Fat Mass Ratio in Brazilian HIV-infected Patients Under Antiretroviral Therapy and Its Relationship With Anthropometric Measurents.

INTRODUCTION: Human immunodeficiency virus-related lipodystrophy is characterized by a variety of phenotypes and metabolic changes; however, consensus has not yet been reached on its diagnostic criteria. Different cutoff values for fat mass ratio have been proposed for this specific population as an objective diagnostic criterion for lipodystrophy. This study aimed to establish sex-specific reference values for fat mass ratio and to correlate them with anthropometric measurements for the diagnosis of human immunodeficiency virus-related lipodystrophy. METHODOLOGY: A cross-sectional study was performed on 189 human immunodeficiency virus-infected patients under antiretroviral therapy. Anthropometric measurements were evaluated, and body composition was determined using dual-energy X-ray absorptiometry. Fat mass ratio was calculated as the ratio of the percentage of the trunk fat mass and the percentage of the lower limb fat mass. RESULTS: One hundred and thirty-two patients (69%) presented lipodystrophy by objective criteria. In men, the cutoff for the fat mass ratio was 1.55 (area under the receiver operating characteristic curve: 0.73 [95% confidence interval: 0.62-0.83], p = 0.000008), with a sensitivity of 62.5%, a specificity of 70.5%, a positive predictive value of 77.8%, and a negative predictive value of 53.4%. In women, the cutoff for the fat mass ratio was 0.959 (area under the receiver operating characteristic curve: 0.70 [95% confidence interval: 0.56-0.85], p = 0.03), with a sensitivity of 83.60%, a specificity of 61.5%, a positive predictive value of 90.2%, and a negative predictive value of 47.1%. Fat mass ratio was positively correlated with waist circumference (men: r = 0.246, p = 0.019; women: r = 0.302, p = 0.014) and neck circumference (men: r = 0.304, p = 0.004; women: r = 0.366, p = 0.003) in both sexes; and body mass index (r = 0.288, p = 0.006) and waist-hip ratio (r = 0.288, p = 0.006) in men. CONCLUSION: The fat mass ratio evaluated using dual-energy X-ray absorptiometry with the sex-specific cutoffs is an objective tool to define human immunodeficiency virus-related lipodystrophy.

Survival and tolerance to sorafenib in Child-Pugh B patients with hepatocellular carcinoma: a prospective study.

Sorafenib has been widely used to treat unresectable hepatocellular carcinoma (HCC) but most studies have been done in Child-Pugh A (CP-A) patients with well-preserved liver function. We evaluated the overall survival (OS) and tolerance to sorafenib in a large cohort of Child-Pugh B (CP-B) HCC patients as compared to CP-A HCC patients. We prospectively studied 130 patients with advanced HCC who started sorafenib between January 2011 and December 2015. Patients were classified as CP-A (n = 65) or CP-B (n = 65). The average OS for all 130 patients was 10 months. CP-A patients had a median survival rate significantly longer than CP-B patients: 12 months vs. 6 months. The OS found in our group of CP-B patients was 6.5 months, which is higher than that found in most studies done so far. When stratified, our CP-B patients had better OS than ever reported. The dose of the drug was interrupted due to adverse events (AEs) in 38 (29%) of the patients, of whom 20 (30%) were CP-A patients and 18 (28%) were CP-B patients. This real-life cohort of CP-B HCC patients treated with sorafenib had a higher survival than that described in the literature, with a satisfactory safety profile. Despite the high prevalence of severe AEs in CP-B patients, there were fewer treatment interruptions in this group, indicating that Child-Pugh B patients can tolerate treatment and may benefit from sorafenib.

High prevalence of Staphylococcus aureus and methicillin-resistant S. aureus colonization among healthy children attending public daycare centers in informal settlements in a large urban center in Brazil.

