Anti-rod and ring antibodies in patients with chronic hepatitis C using direct-acting antivirals.

Anti-rods and rings (anti-RR) antibody induction is related to the combination of interferon and ribavirin in the treatment of hepatitis C virus (HCV) infection. If the main factor leading to this autoimmune reaction is the combination of these drugs, is not well known, but in vitro studies shows that ribavirin alone can induce rods and rings structures. New direct-acting antivirals (DAAs) permit HCV treatment without needing interferon but may be associated with ribavirin in the most difficult-to-treat patients. The aim of this study is to evaluate the occurrence of anti-RR in patients with chronic HCV infection, before and after 12 weeks of treatment with DAAs, with and without ribavirin. From Jun 2016 to Oct 2017, 52 HCV-infected patients were screened for anti-RR before and after DAA therapy, including sofosbuvir, daclatasvir, simeprevir, and ribavirin. Serum samples were analyzed using indirect immunofluorescence. The anti-RR was present in 11 (21%) of the 52 patients (51.9% male and mean age of 59.1 years) before using DAAs. All of them had been previously treated and previous exposed to interferon/ribavirin, with exposure time to ribavirin associated with the presence of anti-RR. After 12 weeks of DAA treatment, 3 patients (5.7%) developed the antibody in low titers, and two of them (66%) were interferon/ribavirin experienced. Only one of the 29 naïve patients (3.44%) developed anti-RR during the current treatment. Anti-RR was present in patients previously treated with interferon/ribavirin and can emerge after DAA treatment probably at a lower frequency than after interferon/ribavirin treatment.

Psychoeducation and Problem-Solving Therapy as an Integrative Model of Mutual-Help Groups for People with Severe Mental Disorders: A Report from Brazil.

This case study describes the "Entrelaços" Peer Support Program, a psychoeducational program of a psychiatric institution in the city of Rio de Janeiro that admitted, between 2011 and 2019, 246 people comprising family members and patients to participate in eight educational seminars followed by multifamily problem-solving groups in cycles that were 18 months in duration. Ninety percent of the participants who completed the program decided to create 7 mutual-help groups in the community independent of technicians and the institution. Community groups have already served spontaneously more than 214 families. They have organized scientific, social and anti-stigma events, expanded their social support network and demonstrated empowerment by switching from service users to peer providers to receive new families. This work is based on a pioneering model in Brazil that integrates psychoeducation with problem-solving therapy, spreading the benefits of education and peer-support with lower cost and greater representativeness.

Long-term persistence of anti-rods and rings antibodies in patients with chronic hepatitis C after antiviral treatment.

Anti-rods and rings (anti-RR) antibodies are related to hepatitis C virus (HCV) in patients treated with pegylated interferon (PEG-IFN) and ribavirin (RBV). Only RBV induces rods/rings structures in vitro; but in vivo, the antibody appearance is related to the combination of these drugs, because data about patients using just one of these drugs alone is missing. Some studies suggest disappearance of these antibodies over time. The aim of this study was to describe the occurrence of anti-RR in patients with chronic hepatitis C treatment-naïve or previously PEG-IFN/RBV-experienced, evaluating the persistence of anti-RR antibodies long after PEG-IFN/RBV treatment. From 2016 to 2017, 70 HCV-infected patients were screened for anti-RR using indirect immunofluorescence. Demographic and clinical data about previous treatments against HCV were assessed. Thirty-four patients (49%) had been previously treated with PEG-IFN/RBV and the average time since they had received the last antiviral treatment was 85.4 months. Anti-RR seropositivity was detected in 16 patients (23%), and all of these had used PEG-IFN/RBV (corresponding to 47% of experienced patients). Previous antiviral treatment and previous exposure time to RBV were associated with anti-RR positivity. Median time elapsed since last treatment was similar between anti-RR-positive and anti-RR-negative patients. Anti-RR seropositivity was not observed in treatment-naïve patients, but was detected in almost half of patients previously treated with PEG-IFN and RBV, even after a long period without exposure to these drugs. This antibody was related to extended prior exposure to ribavirin.

Binding capacity of mannose-binding lectin (MBL) is associated with the severity of chronic Chagas cardiomyopathy.

