Cognitive Performance in Asymptomatic Elderly People with Hepatitis C: The Role of Education.

BACKGROUND: Neurotropism of the hepatitis C virus (HCV) can be the source of subtle neuropsychological symptoms in non-cirrhotic patients. Age is a risk factor for cognitive impairment (CI). Thus, asymptomatic elderly people who carry HCV might be at a greater risk of CI. Education can influence test performance. OBJECTIVES: (1) To verify whether elderly people with HCV performed poorer than controls on cognitive tests. (2) To analyze how education affects performance. (3) To verify whether the extent of the effect of education on performance depends on the group (HCV vs. controls) and the type of cognitive test. METHODS: Asymptomatic HCV carriers older than 60 years (n = 41) were matched with 41 corresponding controls. All participants performed the following tests: Mini-Cog, Mini Mental State Examination, clock drawing test (CDT), and verbal fluency. RESULTS: (1) There were no significant differences in cognitive performance between the two groups. (2) Higher education was always associated with better performance. (3) There was a significant group difference in the slopes of the regression lines between years of education and CDT performance. No differences were found for the other three tests. CONCLUSION: Considering the scores on the CDT, the rate of improvement in performance when schooling increases is higher in HCV carriers.

Hepatitis C Virus (HCV) Infection and Neurocognitive Impairment in Subjects with Mild Liver Disease.

Hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis, hepatocellular carcinoma, and liver-related deaths. It is estimated that 40-74% of patients with hepatitis C will experience at least one extrahepatic manifestation within their lifetime. The finding of HCV-RNA sequences in post-mortem brain tissue raises the possibility that HCV infection may affect the central nervous system and be the source of subtle neuropsychological symptoms, even in non-cirrhotic. Our investigation aimed to evaluate whether asymptomatic, HCV-infected subjects showed cognitive dysfunctions. Twenty-eight untreated asymptomatic HCV subjects and 18 healthy controls were tested using three neuropsychological instruments in a random sequence: Symbol Digit Modalities Test (SDMT), Controlled Oral Word Association Test (COWAT), and Continuous Visual Attention Test (CVAT). We performed depression screening, liver fibrosis assessment, blood tests, genotyping, and HCV-RNA viral load. A MANCOVA and univariate ANCOVAS were performed to examine group differences (HCV vs. healthy controls) in four scores of the CVAT (omission errors, commission errors, reaction time-RT, and variability of RT-VRT), and the scores derived from the SDMT, and the COWAT. A discriminant analysis was performed to identify which test variables effectively discriminate HCV-infected subjects from healthy controls. There were no group differences in the scores of the COWAT, SDMT, and in two variables of the CVAT (omission and commission errors). In contrast, the performance of the HCV group was poorer than the controls in RT (p = 0.047) and VRT (p = 0.046). The discriminant analysis further indicated that the RT was the most reliable variable to discriminate the two groups with an accuracy of 71.7%. The higher RT exhibited by the HCV group may reflect deficits in the intrinsic-alertness attention subdomain. As the RT variable was found to be the best discriminator between HCV patients and controls, we suggest that intrinsic-alertness deficits in HCV patients may affect the stability of response times increasing VRT and leading to significant lapses in attention. In conclusion, HCV subjects with mild disease showed deficits in RT and intraindividual VRT as compared to healthy controls.

Before Direct-Acting Antivirals for Hepatitis C Virus: Evaluation of Core Protein R70Q and L/C91M Substitutions in Chronically Infected Brazilian Patients Unresponsive to IFN and/or RBV.

