Risk factors for hepatitis C virus infection in Inland Brazil: an analysis of pooled epidemiological sectional studies.

In order to assess the contribution of different parenteral routes as risk exposure to the hepatitis C virus (HCV), samples from nine surveys or cross-sectional studies conducted in two Brazilian inland regions were pooled, including a total of 3,910 subjects. Heterogeneity among the study results for different risk factors was tested and the results were shown to be homogeneous. Anti-HCV antibodies were observed in 241 individuals, of which 146 (3.7%, 95% CI = 3.2-4.4) had HCV exposure confirmed by immunoblot analysis or PCR test. After adjustment for relevant variables, a correlation between confirmed HCV exposure and injection drug use, tattooing, and advance age was observed. In a second logistic model that included exposures not searched in all nine studies, a smaller sample was analyzed, revealing an independent HCV association with past history of surgery and males who have sex with other males, in addition to repeated injection drug use. Overall, these analyses corroborate the finding that injection drug use is the main risk factor for HCV exposure and spread, in addition to other parenteral routes.

Clinical, demographic and epidemiological characteristics of patients with hepatitis B followed at a university hospital in southeastern Brazil: predominance of HBeAg negative cases.

INTRODUCTION: Hepatitis B is common in Brazil, although there are regional differences regarding the degree of endemicity, the most frequent forms of transmission and the presence of different evolutive stages of chronic disease. The present study aimed to determine the clinical, demographic and epidemiological characteristics of patients chronically infected with hepatitis B virus (HBV) residing in the Ribeirão Preto region, southeastern Brazil. METHODS: A total of 529 medical records of individuals with HBV monoinfection were reviewed. RESULTS: More than 60% of the subjects were males, with a mean age of 38 years-old. The HBeAg-negative serological pattern was verified in 84.4% of the patients, among whom the risk of vertical/intrafamily transmission was 43.2% (p = 0.02). The consumption of alcohol in amounts exceeding 20 g a day was observed in 21.3% of the subjects and was more frequent among men (33%) (p < 0.001). Among patients with cirrhosis, 54.1% were alcohol abusers (p = 0.04), all of them males. The presence of cirrhosis was more frequent in the HBeAg-positive group (24.4%) than in the HBeAg-negative group (10.2%) (p < 0.001). CONCLUSIONS: High proportions of HBV-infected subjects with an HBeAg-negative pattern were observed, with a higher risk of vertical/intrafamily transmission. Alcohol abuse was associated with male subjects and with cirrhosis of the liver in this group. A tendency toward an increase in the number of HBeAg-negative cases was observed over time.

Clinical, demographic and epidemiological characteristics of patients with hepatitis B followed at a university hospital in southeastern Brazil: predominance of HBeAg negative cases / Características clínicas, demográficas e epidemiológicas dos pacientes com hepatite B em seguimento em hospital universitário no sudeste do Brasil: predominância de casos HBeAg negativos

INTRODUCTION: Hepatitis B is common in Brazil, although there are regional differences regarding the degree of endemicity, the most frequent forms of transmission and the presence of different evolutive stages of chronic disease. The present study aimed to determine the clinical, demographic and epidemiological characteristics of patients chronically infected with hepatitis B virus (HBV) residing in the Ribeirão Preto region, southeastern Brazil. METHODS: A total of 529 medical records of individuals with HBV monoinfection were reviewed. RESULTS: More than 60 percent of the subjects were males, with a mean age of 38 years-old. The HBeAg-negative serological pattern was verified in 84.4 percent of the patients, among whom the risk of vertical/intrafamily transmission was 43.2 percent (p = 0.02). The consumption of alcohol in amounts exceeding 20g a day was observed in 21.3 percent of the subjects and was more frequent among men (33 percent) (p < 0.001). Among patients with cirrhosis, 54.1 percent were alcohol abusers (p = 0.04), all of them males. The presence of cirrhosis was more frequent in the HBeAg-positive group (24.4 percent) than in the HBeAg-negative group (10.2 percent) (p < 0.001). CONCLUSIONS: High proportions of HBV-infected subjects with an HBeAg-negative pattern were observed, with a higher risk of vertical/intrafamily transmission. Alcohol abuse was associated with male subjects and with cirrhosis of the liver in this group. A tendency toward an increase in the number of HBeAg-negative cases was observed over time.

