in their households, and 99.2% reported having garbage collection. As to legal representatives' knowledge about parasitic infections, 74.7% knew what they were and 67.3% knew about their modes of transmission. However, 49.8% considered the information to be insufficient. Conclusions: This study revealed a low prevalence of parasitic infections in schoolchildren and favorable sanitation in their households. A high frequency of antiparasitic drug use without previous diagnosis by stool examination was reported.

Colorectal cancer prevalence linked to human papillomavirus: a systematic review with meta-analysis. / Prevalência de câncer colorretal associado ao papilomavírus humano: uma revisão sistemática com metanálise.

INTRODUCTION:: Colorectal cancer is one of the most prevalent types of tumors worldwide. Deaths caused by these malignant tumors remain high and have stayed practically at the same level for the last few decades. Among the established risk factors for the development of cancer are infections due to pathogens or viruses. Among the viruses, the human papillomavirus (HPV) is the most prevalent, with over 180 strains, 40 of which are directly related to anogenital infections. OBJECTIVE:: Systematically assess the main studies which link HPV to colorectal cancer with meta-analysis. METHODS:: The search strategy adopted was the logic based on specific descriptors (English language), in combination with the Boolean operators (AND/OR). The search was conducted in the following databases: PubMed, ScienceDirect, and Scientific Electronic Library Online (SciELO), between April and May 2015. RESULTS:: 1,549 samples were assessed, with 956 (61.7%) being males. Six hundred thirty out of 1,358 cases of colorectal cancer due to HPV were diagnosed (51.9%). From these, 408 of 767 (51.9%) were male and 404 of 598 (67.5%) were linked to HPV 16 and 18, with tumor prevalence in the area of the cervix (253 of 411; 61.3%). From the total of 598 samples for the prevalence estimate of HPV 16 and 18, the number of cases with similar numbers was 204 (31.7%) and 200 (35.8%), respectively. Relatively significant numbers were found in the area of the cervix, 253 (61.3%), and the area of the rectum, 158 (38.7%). CONCLUSION:: After conducting the present study, the link between HPV and colorectal cancer was made evident, without a distinction between the sexes, with similar values between HPV 16 and HPV 18.

Prevalência de enteroparasitoses e análise socioeconômica de escolares em Flores da Cunha-RS / Prevalence of intestinal parasites and socio-economic analysis of students in Flores da Cunha, RS, Brazil

As verminoses ainda são um sério problema de saúde pública no Brasil. Elas são transmitidas facilmente a crianças em idade escolar em consequência de seu sistema imunológico imaturo e da precariedade na manutenção de hábitos saudáveis de higiene pessoal. O objetivo deste trabalho foi avaliar a prevalência de parasitoses e o perfil socioeconômico da população escolar de Flores da Cunha-RS. Foram coletadas amostras fecais dos alunos para posterior análise por sedimentação espontânea e aplicados questionários acerca das parasitoses e da situação socioeconômica. Das 341 amostras avaliadas, 10,0% foram positivas, sendo observada a presença de cistos de Endolimax nana (55,9%), de Entamoeba coli (26,5%), de Iodamoeba butschlii (5,9%), de Giardia lamblia (2,9% ) e ovos de Ascaris lumbricoides (2,9%), além de indivíduos (5,9%) com parasitose múltipla (Entamoeba coli e Endolimax nana). A maioria dos responsáveis afirma buscar informações sobre parasitoses com profissionais da saúde (49,7%), mesmo assim 49,9% não acham suficientes as informações disponíveis. Em relação ao saneamento básico, 57,2% declaram possuir coleta e tratamento de esgoto, 67,2% têm boa captação da chuva, o que evita acúmulos nas proximidades, e 47,2% fazem algum tipo de controle de pragas. Entre os escolares, 79% nunca fizeram exame parasitológico de fezes ou foram diagnosticados com parasitose, mesmo assim 85,9% afirmaram ter usado antiparasitários. A baixa prevalência de parasitoses encontrada no presente estudo é justificada, sobretudo, pelo constante uso de antiparasitários. Desse modo, é importante melhorar a divulgação de orientações sobre a prevenção de parasitoses e o perigo da automedicação.