Chagas disease (CD) is a global problem. Currently, it affects approximately 15 million individuals in Latin America. It is well know that the human immune response is related to different clinical manifestations. Mannose binding lectin (MBL) plays an important role in innate immunity, and it mediates the phagocytosis and complement-mediated destruction of pathogens. The binding capacity is enhanced by the oligomerization of MBL. In this study, we evaluated the serum concentration and the binding capacity of MBL in patients with chronic chagasic cardiomyopathy. A total of 77 patients with chronic CD were included with indeterminate (n = 19), mild cardiac (n = 29) and severe cardiac (n = 29) forms. The serum concentration and the binding capacity were measured using enzyme-linked immunosorbent assays (ELISA). There was no significant difference in the serum MBL levels between the groups of patients. However, we found a relationship between the binding capacity and the groups studied. Our results suggest that binding capacity of MBL could be an indicator of clinical manifestation in Chronic Chagas cardiomyopathy. Furthermore, combined with the Mannose Binding Index results in a useful clinical tool for management of Chronic Chagas Patients.

Risk factors for the progression of chronic kidney disease after acute kidney injury.

INTRODUCTION: The incidence of chronic kidney disease (CKD) is increasing with the increasing age of the population and the increasing number of elderly survivors of acute kidney injury (AKI). The risk factors for the progression of CKD after AKI are unclear. OBJECTIVE: To investigate the association between AKI and its progression to CKD and the risk factors involved. METHODS: An observational, retrospective study of AKI patients followed from 2009 to 2012 was carried out. We evaluated the etiology of AKI, the use of vasoactive drugs and mechanical ventilation, the need for dialysis, the presence of comorbidities, the glomerular filtration rate (GFR), the length of stay and the progression of CKD. Statistical analyses, including the Chi-square test and Pearson's correlation, were performed using SPSS. RESULTS: The 207 patients analyzed had a mean age of 70.1 ± 13.1, and 84.6% of the male patients exhibited decreased renal function and CKD (vs. 60.4% of the female patients). The progression of AKI to CKD was more frequent in patients admitted to wards (63.8%), cancer patients (74.19%), patients with sepsis (67.18%) and patients with obstruction (91.66%). Dialyses were performed in 16.4% of the patients, but this was not correlated with the progression of CKD. CONCLUSIONS: Being an elderly male patient with AKI due to sepsis and obstruction was correlated with progression to CKD following discharge.

Risk factors for the progression of chronic kidney disease after acute kidney injury / Fatores de risco para a progressão da doença renal crônica após a lesão renal aguda

Abstract Introduction: The incidence of chronic kidney disease (CKD) is increasing with the increasing age of the population and the increasing number of elderly survivors of acute kidney injury (AKI). The risk factors for the progression of CKD after AKI are unclear. Objective: To investigate the association between AKI and its progression to CKD and the risk factors involved. Methods: An observational, retrospective study of AKI patients followed from 2009 to 2012 was carried out. We evaluated the etiology of AKI, the use of vasoactive drugs and mechanical ventilation, the need for dialysis, the presence of comorbidities, the glomerular filtration rate (GFR), the length of stay and the progression of CKD. Statistical analyses, including the Chi-square test and Pearson's correlation, were performed using SPSS. Results: The 207 patients analyzed had a mean age of 70.1 ± 13.1, and 84.6% of the male patients exhibited decreased renal function and CKD (vs. 60.4% of the female patients). The progression of AKI to CKD was more frequent in patients admitted to wards (63.8%), cancer patients (74.19%), patients with sepsis (67.18%) and patients with obstruction (91.66%). Dialyses were performed in 16.4% of the patients, but this was not correlated with the progression of CKD. Conclusions: Being an elderly male patient with AKI due to sepsis and obstruction was correlated with progression to CKD following discharge.