Although chronic hepatitis C has been effectively treated with direct-acting antivirals (DAAs), the use of conventional therapy with peg-interferon (Peg-IFN) or (predominantly) ribavirin (RBV), remains widespread. R70Q/H and L/C91M amino acid substitutions in the hepatitis C virus (HCV) core protein may modulate responses to IFN and/or RBV, and are associated with cirrhosis, hepatocellular carcinoma (HCC), insulin resistance, and liver steatosis. We evaluated the R70Q/H and L/C91M substitutions, clinical and epidemiological profiles, and risk factors of Brazilian patients chronically infected with HCV subgenotypes 1a and 1b (HCV-GT1a and HCV-GT1b) unresponsive to IFN and/or RBV therapy. Sequencing and pyrosequencing analyses and sociodemographic and clinical predictive variables were used to assess the relationship between R70Q/H and L/C91M substitutions. Leukocyte counts, ALT levels, and ALT/AST ratios were significantly reduced in treated individuals, but more of these patients had advanced fibrosis and cirrhosis. L91M was more prevalent (19.7%), occurring only in HCV-GT1b, followed by R70Q/P (11.5%) and R70P (1.4%). R70Q/P exhibited higher mean AST, ALT, and GGT values, whereas L91M showed higher mean GGT values. Pyrosequencing of the L91M position revealed mutant subpopulations in 43.75% of samples.

Dried blood spot sampling as an alternative for the improvement of hepatitis B and C diagnosis in key populations.

BACKGROUND: To achieve the elimination of hepatitis B and C, there is an urgent need to develop alternative strategies to increase the access of diagnosis, particularly among key populations such as people living with human immunodeficiency virus (HIV), individuals with coagulopathies and chronic kidney disease (CKD) patients. AIM: To evaluate the use of dried blood spot (DBS) in the detection of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers. METHODS: A total of 430 individuals comprised of people living with HIV, coagulopathies and CKD provided paired serum and DBS samples. HBsAg, anti-HBc and anti-HCV were tested in those samples using a commercial electrochemiluminescence. Demographic and selected behavioral variables were evaluated to assess possible association with HBV and HCV positivity. RESULTS: Using DBS, HBsAg prevalence varied from 3.9% to 22.1%, anti-HBc rates varied from 25.5% to 45.6% and anti-HCV positivity ranged from 15.9% to 41.2% in key populations. Specificities of HBV and HCV tests using DBS varied from 88.9% to 100%. The HBsAg assay demonstrated the best performance in CKD and coagulopathy individuals and the anti-HCV test had a sensitivity and specificity of 100% in people living with HIV. Accuracy of HBV and HCV detection in DBS varied from 90.2% to 100%. In the CKD group, HBsAg positivity was associated with infrequent use of condoms, and anti-HBc positivity was associated with sharing nail cutters/razors/toothbrushes. Anti-HCV reactivity was positively associated with a history of transplantation and length of time using hemodialysis in both specimens. In people living with HIV, only the male gender was associated with anti-HBc positivity in serum and DBS. CONCLUSION: DBS with electrochemiluminescence are useful tools for the diagnosis and prevalence studies of hepatitis B and C among key populations and may increase the opportunity to foster prevention and treatment.

Cytokine profile during occult hepatitis B virus infection in chronic hepatitis C patients.

BACKGROUND: The hepatitis B virus (HBV) is one of the leading causes of acute, chronic and occult hepatitis (OBI) representing a serious public health threat. Cytokines are known to be important chemical mediators that regulate the differentiation, proliferation and function of immune cells. Accumulating evidence indicate that the inadequate immune responses are responsible for HBV persistency. The aim of this study were to investigate the cytokines IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10 and IL-17A in patients with OBI and verify if there is an association between the levels of these cytokines with the determination of clinical courses during HBV occult infection. METHODS: 114 patients with chronic hepatitis C were investigated through serological and molecular tests, the OBI coinfected patients were subjected to the test for cytokines using the commercial human CBA kit. As controls, ten healthy donors with no history of liver disease and 10 chronic HBV monoinfected patients of similar age to OBI patients were selected. RESULTS: Among 114 HCV patients investigated, 11 individuals had occult hepatitis B. The levels of cytokines were heterogeneous between the groups, most of the cytokines showed higher levels of production detection among OBI/HCV individuals when compared to control group and HBV monoinfected pacients. We found a high level of IL-17A in the HBV monoinfected group, high levels of TNF-α, IL-10, IL-6, IL-4 and IL-2 in OBI/HCV patients. CONCLUSION: These cytokines could be involved in the persistence of HBV DNA in hepatocytes triggers a constant immune response, inducing continuous liver inflammation, which can accelerate liver damage and favor the development of liver cirrhosis in other chronic liver diseases.