BACKGROUND: In the past decade methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly prevalent in community settings. Attending a daycare center (DCC) is a known risk factor for colonization with MRSA. Brazil operates free, public DCCs for low-income families, some of which are located in census tracts defined by the Brazilian Census Bureau as informal settlements (aglomerados subnormais, AGSN). Physical and demographic characteristics of AGSNs suggest that S. aureus colonization prevalence would be higher, but little is known about the prevalence of MRSA in these settings. METHODS: We conducted a cross-sectional study to assess risk factors for S. aureus and MRSA colonization among children attending DCCs located in AGSN vs non-AGSN. Nasal swabs were collected from children aged three months to six years in 23 public DCCs in Niterói, Brazil between August 2011 and October 2012. RESULTS: Of 500 children enrolled in the study, 240 (48%) were colonized with S. aureus and 31 (6.2%) were colonized with MRSA. Children attending DCCs in AGSNs were 2.32 times more likely to be colonized with S. aureus (95% CI: 1.32, 4.08), and 3.27 times more likely to be colonized with MRSA than children attending non-AGSN DCCs (95% CI: 1.52, 7.01), adjusted for confounding variables. CONCLUSION: S. aureus and MRSA colonization prevalence among children attending DCCs in informal settlement census tracts was higher than previously reported in healthy pre-school children in Latin America. Our data suggest that transmission may occur more frequently in DCCs rather than at home, highlighting the importance of DCCs in AGSNs as potential MRSA reservoirs. This finding underscores the importance of local epidemiologic surveillance in vulnerable AGSN communities.

Clinical features and laboratory findings of human parvovirus B19 in human immunodeficiency virus-infected patients.

Immunocompromised patients may develop severe chronic anaemia when infected by human parvovirus B19 (B19V). However, this is not the case in human immunodeficiency virus (HIV)-infected patients with good adherence to highly active antiretroviral treatment (HAART). In this study, we investigated the clinical evolution of five HIV-infected patients receiving HAART who had B19V infections confirmed by serum polymerase chain reaction. Four of the patients were infected with genotype 1a strains and the remaining patient was infected with a genotype 3b strain. Anaemia was detected in three of the patients, but all patients recovered without requiring immunoglobulin and/or blood transfusions. In all cases, the attending physicians did not suspect the B19V infections. There was no apparent relationship between the infecting genotype and the clinical course. In the HAART era, B19V infections in HIV-positive patients may be limited, subtle or unapparent.

Nutritional status of HIV-positive patients in Niterói, Rio de Janeiro, Brazil.

The objective of this cross-sectional study was to assess the nutritional status of HIV-positive patients in a hospital in the city of Niteroi, Rio de Janeiro, Brazil. We studied 235 patients (130 men and 105 women) from May 2009 to June 2010. The frequency of undernourishment among women was 7.6%; 26.7% of the women were overweight, and 16.2% were obese. Among men, the frequency of undernourishment was 3.8%; 25.4% of the men were overweight, and 6.9% were obese. A logistic regression was done to investigate the relationship between nutritional status and potential predisposing factors. Women were more frequently affected by obesity and undernourishment than men. However, only the difference in obesity was significant, and women had almost three times higher odds of being obese (OR 2.6; 95% CI 1.03-6.65). According to a nationwide survey done in Brazil during 2008-2009, 50.1% of the Brazilian healthy males were overweight, and 12.5% were obese; 48% of healthy females were overweight, and 16.9% were obese. Although the prevalence of undernourishment in HIV-positive patients is now lower than that observed in the beginning of the AIDS epidemic and excess weight is increasingly common among people living with HIV/AIDS, the proportion of excess weight was found lower and of undernourishment was higher in the present study than that found in the Brazilian population.

Profile of circulating levels of IL-1Ra, CXCL10/IP-10, CCL4/MIP-1ß and CCL2/MCP-1 in dengue fever and parvovirosis.