INTRODUÇÃO: No Brasil, a hepatite B é comum. No entanto, há diferenças regionais no que diz respeito ao grau de endemicidade, as formas de transmissão mais encontradas e a presença dos diferentes estágios evolutivos da doença crônica. O objetivo deste trabalho foi o de conhecer características clínicas, demográficas e epidemiológicas de pacientes cronicamente infectados pelo vírus da hepatite B (HBV), residentes na região de Ribeirão Preto, no sudeste do Brasil. MÉTODOS: Foi realizada a análise retrospectiva de 529 prontuários de indivíduos com monoinfecção pelo HBV. RESULTADOS: Mais de 60 por cento eram masculinos, a média de idade foi de 38 anos. O padrão sorológico HBeAg negativo foi encontrado em 84,4 por cento dos pacientes, entre os quais o risco para transmissão vertical/intrafamiliar foi de 43,2 por cento (p = 0,02). Verificou-se uso de álcool em quantidades maiores que 20g ao dia em 21,3 por cento dos indivíduos, sendo mais frequente entre os homens (33 por cento) (p < 0,001). Entre os pacientes com cirrose, 54,1 por cento faziam uso abusivo de bebidas alcoólicas (p = 0,04), sendo todos estes do gênero masculino. A presença de cirrose foi maior no grupo HBeAg positivo (24,4 por cento) que no grupo HBeAg negativo (10,2 por cento) (p < 0,001). CONCLUSÕES: Observaram-se elevadas proporções de indivíduos com infecção pelo HBV com padrão sorológico HBeAg negativo, entre os quais houve maior risco para a transmissão vertical/intrafamiliar. O uso abusivo de álcool esteve associado a indivíduos do sexo masculino e, neste grupo, à cirrose hepática. Observou-se tendência ao aumento no número de casos HBeAg negativo ao longo do tempo.

Long-term follow-up of patients with chronic hepatitis C with sustained virologic response to interferon.

BACKGROUND AND AIM: The durability of the sustained virologic response (SVR) in patients with chronic hepatitis C after treatment and the ideal follow-up time for these patients remains undefined. The objective of the study was to evaluate the durability of the virologic response in patients with chronic hepatitis C followed up for at least 12 months after SVR at HCFMRP-USP. METHODS: The study was conducted on 174 patients with chronic hepatitis C treated with different antiviral regimens who had achieved SVR. Qualitative serum HCV-RNA was determined by the commercial kit (COBAS AMPLICOR HCV, v2.0). RESULTS: There was predominance of male (73%) with a mean age of 45.6 ± 10 years. Liver cirrhosis was present in 16.1% of the study subjects. Mean follow-up time after SVR was 47 months (12-156 months). Twenty-two patients received monotherapy with interferon; 94 received interferon plus ribavirin, and 58 received pegylated interferon plus ribavirin. A total of 134 patients (77.0%) received one treatment course, 29 (16.7%) received two courses, and 11 (6.3%) received three courses. The distribution of HCV genotypes was: genotype 1 (40.2%), genotype 3 (40.8%) and genotype 2 (10.3%). Genotype was undetermined in 8.7% of cases. None of the 174 patients had recurrence of HCV infection. Two cirrhotic patients developed hepatocellular carcinoma (HCC) during follow-up. CONCLUSIONS: Among patients with SVR there was no recurrence of HCV infection or evidence of liver disease progression in any patient followed up for a mean of 47 months after SVR, except for patients with advanced hepatic disease before treatment, who may develop HCC despite SVR. Therefore, one can assume that SVR is associated with long term good prognosis.

Long-term follow-up of patients with chronic hepatitis C with sustained virologic response to interferon