Assessment of the Performance and Surface Alteration of Two Single-file Systems According to the Number of Uses

Abstract The aim of this study was to assess the performance and surface alteration of two single-file systems according to the number of uses. Ten WaveOne Primary files (25/.08) and ten One Shape NG files (25/.06) were used for instrumentation of mesial root canals of mandibular molars. Each instrument was cleaned and sterilized after the preparation of two root canals and then reused. The time spent for instrumentation of each root canal was recorded and analyzed by using t-test. Microphotographs of the surface of the instruments were taken with a scanning electron microscope at different magnifications (i.e. 18x, 160x, 500x and 1000x) and at a distance of 4 mm from the instrument's tip before being analyzed by four observers. Presence of disruption of cutting edge, crack, craters and unwinding was assessed and submitted to Fisher's exact test. Both systems showed manufacturing defects and cracks. The presence of disruption of cutting edges was major in WaveOne files from the sixth use, whereas One Shape NG files showed more unwinding. Only preparation time using WaveOne files was influenced by the number of uses. One can conclude that WaveOne files had more disruption of cutting edges and took longer time for root canal preparation from the sixth use onwards, whereas the One Shape NG files showed more unwinding at the tenth use.

Different core-specific T cell subsets are expanded in chronic hepatitis C with advanced liver disease.

Chronic hepatitis C (CHC) is frequently related to liver fibrosis, and several studies have suggested that the immunological activity of HCV antigens contributes to hepatic damage. In the present study, among structural and non-structural HCV antigens, elevatedIL-1ß, IL-6, IL-17 levels were secreted by PBMC cultures obtained from CHC patients following stimulation with core antigen. Moreover, the percentage of core-specific IL-6+IL-17+(CD4+ and CD8+) T cells was significantly higher in patients with worsehepatic lesions, determined on the Metavir scale. When compared with healthy subjects, the percentage of circulating Treg cells was elevated in CHC patients, mainly among those with advanced liver fibrosis. Nevertheless, in this last group of patients, the proportion of CD39+ Treg subsets was very low. Finally, the percentage of senescent (CD57+ CD28-) and exhausted (PD-1+CD28+) core-specific T cells in CHC patients was also found to be a result of fibrotic hepatic status. In summary, imbalances between different core-specific T cell subsets are associated with liver fibrosis severity.

Treatment with Sofosbuvir and Daclatasvir (with or without Ribavirin) Improves Patient Reported Outcomes in Hepatitis C.

OBJECTIVES: To evaluate the impact of 3 treatment regimens upon health-related quality of life and work productivity using patient-reported outcomes (PROs) in chronic hepatitis C infected patients: sofosbuvir (SOF) + daclatasvir (DCV); SOF + DCV + ribavirin (RBV); SOF + simeprevir (SMV). METHODS: 4 questionnaires were used to evaluate PROs before, during and after treatment: Short Form-36 (SF-36), Chronic Liver Disease Questionnaire (CLDQ) - hepatitis C virus (HCV), Work Productivity and Activity Index, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). RESULTS: Of the global sample of 55 patients included in this study; SOF + DCV (n = 10); SOF + DCV + RBV (n = 29); SOF + SMV (n = 16) all had a statistically significant improvement in SF-36, CLDQ and FACIT-F scores during and post-treatment. No statistically significant differences in the PRO questionnaire values were observed between the distinct treatment regimens. The SOF and SMV patient groups presented higher mean PRO variations during and post-treatment, compared to the other groups: SF-36 functional capacity (16.1); SF-36 mental health (21.4); CLDQ activity (1.8); CLDQ emotional function (1.2); FACIT-F physical well-being (8.0); Total FACIT-F (21.6). CONCLUSION: Treatment with SOF + DCV, with or without RBV, results in an improved PRO similar to treatment with SOF + SMV in chronic hepatitis C patients.

Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series.

BACKGROUND: Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data. METHODS: In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms "RSV", "respiratory syncytial virus", or "respiratory syncytial viral" combined with "mortality", "fatality", "death", "died", "deaths", or "CFR" for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables. FINDINGS: We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5·0 months (IQR 2·3-11·0) in low-income or lower middle-income countries, 4·0 years (2·0-10·0) in upper middle-income countries, and 7·0 years (3·6-16·8) in high-income countries. INTERPRETATION: This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries. FUNDING: Bill & Melinda Gates Foundation.