Baixos níveis de atividade física estão associados a prejuízos no perfil lipídico e aumento do percentual de gordura de indivíduos idosos / Low physical activity levels are associated with impairments to the lipid profile and increased percent of body fat in older adults

O envelhecimento promove alterações na composição corporal e no perfil lipídico. Sabe-se que o exercício físico é um grande aliado no controle dessas variáveis e pode ter um importante papel para indivíduos idosos. Neste sentido, pouco se sabe sobre a influência das atividades habituais de vida diária sobre a composição corporal e o perfil lipídico de idosos sedentários. O objetivo desse estudo foi avaliar a composição corporal e o perfil lipídico em idosos classificados pelo nível diário de atividade física. A amostra foi constituída de 50 idosos. Os mesmos foram submetidos às seguintes avaliações: (1) uma coleta sanguínea em jejum de 12 horas para determinar o perfil lipídico, (2) o questionário IPAQ para classificar os níveis de atividade física e (3) uma avaliação antropométrica para mensurar o percentual de gordura (%G) e índice de massa corporal (IMC). Conforme a classificação no IPAQ, os idosos foram divididos em nível moderado (G1) e nível baixo (G2) de atividade física. Um teste T para amostras independentes foi utilizado para comparação das variáveis. O teste de correlação de Pearson foi utilizado para correlacionar o nível de atividade física com as variáveis sanguíneas. O nível de significância adotado foi α=0,05. Não foram observadas diferenças significativas entre os grupos para a idade, massa corporal, estatura e IMC. O %G foi significativamente menor no G1 comparado ao G2 (p≤ 0,01). Quanto ao perfil lipídico, o G1 apresentou menores valores de LDL e maiores valores de HDL comparado ao G2 (p≤ 0,01). Para COL-T, TG e GLI não foram observadas diferenças significativas entre os grupos. Sendo assim, idosos que mantêm níveis moderados de atividade física diária apresentam um menor %G bem como níveis reduzidos de LDL e aumentados de HDL quando comparados a idosos com um nível baixo de atividade física.(AU)

The aging process promotes modifications in body composition and lipid profile. Exercise is considered an ally for the controlling of these variables and is known to be important in older individuals. Accordingly, little is known about the influence of activities of daily living upon the body composition and lipid profile in sedentary older individuals. This study aimed to evaluate body composition and lipid profile of elderly individuals classified by the daily physical activity level. The sample was composed by 50 elderly that were submitted to the following evaluations: (1) blood collection for determination of lipid profile, (2) IPAQ questionnaire for physical activity levels, and (3) anthropometric evaluation for fat percent and body mass index (BMI) determination. According to the IPAQ classification, the elderly were divided in moderate (G1) and low (G2) physical activity level. An independent sample t test was used for comparison between the groups. Pearson correlation coefficient was determined between physical activity level and blood variables. The level of significance of α=0.05 was adopted. There were no significant differences between the groups in terms of age, body mass, height and BMI. The body fat percent was found significantly decreased in G1 compared to G2 (p≤ 0.01). As for the lipid profile, G1 presented lower LDL values and higher HDL values than G2 (p≤ 0.01). Considering total cholesterol, triglycerides and glucose, there were found no significant differences between the groups. Thus, elderly people that maintain daily moderate levels of physical activity show lower percent of body fat, as well as reduced LDL and increased HDL levels when compared to a low daily physical activity group.(AU)

Related factors to atazanavir plasma levels in a cohort of HIV positive individuals with undetectable viral load

OBJECTIVE: To evaluate the factors associated with plasma concentrations of atazanavir (ATV) in a cohort of well-controlled HIV infected subjects (undetectable viremia). Design: Cross-sectional study where 69 subjects were consecutively enrolled between April and November, 2011. METHODS: Patients had to be on atazanavir for at least six months, undetectable viral load for a period equal to or longer than 12 months, T CD4+ lymphocyte count higher than 200 cells/mm³, and aged between 18 years and 70 years old. Exclusion criteria were pregnancy, any neurologic disease, active opportunistic disease, hepatitis or cancer. Atazanavir plasma levels were measured by ultra-performance liquid chromatography. RESULTS AND DISCUSSION: Overall, 54 patients (mean age of 47 years and 50% women) were included in the analysis. Those without ritonavir (unboosted atazanavir) had statistically lower plasma concentrations than those with ritonavir boosted atazanavir (p = 0.001) and total and indirect bilirubin were statistically associated with plasma concentration of atazanavir (r = 0.32 and r = 0.33 respectively; p < 0.05 in both cases). no statistical association was found among gender, ethnicity, age, weight, body mass index (BMI), lipid profile, and the plasma concentration of atazanavir. CONCLUSION: in summary, as expected, concomitant ritonavir use was the only factor associated with atazanavir plasma levels. prospective studies with a larger sample size might help to observe an association of atazanavir concentrations to other characteristics such as body weight, since the p-value showed to be close to significance (p = 0.068).

Related factors to atazanavir plasma levels in a cohort of HIV positive individuals with undetectable viral load.