Dengue virus (DENV) and parvovirus B19 (B19V) infections are acute exanthematic febrile illnesses that are not easily differentiated on clinical grounds and affect the paediatric population. Patients with these acute exanthematic diseases were studied. Fever was more frequent in DENV than in B19V-infected patients. Arthritis/arthralgias with DENV infection were shown to be significantly more frequent in adults than in children. The circulating levels of interleukin (IL)-1 receptor antagonist (Ra), CXCL10/inducible protein-10 (IP-10), CCL4/macrophage inflammatory protein-1 beta and CCL2/monocyte chemotactic protein-1 (MCP-1) were determined by multiplex immunoassay in serum samples obtained from B19V (37) and DENV-infected (36) patients and from healthy individuals (7). Forward stepwise logistic regression analysis revealed that circulating CXCL10/IP-10 tends to be associated with DENV infection and that IL-1Ra was significantly associated with DENV infection. Similar analysis showed that circulating CCL2/MCP-1 tends to be associated with B19V infection. In dengue fever, increased circulating IL-1Ra may exert antipyretic actions in an effort to counteract the already increased concentrations of IL-1ß, while CXCL10/IP-10 was confirmed as a strong pro-inflammatory marker. Recruitment of monocytes/macrophages and upregulation of the humoral immune response by CCL2/MCP-1 by B19V may be involved in the persistence of the infection. Children with B19V or DENV infections had levels of these cytokines similar to those of adult patients.

Parvovirus B19 seroconversion in a cohort of human immunodeficiency virus-infected patients.

Erythrovirus B19 (B19V) infection may cause red cell aplasia in patients infected with human immunodeficiency virus (HIV). The introduction of highly active antiretroviral therapy (HAART) has improved the immune function of these patients by modifying the course of B19V infection. The purpose of this study was to estimate the frequency of B19 seroconversion in a cohort of HIV-infected patients and evaluate the occurrence of B19V-related anaemia during the seroconversion period. Adult HIV-infected patients were studied at a public hospital in Niterói, state of Rio de Janeiro, Brazil. IgG and IgM antibodies against B19V were detected by an enzyme-linked immunosorbent assay and B19 viraemia was assayed by polymerase chain reaction. Medical records were reviewed for any clinical evaluation of anaemia. Seroconversion was detected in 31.8% of the 88 individuals who began the study as anti-B19V IgG-negative. No clinical manifestations of B19V infection were detected during the period of seroconversion. Patients who seroconverted were 5.40 times more likely to have anaemia than those who did not [odds ratio 5.40 (95% confidence interval: 1.33-22.93)]. Anaemia was detected in eight patients. All patients recovered from anaemia by either beginning or continuing HAART, without requiring blood transfusions. In the HAART era, B19V infection may only be associated with a course of disease characterised by less severe chronic anaemia. This milder course of B19V-associated disease is likely due to the increased immune function of HAART-treated patients.

Low bone mass and vitamin D in Brazilian people living with HIV under antiretroviral therapy.

We performed a cross-sectional study in 212 PLHIV under antiretroviral therapy. Bone mass was compromised in 36.5% of relatively young sample and associated with hypogonadism, older age, higher PTH levels, and metabolic syndrome. Hypovitaminosis D was present in 85%, especially those on NNRTI. PURPOSE: Previous studies have reported an increased prevalence of bone demineralization among people living with the human immunodeficiency virus (PLHIV). We aimed to assess bone mineral density (BMD), vitamin D levels, and associated risk factors in Brazilian PLHIV. METHODS: Cross-sectional study with 212 patients in a specialized assistance service. Clinical and demographic information were registered. Laboratory tests were performed, and BMD was measured at the lumbar spine, total hip/femoral neck, and forearm by dual-energy X-ray absorptiometry. Participants were classified into "with low bone mass (wLBM)" and "without low bone mass (woLBM)." Those wLBM encompasses osteoporosis, osteopenia, and below the expected range for age as recommended by the World Health Organization. RESULTS: One hundred and eighty-seven patients were included. Median age was 46.3 years (interquartile range (IQR) 40-52) and duration of HAART exposure was 11.2 years (IQR 7-15). Plasma viral load was undetectable in 79%. Hypovitaminosis D (< 30 ng/mL) was present in 85% and LBM in 36.5%. Men wLBM were more likely to have testosterone deficiency and had higher PTH levels than those woLBM. LBM in women was associated with older age, menopause, and metabolic syndrome. CONCLUSION: This study showed a high frequency of LBM in a relatively young sample, and suggests a detrimental effect of hypogonadism, older age, higher PTH levels, and metabolic syndrome. Hypovitaminosis D was frequent, especially those on non-nucleoside reverse transcriptase inhibitor, higher body mass index, and abdominal circumference.