Performance of rapid diagnostic tests for detection of Hepatitis B and C markers in HIV infected patients.

There is little information describing the influence of HIV infection upon the performance of rapid diagnostic tests (RDTs) for hepatitis B and C virus diagnosis. This study aims to evaluate the performance of RDTs for HBsAg and anti-HCV detection among HIV-infected individuals. A total of 362 HIV infected individuals were recruited from clinics between January 2013 to November 2014 in the southeast and northeast of Brazil. HBsAg and anti-HCV were detected using commercial EIAs and four RDTs: HBV (Vikia HBsAg® and Wama Imuno-Rapido HBV®) and HCV (Bioeasy Teste Rápido HCV® and Wama Imuno-Rapido HCV®). Reactive HBsAg and anti-HCV serum samples were tested for HBV DNA and HCV RNA. Sensitivity, specificity and kappa statistic were determined. Using EIA, HBsAg and anti-HCV were detected in 14 (3.9%) and 37 (10.2%) serum samples respectively. Using serum only, HBsAg RDTs demonstrated sensitivities and specificities above 92.0% and Kappa values above 89.0%. Anti-HCV RDTs demonstrated sensitivity and specificities above 82.0% and Kappa higher than 89.0%. Using whole blood samples, Vikia HBsAg® and Wama Imuno-Rapido HCV® showed sensitivity and specificity above 99.0% with Kappa of 66.4% and 100%, respectively. HIV viral load was higher among discordant results for anti-HCV RDT. RDTs demonstrated good performance in HIV infected individuals showing the usefulness of assays in this population.

Evaluation of HBsAg and anti-HBc assays in saliva and dried blood spot samples according HIV status.

Influence of HIV status in HBV markers detection in saliva and dried blood spots (DBS) was not well established. This study aims to evaluate the performance of optimized commercial immunoassay for identifying HBsAg and anti-HBc in saliva and DBS according HIV status. A sum of 535 individuals grouped as HIV+, HBV+, HIV/HBV+ and HIV/HBV- were recruited where 347 and 188 were included for HBsAg and anti-HBc evaluation, respectively. Serum, DBS collected in Whatman 903 paper and saliva obtained using salivette device were analyzed using EIA. Increased sample volume and ROC curve analysis for cut off determination were used for DBS and saliva testing. HBsAg detection in saliva and DBS exhibited sensitivities of 80.9% and 85.6% and specificities of 86.8% and 96.3%. Sensitivity of anti-HBc in saliva and DBS were 82.4% and 76.9% and specificities in saliva and DBS were 96.9% and 91.7%. Low sensitivities were observed for HBsAg (62%) and anti-HBc (47%) detection in saliva of HIV/HBV+ individuals. OD values were also lower for HBsAg detection in DBS and saliva of HIV/HBV+ individuals compared to their serum samples. Statistical significance was found for sensitivities in HBsAg detection between saliva and DBS demonstrating high sensitivity for DBS specimens. In conclusion, HIV status or antiretroviral treatment appears to interfere in the performance of HBsAg and anti-HBc detection in DBS and saliva samples using the adapted commercial EIA.

Performance of ANTI-HCV testing in dried blood spots and saliva according to HIV status.

The use of saliva and dried blood spots (DBS) could increase access to HCV diagnosis for high-risk populations, such as HIV-infected individuals, but the performance of these assays has not been well established in this group. This study aims to evaluate HIV status, particularly TCD4+ cell count and viral load, in the performance of anti-HCV testing using DBS and saliva. A total of 961 individuals classified as HCV+, HIV+, or HIV/HCV+, as well as negative controls, donated serum, DBS, and saliva samples for anti-HCV testing using a commercial enzyme immunoassay. Sample volume was modified for DBS and saliva, and an ROC curve was used for cut-off determination in saliva. Anti-HCV sensitivities were greater than 93% using DBS and saliva in the HCV+ group, while they were 83.3% and 95.6% for HCV/HIV+ individuals for DBS and saliva assays, respectively. Specificity varied from 91.7% to 100% using saliva and DBS in HIV monoinfected and control subjects. When only anti-HCV/HCV RNA+ serum samples, that is, true positives, were considered, the sensitivities were 98.3% and 100% for DBS and saliva, respectively, in the HCV+ group and 91.6% and 94.8% for DBS and saliva, respectively, in the HIV/HCV+ group. High absorbance values were observed among those presenting with HCV RNA in serum and low HIV viral load (less than 50 copies/mL). In conclusion, DBS and saliva samples could be used for anti-HCV detection, particularly to identify active HCV cases, but low sensitivity was observed for anti-HCV testing using DBS in the HIV/HCV+ group.