OBJECTIVE: To evaluate the factors associated with plasma concentrations of atazanavir (ATV) in a cohort of well-controlled HIV infected subjects (undetectable viremia). DESIGN: Cross-sectional study where 69 subjects were consecutively enrolled between April and November, 2011. METHODS: Patients had to be on atazanavir for at least six months, undetectable viral load for a period equal to or longer than 12 months, T CD4+ lymphocyte count higher than 200 cells/mm(3), and aged between 18 years and 70 years old. Exclusion criteria were pregnancy, any neurologic disease, active opportunistic disease, hepatitis or cancer. Atazanavir plasma levels were measured by ultra-performance liquid chromatography. RESULTS AND DISCUSSION: Overall, 54 patients (mean age of 47 years and 50% women) were included in the analysis. Those without ritonavir (unboosted atazanavir) had statistically lower plasma concentrations than those with ritonavir boosted atazanavir (p=0.001) and total and indirect bilirubin were statistically associated with plasma concentration of atazanavir (r=0.32 and r=0.33 respectively; p<0.05 in both cases). No statistical association was found among gender, ethnicity, age, weight, body mass index (BMI), lipid profile, and the plasma concentration of atazanavir. CONCLUSION: In summary, as expected, concomitant ritonavir use was the only factor associated with atazanavir plasma levels. Prospective studies with a larger sample size might help to observe an association of atazanavir concentrations to other characteristics such as body weight, since the p-value showed to be close to significance (p=0.068).

Prevalence and risk factors associated to chronic kidney disease in HIV-infected patients on HAART and undetectable viral load in Brazil.

BACKGROUND: To determine the prevalence and associated factors with chronic kidney disease (CKD) in a cohort of HIV-positive individuals with undetectable viral load on HAART. METHODS: From March, 2009 to September 2009, 213 individuals between 18-70 years, period on HAART ≥12 months, viral load < 50 copies/mm(3), and CD4 ≥ 200 cells/mm(3), were consecutively enrolled at the outpatient clinic of Hospital de Clínicas, Porto Alegre, Brazil. Exclusion criteria were obesity, malnourishment, amputee, paraplegic, previous history of renal disease, pregnancy and hepatic insufficiency. Renal function was determined by estimated glomerular filtration rate (eGFR) assessed by the modification of diet in renal disease. CKD was defined as an eGFR less or equal than 60 ml/min/1.73 m(2), for a period of at least 3 months. Poisson regression was used to determine factors associated with CKD. RESULTS: CKD was diagnosed in 8.4% of the population, and after adjustment, the risk factors were hypertension (RR = 3.88, 95%CI, 1.84-8.16), time on HAART (RR = 1.15, 95%CI,1.03-1.27) and tenofovir exposure (RR = 2.25, 95%CI, 1.04-4.95). Higher weight (RR = 0.88 95%CI, 0.82-0.96) was associated to normal function. CONCLUSIONS: CKD was a common finding in this cohort of patients and was related to hypertension, time on HAART and tenofovir exposure. We suggest a more frequent monitoring of renal function, especially for those with risk factors to early identify renal impairment.

Plasma concentrations of efavirenz are associated with body weight in HIV-positive individuals.

BACKGROUND: Efavirenz is among the most widely used antiretroviral drugs. Increased efavirenz exposure has been associated with CNS side effects and also with the chance of emergence of resistance upon treatment interruptions. The objective of this study was to evaluate factors associated with efavirenz plasma concentrations in a cohort of HIV-infected individuals. METHODS: From July 2009 to March 2010, HIV-infected patients with efavirenz as part of antiretroviral therapy (600 mg at night), undetectable viral load for at least 1 year and CD4 cell count >200 cells/mm(3) were consecutively enrolled at the HIV/AIDS ambulatory care unit in southern Brazil. Plasma samples were taken 18-23 h after efavirenz last dose and analysed by validated ultra-performance liquid chromatography. RESULTS: Forty-one subjects were included (21 females). Mean age and weight were 45.4 years and 70.9 kg, respectively. Mean efavirenz plasma concentration was 2.20 ±â€Š2.17 mg/L. Most plasma concentrations (73%) were within the therapeutic window (1-4 mg/L); 17% were below and 10% above the limits. There were no significant associations between efavirenz concentration and age, CD4 cell count, time on antiretroviral treatment and gender. There was significant and inverse correlation between efavirenz concentrations and body weight (P = 0.013) and body mass index (P = 0.001). CONCLUSIONS: In this cohort of well-controlled HIV-positive individuals, patients with lower weight or body mass index had a higher chance of presenting elevated plasma concentrations of efavirenz. Therapeutic drug monitoring to adjust dose might be a helpful tool to decrease efavirenz dose in order to minimize costs and adverse effects.