Clinical and imaging manifestations of hemorrhagic pulmonary leptospirosis: a state-of-the-art review.

Leptospirosis, a spirochetal zoonosis, is frequently unrecognized due to its manifestation as an undifferentiated fever. It is an emerging infectious disease that has changed from an occupational disease of veterinarians, farmers, butchers, and other animal handlers to a cause of epidemics in poor and decayed urban communities in developing countries. Humans are infected when mucous membranes or abraded skin come into direct contact with the urine of infected animals, especially rats and dogs. Mortality from severe leptospirosis is high, even when optimal treatment is provided. The diagnosis of leptospirosis is based on clinical findings, history of direct or indirect exposure to infected animals in endemic areas, and positive serological tests. It should be considered in the differential diagnosis of patients with febrile illnesses associated with pneumonitis and respiratory failure, especially when hemoptysis is present. Severe pulmonary involvement in leptospirosis consists primarily of hemorrhagic pneumonitis. In advanced cases, adult respiratory distress syndrome and massive pulmonary hemorrhage may occur. Chest radiographs show bilateral alveolar infiltrates and/or resemble viral pneumonia, bronchopneumonia, tuberculosis, adult respiratory distress syndrome, and other causes of pulmonary hemorrhage such as Goodpasture syndrome. High-resolution computed tomography scans may show nodular infiltrates, areas of consolidation, ground-glass attenuation, and crazy-paving patterns. Bronchoalveolar lavage and autopsy studies have suggested that ground-glass opacities and air-space consolidations are secondary to pulmonary hemorrhage. Although not specific, the presence of these computed tomography findings in a febrile patient with an appropriate history should suggest a diagnosis of leptospirosis.

Seroepidemiological study of human parvovirus B19 among human immunodeficiency virus-infected patients in a medium-sized city in Rio de Janeiro, Brazil.

Parvovirus B19 (B-19) may cause chronic anaemia in immunosuppressed patients, including those infected with human immunodeficiency virus (HIV). We studied single serum samples from 261 consecutive HIV-infected patients using an enzyme immunoassay to detect IgG antibodies to B-19. The seroprevalence of B-19-IgG was 62.8%. The differences in seroprevalence across gender, age, educational categories, year of collection of the serum samples, clinical and antiretroviral therapy characteristics, CD4+ count, CD4+ and CD8+ percentage and CD4+/CD8+ ratios were neither substantial nor statistically significant. There was a non-significant, inverse association between B-19 seropositivity and plasma HIV load and haemoglobin level. Our results indicated that 37.1% of patients might be susceptible to B-19 infection and remained at risk for being infected, mainly during epidemic periods. As B-19 infection can be treated with immune globulin preparations, it may be included in the diagnostic approach toward chronic anaemia in HIV-infected patients.

Post-surgical atypical mycobacteriosis in 125 patients in Rio de Janeiro.

INTRODUCTION: The growing incidence of post-surgical atypical mycobacteriosis (PSAM) may be related to the increased use of low- and medium-complexity video-assisted surgery. METHODS: Between April 2007 and June 2009, 125 patients were referred from the State Health Department of Rio de Janeiro for the treatment of confirmed, probable, or suspected PSAM. RESULTS: Laparoscopic cholecystectomy was the most frequent surgical procedure (48.8%) among patients. Clarithromycin, ethambutol, and terizidone were used to treat 113 patients for a mean duration of 226 days. CONCLUSIONS: Despite the need for multidrug therapy and long treatment duration, most included patients adhered to treatment and experienced cure without relapse.

Influence of vaccine-preventable diseases and HIV infection on demand for an infectious diseases service in Rio de Janeiro State, Brazil, over 22 years - Part II (1995-2016).