The proportion of different interleukin-17-producing T-cell subsets is associated with liver fibrosis in chronic hepatitis C.

Studies have suggested the pivotal role of T helper type 1 (Th1) -related cytokines on the outcome of hepatitis C virus (HCV) infection. Nevertheless, the role of different interleukin-17 (IL-17) -secreting T cells on chronic hepatitis C (CHC) is less clear. Here, the in vivo IL-1ß, IL-6, and IL-17 levels were positively correlated with both alanine transaminase (ALT) levels and hepatic lesions. When compared with the control group, CHC patients showed a lower proportion of IL-17-secreting (CD4+ and CD8+ ) T cells capable of simultaneously producing IL-21. Moreover, the percentage of IL-10-secreting Th17 cells was also lower in CHC patients. Notably, advanced liver lesions were observed among those patients with lower percentage levels of IL-17-producing T cells positive for IL-21, interferon-γ (IFN-γ) and IL-10. In contrast, the severity of hepatic damage was associated with peripheral single IL-17+ T cells. The percentage of IL-17+ IL-21- IFN-γ+ (CD4+ and CD8+ ) T-cell phenotypes was positively associated with plasma CD14 levels. Finally, elevated levels of circulating CD14 were detected among CHC patients with extensive liver damage. In summary, although preliminary, our results suggest that a balance between different IL-17-producing T cells, associated with peripheral levels of CD14, may be a progress marker for liver disease in chronically HCV-infected patients.

Produção do cuidado na emergência pediátrica na perspectiva da integralidade: perfil da clientela atendida, linha de cuidado e ficha de atendimento de enfermagem / Care production in the pediatric emergency from the perspective of integrality: profile of the clientele served, care line and nursing attendance sheet

Introdução: o objeto deste estudo é a organização da atenção à saúde prestada na Emergência Pediátrica (EP) do Hospital Universitário Antônio Pedro (HUAP) na perspectiva da integralidade do cuidado. Este estudo justifica-se pela necessidade de adequar as práticas de enfermagem ao novo perfil dos pacientes atendidos na EP do HUAP frente ao conceito de hierarquização, referência e contrarreferência preconizado pelo Sistema Único de Saúde, no qual este hospital está inserido como nível terciário e quaternário de atendimento. Objetivo geral: construir uma ficha de atendimento de enfermagem cujos dados gerados sejam capazes de subsidiar ações gerenciais na perspectiva da integralidade do cuidado, a partir do perfil da clientela atendida e da linha do cuidado na EP. Objetivos específicos: caracterizar os atendimentos realizados na EP no período de 1 de janeiro de 2012 a 31 de dezembro de 2014; representar a linha do cuidado que traduz a atenção à saúde prestada na EP na perspectiva da integralidade do cuidado e elaborar um instrumento adequado ao registro dos atendimentos na EP que possa gerar informações para o gerenciamento em enfermagem. Bases conceituais: abordase o atendimento de emergência no sistema de referência e contrarreferência, as especificidades do atendimento de emergência em pediatria, o processo de trabalho gerencial do enfermeiro sob a ótica do conceito de gerenciamento do cuidado de enfermagem, a linha do cuidado como dispositivo para a integralidade da atenção e o "Fluxograma Analisador do Modelo de Atenção" proposto por Merhy como ferramenta de gestão. Metodologia: trata-se de uma pesquisa com abordagem quanti-qualitativa, desenvolvida na unidade de EP, cujos participantes foram os membros da equipe multidisciplinar atuante na unidade. Para coleta de dados quantitativos foi utilizada uma planilha pré-formatada, desenvolvida em Excel, composta pelas variáveis contidas na "Ficha de Admissão"; os dados qualitativos foram coletados por observação sistemática direta e a técnica de vinheta. Resultados e discussão: a abordagem quantitativa levantou as características demográficas e clínicas das crianças que frequentam a EP e com o caráter qualitativo do estudo pode-se observar, entender e descrever como os profissionais desenvolvem seus processos de trabalho na perspectiva da integralidade do cuidado, resultando na representação gráfica da linha do cuidado na EP. Produtos: a construção da linha do cuidado da EP e um instrumento que possa identificar o tipo de cuidado, o grau de gravidade, o nível de dependência dos cuidados de enfermagem e a estimativa de recursos humanos e materiais necessários para a implementação de uma assistência de qualidade denominado "Ficha de Atendimento de Enfermagem na Emergência Pediátrica"