BACKGROUND AND AIM: The durability of the sustained virologic response (SVR) in patients with chronic hepatitis C after treatment and the ideal follow-up time for these patients remains undefined. The objective of the study was to evaluate the durability of the virologic response in patients with chronic hepatitis C followed up for at least 12 months after SVR at HCFMRP-USP. METHODS: The study was conducted on 174 patients with chronic hepatitis C treated with different antiviral regimens who had achieved SVR. Qualitative serum HCV-RNA was determined by the commercial kit (COBAS AMPLICOR HCV, v2.0). RESULTS: There was predominance of male (73 percent) with a mean age of 45.6 ± 10 years. Liver cirrhosis was present in 16.1 percent of the study subjects. Mean follow-up time after SVR was 47 months (12-156 months). Twenty-two patients received monotherapy with interferon; 94 received interferon plus ribavirin, and 58 received pegylated interferon plus ribavirin. A total of 134 patients (77.0 percent) received one treatment course, 29 (16.7 percent) received two courses, and 11 (6.3 percent) received three courses. The distribution of HCV genotypes was: genotype 1 (40.2 percent), genotype 3 (40.8 percent) and genotype 2 (10.3 percent). Genotype was undetermined in 8.7 percent of cases. None of the 174 patients had recurrence of HCV infection. Two cirrhotic patients developed hepatocellular carcinoma (HCC) during follow-up. CONCLUSIONS: Among patients with SVR there was no recurrence of HCV infection or evidence of liver disease progression in any patient followed up for a mean of 47 months after SVR, except for patients with advanced hepatic disease before treatment, who may develop HCC despite SVR. Therefore, one can assume that SVR is associated with long term good prognosis.

[Influence of acute-phase inflammatory response on serum levels of retinol and retinol binding protein in HIV/AIDS patients]. / Influência da resposta inflamatória de fase aguda nos níveis séricos de retinol e da proteína de ligação do retinol em pacientes com AIDS.

INTRODUCTION: Hyporetinolemia is an independent prognostic factor in AIDS patients. Inflammatory activity causes a reduction in the serum levels of this nutrient in the general population. However, there are no studies assessing the impact of inflammatory activity on the serum retinol level in AIDS patients. METHODS: A cross-sectional assessment was conducted on 41 patients hospitalized due to AIDS complications. Inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) and serum retinol and retinol binding protein concentrations were quantified. RESULTS: Despite the low (14.6%) prevalence of hyporetinolemia, a significant negative correlation was observed between the inflammatory markers and the serum retinol and retinol binding protein levels in AIDS patients. CONCLUSIONS: Acute-phase inflammatory activity is associated with low serum retinol levels in individuals with AIDS.

Influência da resposta inflamatória de fase aguda nos níveis séricos de retinol e da proteína de ligação do retinol em pacientes com AIDS / Influence of acute-phase inflammatory response on serum levels of retinol and retinol binding protein in HIV/AIDS patients

INTRODUÇÃO: a hiporretinolemia constitui fator prognóstico independente em pacientes com AIDS, e a atividade inflamatória causa redução dos níveis séricos deste nutriente na população em geral. Entretanto, faltam estudos que avaliem o impacto da atividade inflamatória sobre o nível sérico do retinol em pacientes com AIDS. MÉTODOS: foram avaliados transversalmente 41 pacientes internados por complicações da AIDS, que tiveram quantificados alguns marcadores de inflamação (proteína C reativa e fator de necrose tumoral alfa) e concentrações séricas de retinol e da proteína de ligação do retinol. RESULTADOS: apesar da baixa (14,6 por cento) prevalência de hiporretinolemia evidenciou-se correlação negativa dos marcadores de inflamação com os níveis séricos de retinol e de sua proteína de ligação nos pacientes com AIDS. CONCLUSÕES: a atividade inflamatória de fase aguda está associada a baixos níveis séricos de retinol em indivíduos com AIDS.

INTRODUCTION: Hyporetinolemia is an independent prognostic factor in AIDS patients. Inflammatory activity causes a reduction in the serum levels of this nutrient in the general population. However, there are no studies assessing the impact of inflammatory activity on the serum retinol level in AIDS patients. METHODS: A cross-sectional assessment was conducted on 41 patients hospitalized due to AIDS complications. Inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) and serum retinol and retinol binding protein concentrations were quantified. RESULTS: Despite the low (14.6 percent) prevalence of hyporetinolemia, a significant negative correlation was observed between the inflammatory markers and the serum retinol and retinol binding protein levels in AIDS patients. CONCLUSIONS: Acute-phase inflammatory activity is associated with low serum retinol levels in individuals with AIDS.