Resumo Introdução: A incidência da doença renal crônica (DRC) está aumentando com o aumento da idade da população e o número crescente de idosos sobreviventes da lesão renal aguda (LRA). Os fatores de risco para a progressão da DRC após a lesão renal aguda (LRA) não são claros. Objetivos: Investigar a associação entre a LRA e sua progressão para a DRC e os fatores de risco envolvidos. Métodos: Foi realizado estudo observacional, retrospectivo de pacientes com LRA acompanhados de 2009 a 2012. Foram avaliados a etiologia da LRA, o uso de drogas vasoativas, ventilação mecânica, necessidade de diálise, presença de morbidades associadas, ritmo de filtração glomerular estimado (eGFR), duração da internação e a progressão da DRC. As análises estatísticas incluíram o teste Qui-quadrado e a correlação de Pearson utilizando o programa do SPSS. Resultados: Os 207 pacientes analisados apresentaram idade de 70,1 ± 13,1 anos, 84,6% eram do sexo masculino e que apresentaram redução da função renal e DRC (vs. 60,4% dos pacientes do sexo feminino). A progressão da LRA para DRC foi mais frequente em pacientes internados em enfermarias (63,8%), pacientes com câncer (74,19%), com sepse (67,18%) e com obstrução do trato urinário (91,66%). As dialises foram realizadas em 16,4% dos pacientes, mas isso não foi correlacionado com a progressão da DRC. Conclusões: Pacientes idosos com LRA devido à sepse e obstrução do trato urinário foram correlacionados com a progressão para DRC após a alta.

Serological markers of hepatitis B and C in patients with HIV/AIDS and active tuberculosis.

Infection with hepatitis B virus (HBV) and C virus (HCV) are common in patients with HIV/AIDS and tuberculosis (TB). This is a cross-sectional study with patients infected with HIV/AIDS and active TB in Recife, Brazil, aiming to verify the prevalence of markers for HBV: antibody to hepatitis B core antigen (anti-HBc); and HCV: antibody to hepatitis C virus (anti-HCV) by chemiluminescence, and to identify the frequency of associated factors. Data were collected through questionnaires, and blood was drawn from patients for analysis. We used the chi-square test and the Fisher exact test when necessary. We conducted a bivariate logistic regression analysis and the magnitude of the associations was expressed as odds ratio (OR) with a confidence interval of 95%. Among 166 patients studied with HIV/AIDS and active TB, anti-HBc was positive in 61 patients [36.7%; 95%CI (29.4-44.6%)] and anti-HCV in 11[6.6%; 95%CI (3.4-11.5%)]. In the logistic regression analysis, male sex, and age ≥40 years were independent factors associated with the occurrence of anti-HBc. In conclusion, we verified a high frequency of HBV contact marker and a low frequency of HCV markers in patients with HIV/AIDS and TB in Recife.

Prevalencia de la co-infección con hepatitis B y C en pacientes HIV positivos y factores de riesgo asociados / Prevalence of co-infection with hepatitis B and C in HIV-positive patients and associated risk factors

Los virus de la hepatitis B (HBV) y C (HCV) son, frecuentemente, causa de enfermedad hepática crónica en pacientes infectados por el HIV (HIV +), ya que tienen las mismas rutas de transmisión. Se ha informado de prevalencias variables de co-infección, dependiendo de la población bajo estudio. El objetivo de este estudio fue determinar la prevalencia y los factores de riesgo asociados a la infección por HBV y HCV en pacientes HIV+ en el Hospital Universitario Oswaldo Cruz (HUOC) de Recife, Brasil, entre julio y spetiembre de 2004.

Hepatitis B and C are highly prevalent among HIV infected patients, resulting of shared transmission routes. Prevalences of HIV and hepatitis co-infections vary depending on the population studied. The main goal was to assess the prevalence and associated risk factors for HBV and HCV among HIV-infected patients. HIV infected patients at the Hospital Universitário Oswaldo Cruz (HUOC), Recife, Brazil, were studiend from July through September 2004.