Introduction: the object of this study is to organize the health care provided at the Pediatric Emergency (PE) of Hospital Universitário Antônio Pedro (HUAP) in the perspective of integral care. This study is justified by the need to adapt nursing practices to the new profile of the patients seen in the HUAP's PE, face to the concept of hierarchy, reference and counter-reference advocated by the Unified Health System, in which this hospital is inserted as tertiary and quaternary level of service. General objective: to build a nursing care sheet whose data generated can subsidize managerial actions in the perspective of integral care, based on the profile of the clientele served and the care line in the PE. Specific objectives: characterize the services performed in the PE from January 1, 2012 to December 31, 2014; to represent the care line that reflects the health care provided in the PE from the perspective of integral care and to elaborate an adequate instrument to record the care in the PE that can generate information for nursing management. Conceptual bases: it is approached the emergency attendance in the referral and counter-referral system, the specificities of emergency attendance in pediatrics, the nurse's managerial work process from the point of view of the concept of nursing care management, the care line as a device for integrality and the "Attention Model Analyzer Flow Chart" proposed by Merhy as a management tool. Methodology: it is a research with quantitative-qualitative approach, developed in the PE unit, whose participants were the members of the multidisciplinary team working in the unit. For the collection of quantitative data, was use a pre-formatted spreadsheet, developed in Excel, was composed of the variables contained in the "Admission Sheet"; the qualitative data were collected by direct systematic observation and the technique of vignette. Results and discussion: the quantitative approach identified the demographic and clinical characteristics of the children attending PE and by means the qualitative approach it was possible observation, understand and describe how professionals develop their work processes in the perspective of integrality of care, resulting in the graphic representation of the PE care line. Products: The construction of the PE care line and an instrument that can identify the type of care, the degree of severity, the level of dependency of the nursing care and the human and material resources estimation necessary for the implementation of a quality assistance denominated "Sheet Nursing Attendance in the Pediatric Emergency"

Linha do cuidado: a emergência pediátrica na perspectiva da integralidade do cuidado / Line care: the pediatric emergency in wholeness perspective care

Objetiva-se caracterizar a linha do cuidado que traduza a atenção prestada pela equipe multiprofi ssional em diferentes etapas da produção do cuidado na Emergência Pediátrica de um Hospital Universitário, na perspectiva da integralidade do cuidado através do uso da ferramenta "Fluxograma Analisador do Modelo de atenção". Apresentado como estudo qualitativo, cuja coleta de dados se deu por meio da observação sistemática no setor, acrescido da contribuição da equipe multiprofi ssional atuante através da técnica da vinheta. Resultou-se a construção da linha de cuidado que traduz a atenção prestada pela equipe multiprofi ssional na Emergência Pediátrica. Conclui-se que a construção do fl uxograma permitiu identifi car os principais processos de trabalho, bem como avaliar uma série de atividades que implicam em novos processos em outras áreas da organização evidenciando, assim, o trabalho interdisciplinar. Contribuindo não só para o atendimento seguro e de qualidade, mas também favorecendo o ensino e a pesquisa desenvolvida neste ambiente do Hospital