Valorização por pós-graduandos dos papéis do professor de ciências da saúde / Valuation by graduated students of the roles of the health sciences teacher

Introdução: No passado, idealmente, o Professor de Ciências da Saúde deveria ser conferencista exímio e ter grande competência profissional. Atualmente, os papéis de um “bom professor” são mais amplos. O estudo foi desenvolvido com o objetivo de verificar se este novo conceito está disseminado entre pós-graduandos, coletando suas opiniões sobre o valor de múltiplos papéis. Método: Opiniões de 92 pós-graduandos foram colhidas por meio de questionário, autoadministrado, contendo 13 itens relacionados com as principais atribuições do Professor de Ciências da Saúde: administrador institucional; avaliador de alunos; avaliador de cursos; captador de recursos materiais externos, para a instituição; gerador de novos conhecimentos; membro ativo da estrutura universitária; modelo de atitudes, valores e crenças; planejador de cursos/currículos; produtor de material didático; profissional hábil e competente; provedor de informações na prática médica; provedor de informações para o aluno em aulas formais; tutor/facilitador. As respostas foram registradas em escala Likert de 5 pontos, sendo o ponto 1 correspondente a “sem importância” e o ponto 5 a “muito importante”. Resultados: O papel mais valorizado foi o de “gerador de novos conhecimentos”, seguido dos papéis de “avaliador de alunos” e de “provedor de informações em aulas formais”. E os menos valorizados foram: “tutor”, “modelo de atitudes valores e crenças” e “captador de recursos para a instituição”. Conclusão: Os resultados indicam que há necessidade de inclusão, nos Programas de Pós-Graduação, de maior número de atividades formativas que ampliem a visão dos mestrandos e doutorandos sobre os múltiplos papéis do moderno professor de ciências da saúde.

Background: In the past, the Professor of Health Sciences was ideally supposed to be a distinguished lecturer with high professional competence. Today, the roles of a “good teacher” have expanded. The objective of the present study was to determine whether this new concept is disseminated among postgraduate students, whose opinions about the values of multiple roles were surveyed. Method: The opinions of 92 postgraduate students were collected with a self-administered questionnaire containing 13 items related to the major attributions of a Professor of Health Sciences: institutional administrator; evaluator of students; evaluator of courses; fund raiser for external financial resources, for the institution; generator of new knowledge; active member of the university structure; role model for actions, values and beliefs; planner of courses/syllabi; producer of teaching material; skilled and competent professional; provider of information in medical practice; provider of information for the students in formal classes; tutor/facilitator. The replies were scored on a 5-point Likert scale, with point 1 corresponding to “not important” and point 5 to “very important”. Results: The most valued role was that of “generator of new knowledge”, followed by “evaluator of students” and “provider of information in formal classes’. And the least valued roles were: “tutor”, “role model for attitudes, values and beliefs”, and “fund raiser for external financial resources, for the institution”. Conclusion: The results indicate the need to include a larger number of educational activities in order to expand the view of Masters and Doctoral students regarding the multiple roles of modern Professors of Health Sciences.

Group mentoring for junior medical students: perceptions of mentees and mentors / Percepções de estudantes de medicina e de mentores sobre um programa de tutoria (mentoring) desenvolvido em grupos

Entering medical school can be associated with a number of difficulties that can hinder students' performance. Mentoring programs are designed to help students circumvent difficulties and improve their learning and personal development. The current study aimed to evaluate the perceptions of both students and mentors regarding a recently introduced, group-based mentoring program designed to support first-year students. After one year of regular meetings, students and mentors' perceptions of the program were assessed by means of structured questionnaires. Response content categories were identified through multiple readings. Both regular attendees and non-participating students had positive opinions about the program. Mentors were highly satisfied at having participated and acknowledged that the program has been useful not only for assisting students, but also for fostering their own personal and professional development. In conclusion, the group-based mentoring program is feasible and can elicit positive views from both mentors and students. In addition, faculty members' participation as mentors can also be beneficial, since the program appears to contribute to their own personal and professional development.