Prevalencia de la co-infección con hepatitis B y C en pacientes HIV positivos y factores de riesgo asociados / Prevalence of co-infection with hepatitis B and C in HIV-positive patients and associated risk factors

Los virus de la hepatitis B (HBV) y C (HCV) son, frecuentemente, causa de enfermedad hepática crónica en pacientes infectados por el HIV (HIV +), ya que tienen las mismas rutas de transmisión. Se ha informado de prevalencias variables de co-infección, dependiendo de la población bajo estudio. El objetivo de este estudio fue determinar la prevalencia y los factores de riesgo asociados a la infección por HBV y HCV en pacientes HIV+ en el Hospital Universitario Oswaldo Cruz (HUOC) de Recife, Brasil, entre julio y spetiembre de 2004.(AU)

Hepatitis B and C are highly prevalent among HIV infected patients, resulting of shared transmission routes. Prevalences of HIV and hepatitis co-infections vary depending on the population studied. The main goal was to assess the prevalence and associated risk factors for HBV and HCV among HIV-infected patients. HIV infected patients at the Hospital Universitário Oswaldo Cruz (HUOC), Recife, Brazil, were studiend from July through September 2004.(AU)

(Des)conforto de trabalhadores de enfermagem: uma questão de (in)justiça social / (Des)confort de trabajadores de enfermería: una cuestion de (in)justicia social / Nursing workers´(dis)comfort: a matter of social (in)justice

Estudo exploratório descritivo realizado com 52 trabalhadores de enfermagem de um hospital universitário buscou identificar os níveis de conforto em relação ao trabalho e ao cuidado recebido pelo cliente, as necessidades e propostas para aumentar o conforto. A análise das entrevistas semi-estruturadas mostrou que a maioria dos respondentes (79 por cento e 85 por cento) referiu níveis alto e médio de conforto em relação ao trabalho e ao cuidado. O conforto estava relacionado ao reconhecimento por parte do cliente e relacionamento harmônico com a equipe. Identificamos desconforto em relação à estrutura precária e recursos insuficientes, e a necessidade de ter melhores condições de trabalho para proporcionar assistência adequada. Concluímos que a atenção às necessidades dos profissionais levará a maior conforto e satisfação no trabalho.

El estudio exploratorio-descriptivo hecho con 52 trabajadores de enfermería de un hospital de la universidad, busca identificar los niveles de comodidad respecto al trabajo y al cuidado que el cliente recibe, las necesidades y la demanda para aumentar su confort. El análisis de las entrevistas semiestructuradas pone de manifiesto que la mayoría de los trabajadores (79 por ciento y 85 por ciento) relaciona los niveles alto y promedio de confort cuando se trata del trabajo y del cuidado. Y éstos dos a la vez se relacionan con el reconocimiento por parte del cliente y con la relación armónica con el equipo. El malestar se puede comprobar respecto a la estructura precaria, a los recursos escasos y a la necesidad de que haya mejores condiciones de trabajo para que se proporcione una asistencia adecuada. Se concluye que cuando se atiendan las necesidades de los profesionales habrá más confort y satisfacción en el trabajo.

An exploratory, descriptive study carried out with 52 Nursing workers from a university hospital. Its purpose was to identify the levels of comfort concerning both work and care received by clients, workers´ needs and strategies to increase their levels of comfort. An analysis of interviews showed that most participants (79 percent and 85 percent) referred high and average levels of comfort, respectively, in relation to work and health care. Comfort was related mainly to response they heard from clients, and to an harmonic relationship among team members. Discomfort was related to the hospital precarious structure and insufficient resources for health care, besides the need workers have for better work conditions in order to provide quality nursing care. Our conclusion was that attention given to workers´ needs will maximize comfort concerning both work and health care provided.

Prevalência de hepatite B em parturientes e perfil sorológico perinatal / Prevalence of hepatitis B in parturients and perinatal serologic profile