The aim is to characterize the care line that refl ects in the attention provided by the multidisciplinary team at different stages of production in the Pediatric Emergency Care in a University Hospital from the perspective of comprehensive care through the use of the tool "Flowchart attention Model Analyzer". Presented as a qualitative study, whose data collection was through systematic observation of the "day to day" in the industry, plus the multi-professional team of the contribution that there acts by the vignette technique. Resulting in a care line construction that refl ects the attention paid by the multidisciplinary team at the Pediatric Emergency. It concludes that the construction of the fl ow chart has identifi ed the main work processes and evaluate a range of activities that include new processes in other areas of the organization thus highlighting the interdisciplinary work. Contributing not only to safe and quality care, but also promoting the teaching and research conducted in this hospital environment

Importância do uso do ultrassom no acesso endodôntico de dentes com calcificação pulpar / Importance of ultrasound in endodontic access of teeth with pulp calcification

Um dos desafios da Endodontia é a localização dos canais radiculares, para que esses possam ser limpos, remodelados e obturados adequadamente. O uso do ultrassom e da visualização do campo operatório sob magnificação tem aumentado a segurança em determinados tratamentos endodônticos, garantindo resultados ótimos. O objetivo deste trabalho é mostrar uma abordagem clínica de tratamento de um dente com calcificação na entrada dos condutos, no qual realizou-se o acesso à câmera pulpar e, em seguida, a remoção da calcificação e a localização dos condutos foram feitas por meio de pontas ultrassônicas sob magnificação, concluindo-se o caso com a blindagem corono-radicular definitiva em sessão única. Pode-se concluir que a associação do uso do ultrassom sob magnificação é uma estratégia clínica viável para acessar áreas de calcificação.

IL28B gene polymorphisms in mono- and HIV-coinfected chronic hepatitis C patients.

INTRODUCTION: Single-nucleotide polymorphisms (SNPs) associated with hepatitis C virus (HCV) clearance were identified near the IL28B gene. Coinfection by the human immunodeficiency virus (HIV) influences the course of HCV contributing to liver damage. Nevertheless, little is known about the relationship between these SNPs and HCV/HIV coinfection. Our aim was to estimate the frequencies of the allelic and genotypic variants of the IL28B polymorphisms rs12979860 (C/T) and rs8099917 (T/G) and their possible association with the establishment of HCV infection. METHODOLOGY: A total of 199 non-infected controls and 230 patients with chronic hepatitis C, including 53 coinfected with HIV, participated in the study. Genotyping consisted of polymerase chain reaction and subsequent analysis of the restriction patterns resulting from exposure to endonucleases. RESULTS: Among the controls with established results, 47.4% (90/190) exhibited the rs12979860 CC genotype, 43.7 CT, and 8.9% TT, whereas 29.1% (66/227), 51.5%, and 19.4% of the patients exhibited the CC, CT, and TT genotypes, respectively. With respect to rs8099917, 66.8% (133/199) of the controls exhibited the TT genotype, 31.2% TG, and 2.0% GG, whereas 56.1% (129/230), 40.9%, and 3.0% of the patients exhibited the TT, TG, and GG genotypes, respectively. CONCLUSION: The frequencies of the rs12979860 C allele and CC genotype and of the rs8099917 T allele and TT genotype were significantly higher among controls compared with patients, thus confirming the suggested protective effect against HCV infection. No significant difference was observed in the genotype and allelic distributions between the mono- and coinfected patients.

Coqueluche em crianças menores de 3 anos de idade hospitalizadas em 2011 e 2012 / Pertussis in children below 3 years of age admitted in 2011 and 2012