O ingressante na escola médica pode encontrar dificuldades variadas, que afetam seu desempenho. Programas de apoio com mentores podem servir para auxiliar os estudantes e favorecer seu desenvolvimento pessoal e acadêmico. Neste trabalho avaliamos as percepções de estudantes e de mentores sobre um programa de apoio baseado em grupos e planejado para apoiar estudantes ingressantes. Após um ano de funcionamento regular do programa, as percepções dos estudantes e dos mentores sobre o programa foram avaliadas utilizando questionários estruturados, cuja análise permitiu estabelecer categorias de conteúdo das respostas. Tanto os estudantes que participaram regularmente do programa, como os que não haviam participado expressaram opiniões positivas sobre o programa. Os mentores expressaram alto grau de satisfação em participar do programa e opinaram que o programa vem sendo útil também para auxiliar na formação docente. Concluímos que o programa de apoio ao estudante ingressante, baseado em grupos que operam ao redor de mentores, é viável e efetivo no auxílio ao estudante e pode também contribuir para a formação e o desenvolvimento dos docentes e médicos que participam como mentores.

Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral / Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

OBJETIVO: Avaliar a freqüência de infecção relacionada ao cateter venoso central em pacientes submetidos a terapia nutricional parenteral. MÉTODOS: Foram analisados os cateteres venosos centrais de pacientes em terapia nutricional parenteral que tiveram a indicação de retirada do cateter venoso central por infecção, alta hospitalar, ou trombose. Os pacientes com infecção foram denominados de Grupo 1 e os demais de Grupo 2. RESULTADOS: Não houve diferença estatisticamente significante quanto ao estado nutricional dos 18 pacientes analisados. Foram analisados 28 cateteres e destes 68 por cento estavam infectados, sendo 72 por cento do Grupo 1 e 28 por cento do Grupo 2 (assintomáticos). No Grupo 1, houve infecção sistêmica em 70 por cento dos casos, já no Grupo 2 a hemocultura foi positiva em 17 por cento dos casos. A colonização por Staphylococcus sp. ocorreu em 48 por cento dos casos, seguida de Candida sp. (21 por cento), Enterococcus faecalis (16 por cento), Pseudomonas aerurginosa (10 por cento) e Proteus sp.(5 por cento). CONCLUSÃO: A contaminação de cateter venoso central utilizado para terapia nutricional parenteral é freqüente. Mesmo pacientes assintomáticos recebendo nutrição parenteral têm uma incidência maior de infecção por Candida sp. Portanto é necessária a criação de barreiras que impeçam a colonização destes cateteres venosos centrais, a fim de diminuir a morbimortalidade de pacientes dependentes deste tipo de terapia.

OBJECTIVE: The aim of this study was to evaluate the frequency of central venous catheter-related infections in hospitalized patients receiving total parenteral nutrition. METHODS: Central venous catheters were analyzed immediately after removal due to infection, hospital discharge or thrombosis. The patients with catheter-related infection were named Group 1 and the other patients were named Group 2. RESULTS: Eighteen patients were studied. There was no statistically significant difference in nutritional status between the two groups. A total of 28 catheters were analyzed. Sixty-eight percent of the catheters were infected: 72 percent of them were from Group 1 and 28 percent from Group 2 (asymptomatic patients). Systemic infection was diagnosed in 70 percent of the patients from Group 1. Positive blood culture was found in 17 percent of the patients from Group 2. The microorganisms found were: Staphylococcus sp. (48 percent), Candida sp. (21 percent), Enterococcus faecalis (16 percent), Pseudomonas aerurginosa (10 percent) and Proteus sp. (5 percent). CONCLUSION: Central venous catheter infection is common in hospitalized asymptomatic patients. Patients receiving total parenteral nutrition are most frequently infected with Candida sp. Therefore, the creation of barriers that block colonization in the central venous catheter is essential to decrease the morbidity and mortality among patients that depend on total parenteral nutrition.

Predictive markers for hepatitis C virus infection among Brazilian inmates.

Hepatitis C virus (HCV) infection has quite high prevalence in the prison system, reaching rates of up to 40%. This survey aimed to estimate the prevalence of HCV infection and evaluate risk factors for this exposure among male inmates at the Ribeirão Preto Prison, State of São Paulo, Brazil, between May and August 2003. A total of 333 participants were interviewed using a standardized questionnaire and underwent immunoenzymatic assaying to investigate anti-HCV. The prevalence of HCV infection among the inmates was 8.7% (95% CI: 5.7-11.7). The participants'mean age was 30.1 years, and the prevalence was predominantly among individuals over 30 years of age. Multivariate analysis showed that the variables that were independently associated with HCV infection were age > 30 years, tattooing, history of previous hepatitis, previous injection drug use and previous needle-sharing.