OBJETIVOS: avaliar a prevalência do antígeno de superfície do vírus B da hepatite (HBsAg) em parturientes internadas no Instituto Materno-Infantil de Pernambuco (IMIP), Recife-PE, e o perfil sorológico das positivas. MÉTODOS: este é estudo de secçäo de corte transversal prospectivo no qual foram utilizados os sistemas VIDAS e VIDAS HBs, respectivamente, para detecçäo e confirmaçäo do HBsAg. As participantes foram selecionadas de forma aleatória. Nas pacientes HBsAg+, os outros marcadores sorológicos foram testados com o sistema automatizado AxSYM. Os recém-nascidos de mäes HBsAg+ foram vacinados ao nascer com a vacina Engerix B. RESULTADOS: de um total de 1584, encontramos 9 (0,6 por cento) gestantes HBsAg positivas. Nenhuma delas apresentava anti-HBc IgM, sendo assim casos prevalentes. Em 1/9 (11,1 por cento) das gestantes havia presença do HBeAg isolado e em 4/9 (44,4 por cento), deste antígeno e seu anticorpo correspondente, revelando os diferentes graus de risco de transmissäo vertical da infecçäo. Com a exceçäo de dois recém-nascidos de um parto gemelar (um de baixo peso), todos apresentaram soroconversäo para o anti-HBs com três doses da vacina. Os gemelares prematuros só mostraram soroconversäo após a quarta dose da vacina. CONCLUSÖES: a prevalência da hepatite B em parturientes no IMIP é relativamente baixa e todas as pacientes detectadas entäo tinham a forma crônica da infecçäo

The biological meaning of anti-HBC positive result in blood donors: relation to HBV-DNA and to other serological markers.

In order to assess the potential risk of anti-HBc-positive blood donors for post-transfusional hepatitis and to investigate whether other HBV serological markers are capable of identifying the presence of the virus, 1000 first-time blood donors were enrolled between June and July 1997. These donors were screened using routine Brazilian blood center tests (HIV 1 and 2, HTLV 1 and 2, Chagas disease, Syphilis, HCV, HBsAg, anti-HBc and ALT ). The 120 (12%) found to be anti-HBc-positive underwent further tests: HBe, anti-HBe, anti-HBs and HBV-DNA by PCR. Ten cases were HBsAg positive and all were HBV-DNA positive by PCR. Three HBsAg-negative donors were HBV-DNA-positive. Two HBV-DNA-positive donors were also anti-HBs-positive. All the HBV-positive donors had at least one HBV marker other than anti-HBc. Anti-HBc is an important cause of blood rejection. Testing for HBsAg alone is not fully protective and anti-HBc remains necessary as a screening test. The presence of anti-HBs is not always indicative of absence of the virus. The addition of other HBV serological markers could represent an alternative in predicting the presence of the virus when compared with PCR. It is recommended that other studies should be carried out to confirm this finding.

The biological meaning of anti-HBC positive result in blood donors: relation to HBV-DNA and to other serological markers

In order to assess the potential risk of anti-HBc-positive blood donors for post-transfusional hepatitis and to investigate whether other HBV serological markers are capable of identifying the presence of the virus, 1000 first-time blood donors were enrolled between June and July 1997. These donors were screened using routine Brazilian blood center tests (HIV 1 and 2, HTLV 1 and 2, Chagas disease, Syphilis, HCV, HBsAg, anti-HBc and ALT ). The 120 (12 percent) found to be anti-HBc-positive underwent further tests: HBe, anti-HBe, anti-HBs and HBV-DNA by PCR. Ten cases were HBsAg positive and all were HBV-DNA positive by PCR. Three HBsAg-negative donors were HBV-DNA-positive. Two HBV-DNA-positive donors were also anti-HBs-positive. All the HBV-positive donors had at least one HBV marker other than anti-HBc. Anti-HBc is an important cause of blood rejection. Testing for HBsAg alone is not fully protective and anti-HBc remains necessary as a screening test. The presence of anti-HBs is not always indicative of absence of the virus. The addition of other HBV serological markers could represent an alternative in predicting the presence of the virus when compared with PCR. It is recommended that other studies should be carried out to confirm this finding

[Nursing workers' (dis)comfort: a matter of social (in)justice]. / (Des)conforto de trabalhadores de enfermagem: uma questão de (in)justiça social.

An exploratory, descriptive study carried out with 52 Nursing workers from a university hospital. Its purpose was to identify the levels of comfort concerning both work and care received by clients, workers' needs and strategies to increase their levels of comfort. An analysis of interviews showed that most participants (79% and 85%) referred high and average levels of comfort, respectively, in relation to work and health care. Comfort was related mainly to response they heard from clients, and to an harmonic relationship among team members. Discomfort was related to the hospital precarious structure and insufficient resources for health care, besides the need workers have for better work conditions in order to provide quality nursing care. Our conclusion was that attention given to workers' needs will maximize comfort concerning both work and health care provided.