Descrever as características demográficas e clínicas de pacientes pediátricos internados com reação em cadeia da polimerase (PCR) positivo para Bordetella pertussis. Métodos: Estudo retrospectivo, observacional incluindo todos os pacientes pediátricos entre zero e 2 anos, 11 meses e 29 dias de idade internados em um hospital universitário com diagnóstico de coqueluche confirmado por PCR, no período de julho de 2011 a dezembro de 2012. Resultados: Foram incluídos no estudo 155 pacientes com idade média de 7,8 meses. Apenas 22 casos tinham história de contato com tosse paroxística ou prolongada (>14 dias). O tempo médio de duração de sintomas antes da admissão hospitalar foi de 9,87±10,08 dias e o tempo de internação médio foi de 5,52±9,60 dias. Tosse foi o sintoma mais prevalente (99%), sendo paroxística em apenas 16,8%. Cianose esteve presente em 29,7% e apneia em 5,8%. Além disso, 52,2% dos pacientes necessitaram oxigênio suplementar, 6,5% necessitaram de ventilação mecânica, e 2,5% foram a óbito. Conclusão: O estudo corrobora o impacto da coqueluche epidêmica sobre as crianças, principalmente lactentes, evidenciando a necessidade da implementação de novas estratégias de prevenção e controle desta infecção...

To describe the demographic and clinical characteristics of pediatric patients admitted with positive polymerase chain reaction (PCR) for Bordetella pertussis. Methods: Retrospective, observational study including all pediatric patients between zero and 2 years, 11 months and 29 days of age admitted to a university hospital, diagnosed with pertussis confirmed by PCR from July 2011 to December 2012. Results: The study included 155 patients with a mean age of 7.8 months. Only 22 cases had history of contact with people with paroxysmal or prolonged cough (>14 days). The average duration of symptoms before hospital admission was 9.87±10.08 days and the average time of hospitalization was 5.52±9.60 days. Coughing was the most prevalent symptom (99%), with paroxysmal features in only 16.8%. Cyanosis was present in 29.5% and apnea was present in 5.8%. Additionally, 52.2% of patients required supplemental oxygen, 6.5% required mechanical ventilation, and 2.5% died. Conclusion: The study corroborates the impact of epidemic pertussis in children, particularly in infants, highlighting the need for new strategies to prevent and control this infection...

Viral epidemiology of respiratory infections among children at a tertiary hospital in Southern Brazil.

INTRODUCTION: This study reports the pediatric epidemiology of respiratory syncytial virus (RSV), influenza (IF), parainfluenza (PIV), and adenovirus (ADV) at Hospital de Clínicas de Porto Alegre. METHODS: Cases of infection, hospitalizations in intensive care units (ICUs), nosocomial infections, and lethality rates were collected from 2007 to 2010. RESULTS: RSV accounted for most nosocomial infections. Intensive care units admission rates for ADV and RSV infections were highest in 2007 and 2010. During 2008-2009, H1N1 and ADV had the highest ICU admission rates. ADV had the highest fatality rate during 2007-2009. CONCLUSIONS: Each virus exhibited distinct behavior, causing hospitalization, outbreaks, or lethality.

Evaluation of respiratory syncytial virus group A and B genotypes among nosocomial and community-acquired pediatric infections in Southern Brazil.

BACKGROUND: Respiratory syncytial virus (RSV) is the main cause of lower respiratory tract illness in children worldwide. Molecular analyses show two distinct RSV groups (A and B) that comprise different genotypes. This variability contributes to the capacity of RSV to cause yearly outbreaks. These RSV genotypes circulate within the community and within hospital wards. RSV is currently the leading cause of nosocomial respiratory tract infections in pediatric populations. The aim of this study was to evaluate the G protein gene diversity of RSV amplicons. METHODS: Nasopharyngeal aspirate samples were collected from children with nosocomial or community-acquired infections. Sixty-three RSV samples (21 nosocomial and 42 community-acquired) were evaluated and classified as RSV-A or RSV-B by real-time PCR. Sequencing of the second variable region of the G protein gene was performed to establish RSV phylogenetics. RESULTS: We observed co-circulation of RSV-A and RSV-B, with RSV-A as the predominant group. All nosocomial and community-acquired RSV-A samples were from the same phylogenetic group, comprising the NA1 genotype, and all RSV-B samples (nosocomial and community-acquired) were of the BA4 genotype. Therefore, in both RSV groups (nosocomial and community-acquired), the isolates belonged to only one genotype in circulation. CONCLUSIONS: This is the first study to describe circulation of the NA1 RSV genotype in Brazil. Furthermore, this study showed that the BA4 genotype remains in circulation. Deciphering worldwide RSV genetic variability will aid vaccine design and development.