Predictive markers for hepatitis C virus infection among Brazilian inmates / Marcadores preditivos para infecção do vírus da hepatite C em presidiários brasileiros

Hepatitis C virus (HCV) infection has quite high prevalence in the prison system, reaching rates of up to 40 percent. This survey aimed to estimate the prevalence of HCV infection and evaluate risk factors for this exposure among male inmates at the Ribeirão Preto Prison, State of São Paulo, Brazil, between May and August 2003. A total of 333 participants were interviewed using a standardized questionnaire and underwent immunoenzymatic assaying to investigate anti-HCV. The prevalence of HCV infection among the inmates was 8.7 percent (95 percent CI: 5.7-11.7). The participants'mean age was 30.1 years, and the prevalence was predominantly among individuals over 30 years of age. Multivariate analysis showed that the variables that were independently associated with HCV infection were age > 30 years, tattooing, history of previous hepatitis, previous injection drug use and previous needle-sharing.

Infecção pelo vírus da hepatite C no sistema prisional apresenta elevada prevalência, chegando a atingir cifras superiores a 40 por cento. Esta pesquisa objetivou estimar a prevalência do HCV e avaliar fatores de risco para esta exposição na população masculina carcerária da Penitenciária de Ribeirão Preto - SP, no período de maio a agosto de 2003. Um total de 333 participantes foi submetido à aplicação de um questionário padronizado e a ensaio imunoenzimático para pesquisa de anti-HCV. A prevalência encontrada de infecção pelo HCV nos presidiários foi de 8,7 por cento (IC 95 por cento: 5,7-11,7). A média de idade dos participantes foi de 30,1 anos, com a prevalência predominando nos indivíduos acima de 30 anos. Na análise multivariada, as variáveis que se mostraram associadas de forma independente à infecção pelo HCV foram idade > 30 anos, tatuagem, história prévia de hepatite, passado de uso de droga injetável e passado de compartilhamento de agulhas.

Soroprevalência da infecção pelo vírus da Hepatite B em uma prisão brasileira / Seroprevalence of Hepatitis B virus infection in a Brazilian jail

Esta pesquisa objetivou estimar a prevalência do marcador do HBV e seus fatores de risco na população masculina carcerária da Penitenciária de Ribeirão Preto - SP, Brasil. De 1.030 presidiários, foram sorteados 333 participantes, os quais foram submetidos à aplicação de um questionário e à coleta de sangue, no período de maio a agosto de 2003. Para diagnóstico de exposição ao HBV foi utilizado o ensaio imunoabsorvente de ligação de enzimas (ELISA) para detecção dos marcadores HBsAg, anti-HBsAg e anti-HBc total. A prevalência total de infecção pelo HBV nos presidiários foi de 19,5 por cento (IC95 por cento: 15,2 - 23,8). A média de idade dos participantes foi de 30,1 anos. Na análise univariada, a infecção pelo HBV esteve associada à idade acima de 30 anos (p<0,001), uso prévio de drogas injetáveis (p<0,001) e compartilhamento de agulhas prévio (p<0,001). Em um modelo multivariado, de regressão logística, a infecção pelo HBV foi associada à idade acima de 30 anos (OR = 3,3: IC95 por cento: 1,8 - 6.1) e uso prévio de droga injetável (OR = 2,7; IC95 por cento: 1.9 - 6.4). Infecção pelo HBV nas prisões representa grave problema de saúde pública, principalmente relacionado à idade acima de 30 anos e uso prévio de drogas injetáveis.

This survey aimed to estimate the prevalence of HBV serological markers and risk factors for this infection in male inmates at the Penitentiary of Ribeirão Preto, State of São Paulo, Brazil. Out of 1030 inmates, a simple random sample of 333 participants answered a questionnaire and had blood samples collected, from May to August 2003. Enzyme-linked immunosorbent assay (ELISA) was used to diagnose HBV infection (HBsAg, anti-HBsAg, and total anti-HBc). The overall prevalence for HBV markers in inmates was 19.5 percent (CI95 percent: 15.2 - 23.8). The participants' mean age was 30.1 years. In univariate analysis, HBV infection was associated with age > 30 years (p<0.001), previous injecting drug use (p<0.001) and previous sharing of needles (p<0.001). In a logistic regression multivariate model, HBV infection was associated with age > 30 years (OR = 3.3; CI95 percent: 1.8 - 6.1) and previous injecting drug use (OR = 2.7; CI95 percent: 1.9 - 6.4). HBV infection on prisons represents a major health problem, mainly associated with age over 30 years and previous injecting drug use.

Biofilms, infection, and parenteral nutrition therapy.

Parenteral nutrition therapy is used in patients with a contraindication to the use of the gastrointestinal tract, and infection is one of its frequent and severe complications. The objective of the present study was to detect the presence of biofilms and microorganisms adhering to the central venous catheters used for parenteral nutrition therapy by scanning electron microscopy. Thirty-nine central venous catheters belonging to patients with clinical signs of infection (G1) and asymptomatic patients (G2) and patients receiving central venous catheters for clinical monitoring (G3) were analyzed by semiquantitative culture and scanning electron microscopy. The central venous catheters of G1 presented more positive cultures than those of G2 and G3 (81% vs 50% and 0%, respectively). However, biofilms were observed in all catheters used and 55% of them showed structures that suggested central venous catheters colonization by microorganisms. Approximately 53% of the catheter infections evolved with systemic infection confirmed by blood culture. The authors conclude that the presence of a biofilm is frequent and is an indicator of predisposition to infection, which may even occur in patients who are still asymptomatic.

[High prevalence of hepatitis C in the district of Botafogo, municipality of Bebedouro, São Paulo State, Brazil, 2007]. / Prevalência elevada de hepatite C no distrito de Botafogo, cidade de Bebedouro, interior do Estado de São Paulo, Brasil, 2007.

This article aimed to estimate the prevalence of hepatitis C in Botafogo, a district of Bebedouro, São Paulo State, Brazil, and investigate possible risk factors. One individual over 18 years of age was selected from each household to answer a questionnaire on socio-demographic variables and factors associated with hepatitis C. Blood samples were also drawn for immunoenzymatic tests. Positive HCV-antibody samples were submitted to viral RNA detection. HCV prevalence was 8.8% (95%CI: 5.8-11.7), and independent variables associated with risk of infection were: male gender, time of local residence > 30 years, and history of injected medication using non-disposable material, sterilized by boiling. The high prevalence of hepatitis C infection in this relatively isolated rural population appears to result from previous exposure to injections with inadequately sterilized material, with some evidence suggesting a specific elderly pharmacy employee who customarily applied such injections and may have been a chronic HCV carrier.

Prevalência elevada de hepatite C no distrito de Botafogo, cidade de Bebedouro, interior do Estado de São Paulo, Brasil, 2007 / High prevalence of hepatitis C in the district of Botafogo, municipality of Bebedouro, São Paulo State, Brazil, 2007

O objetivo deste artigo foi estimar a prevalência de hepatite C nos moradores de Botafogo, distrito de Bebedouro, São Paulo, Brasil, e estudar possíveis fatores associados. Em cada domicílio foi sorteado um indivíduo com idade mínima de 18 anos, submetido a um questionário que levantava variáveis sócio-demográficas e fatores associados à infecção por hepatite C. Ao mesmo tempo, foi coletada uma amostra de sangue para realização de exames imunoenzimáticos. As amostras positivas ao anti-HCV foram submetidas à detecção do RNA viral. A prevalência de hepatite C encontrada foi 8,8 por cento (IC95 por cento: 5,8-11,7) e as variáveis preditoras independentes para o risco de infecção foram: sexo masculino, tempo de residência no local superior a trinta anos e uso de medicações parenterais com material não descartável, esterilizado com técnica de fervura. A prevalência elevada de infecção pela hepatite C nessa população relativamente isolada, de características rurais, parece ser resultado de exposições pregressas a injeções com material não adequadamente esterilizado, com algumas evidências apontando para a possibilidade de envolvimento de um antigo farmacêutico prático, que centralizava a aplicação desses produtos e era possivelmente um portador crônico da infecção.

This article aimed to estimate the prevalence of hepatitis C in Botafogo, a district of Bebedouro, São Paulo State, Brazil, and investigate possible risk factors. One individual over 18 years of age was selected from each household to answer a questionnaire on socio-demographic variables and factors associated with hepatitis C. Blood samples were also drawn for immunoenzymatic tests. Positive HCV-antibody samples were submitted to viral RNA detection. HCV prevalence was 8.8 percent (95 percentCI: 5.8-11.7), and independent variables associated with risk of infection were: male gender, time of local residence > 30 years, and history of injected medication using non-disposable material, sterilized by boiling. The high prevalence of hepatitis C infection in this relatively isolated rural population appears to result from previous exposure to injections with inadequately sterilized material, with some evidence suggesting a specific elderly pharmacy employee who customarily applied such injections and may have been a chronic HCV carrier.

Hepatitis C among former athletes: association with the use of injectable stimulants in the past

This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5 percent), reaching 50.8 percent in the professionals. The overall prevalence for hepatitis C was 7.2 percent, with values of 11 percent among professionals and 5.5 percent among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36 percent and 0.8 percent among amateurs; 21.9 percent and 0 percent among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.

HLA profile in patients with AIDS and tuberculosis.

Studies carried out in various populations have reported an association between some HLA specificities and susceptibility to tuberculosis. We investigated the class I and class II HLA profile in Brazilian patients of various ethnic backgrounds who had AIDS and tuberculosis. Twenty-two adult patients with AIDS and tuberculosis (Group I), 103 patients with AIDS without tuberculosis (Group II) and 423 healthy individuals not infected with HIV (Group III) were evaluated. Diagnosis of HIV infection was made by ELISA, confirmed by a gelatin particle agglutination test. Diagnosis of tuberculosis was made based on clinical/radiological presentation and direct bacilloscopy or clinical specimen cultures. Class I antigens were typed by microlymphotoxicity. Class II alleles were characterized by the polymerase chain reaction (PCR). Differences in frequency of HLA specificities between groups were found in the following antigens/alleles: Group I x Group II: HLA-A31 - p=0.026; HLA-B41 - p= 0.037; HLA-DRB1*10 - p=0.037; HLA-DQB1*5 - p=0.009. Group I x Group III (control): HLA-A31 - p = 0.000008; odds ratio (OR)=31.75; HLA-B41 - p=0.003; HLA-DQB1*5 - p=0.02. HLA-A31 and HLA-B41 antigens and the HLA-DRB1*10 and HLA-DQB1*05 alleles were over-represented in patients with AIDS and tuberculosis (Group I), suggesting that these HLA molecules are associated with susceptibility to tuberculosis in Brazilian patients with AIDS.

HCV virological response during treatment of chronic hepatitis C is associated with liver histological improvement in patients with HCV/HIV co-infection.

Liver histological improvement after treatment for chronic hepatitis C in patients co-infected with human immunodeficiency virus-1 (HIV-1) has been described. Paired liver biopsies in twenty six HCV/HIV co-infected patients were compared to determine factors possibly associated with histological improvement. The patients were submitted to a liver biopsy before treatment for hepatitis C and 25 months after the end of treatment. Fragments of the liver biopsy obtained before and after treatment were compared regarding the following parameters: histological activity index (HAI) and degree of fibrosis (Knodell); intensity of collagen deposits (Sirius Red staining) and degree of stellate cell activation (alpha-smooth muscle actin labeling). The ratios of the post and pre-treatment variables were related through logistic regression to body mass index (BMI), alcohol ingestion, HCV genotype, HCV viremia, presence of hepatic iron and pre-treatment hepatic steatosis. A negative RNA test in the 24th week of treatment was associated with improvement in fibrosis, collagen deposits and stellate cell numbers. The other variables analyzed did not correlate to an improvement in hepatic histology after hepatitis C treatment. Reduction in HCV viremia during treatment may result in reduced hepatic fibrosis even in patients without a sustained virological response.

L. (L.) chagasi in AIDS and visceral leishmaniasis (kala-azar) co-infection.

Concomitant skin lesions in visceral leishmaniasis (VL) or kala-azar are rare, being more common the description of post-kala-azar dermal leishmaniasis occurring post treatment of kala-azar. Skin lesions caused by Leishmania donovani are frequently seen in the aids-VL co-infection. In Brazil cutaneous or mucosal forms of tegumentary leishmaniasis concomitant with aids are more commonly registered. Here we present a case of aids-VL co-infection, with unusual cutaneous and digestive compromising attributed to L. (L.) chagasi, with special attention to ecthymatous aspect of the lesion, allied to the absence of parasite on the histological skin biopsy.