Patients' data during daily clinical care are extremely important for improving the allocation of healthcare resources and for assessing healthcare demands. The prospective gathering of these data over decades allowed us to describe the trends of infectious diseases in a tertiary hospital. The results concerning the period between 1965 and 1994 described the exponential increase in the incidence of HIV infection and its important effects on our institutional mortality. The present study describes the demand for the same hospital between 1995 and 2016. There were 4,691 admissions and the main causes of admissions were, in descending order, HIV infection (1,312, 28.0%), noninfectious diseases (447, 9.5%), meningoencephalitis (432, 9.2%), soft tissue infections (427; 9.1%), tuberculosis (272, 5.8%), pneumonias (212, 4.5%) and leptospirosis (212, 4.5%). There were 864 readmissions; most due to HIV infections (65.2%). The institutional mortality fell from 16.9% in the first two years to 5.0% in the last two years of the study. The case-fatality rates among the HIV patients decreased from more than 40% to approximately 5% over the study period. In the last two decades, the hospital experienced a decrease in demand due to vaccine-preventable diseases. The demand for children has fallen and the demand for patients over the age of 50 has increased. These results reflect the improvement in public health standards over more than half a century and the positive effects of the National Immunization Program. They also illustrate the sharp decline in the HIV case-fatality rate after the introduction of combined antiretroviral therapy.

Radiological aspects in computed tomography as determinants in the diagnosis of pulmonary tuberculosis in immunocompetent infants.

OBJECTIVE: To describe the chest computed tomography (CT) findings in immunocompetent children under 36 months of age with pulmonary tuberculosis. MATERIALS AND METHODS: This was a descriptive case series conducted in the city of Rio de Janeiro, Brazil, between January 2004 and July 2013, involving 20 young children who underwent CT after undergoing chest X-rays that did not provide a definitive diagnosis. RESULTS: All of the participants had lymph node enlargement and consolidations. In 15 cases (75%), the consolidations were accompanied by atelectasis. Pulmonary cavitation was seen in 10 cases (50%), and cavitation within consolidations was seen in 7 (35%). The areas of cavitation and parenchymal destruction were not seen on conventional chest X-rays. CONCLUSION: The radiological presentation of pulmonary tuberculosis in young children differs from that described in older children and adults. CT is an effective method for the early diagnosis of pulmonary tuberculosis in immunocompetent infants, allowing the rapid institution of specific treatment, which is crucial for halting disease progression, as well as for preventing local and systemic complications.

OBJETIVO: Descrever achados radiológicos na tomografia computadorizada (TC) de tórax de crianças imunocompetentes menores de 36 meses com tuberculose pulmonar. MATERIAIS E MÉTODOS: Esta série de casos foi desenvolvida na cidade do Rio de Janeiro, no período de janeiro de 2004 a julho de 2013, onde 20 pacientes foram submetidos a TC após a realização de radiografias de tórax que não definiram o diagnóstico. RESULTADOS: Todos os participantes tiveram linfonodomegalias e consolidações. Em 15 casos (75%) as consolidações tiveram atelectasia associada. Escavações pulmonares ocorreram em 10 casos (50%), havendo consolidações em 7 (35%). Áreas de escavação e destruição parenquimatosa em fase inicial não foram observadas nas radiografias simples. CONCLUSÃO: A apresentação radiológica de tuberculose pulmonar em lactentes não foi a mesma descrita em crianças maiores e adultos. A TC é um método aplicável para o diagnóstico precoce de tuberculose pulmonar em lactentes imunocompetentes, permitindo a rápida instituição de tratamento específico, que é crucial para interromper a progressão da doença e prevenir suas complicações locais e sistêmicas.

The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls.

BACKGROUND: Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients. OBJECTIVES: To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals. METHODS: Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS - version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis' non-parametric test was done, followed by Dunn's multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests. RESULTS: The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups. CONCLUSION: The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.

The accuracy of anti-human herpesvirus 6 IgM detection in children with recent primary infection.

Human herpesvirus 6 (HHV-6) has been shown to infect almost all children by 4 years of age. Even with a typical clinical presentation, HHV-6 infection is misdiagnosed frequently as measles or rubella. The aim of this study was to assess the accuracy of the IgM test for detection of recent primary HHV-6 infection. The study was conducted between January, 1998 and December, 2006 at primary health care units in Niterói, Rio de Janeiro, Brazil. Sera from 185 children, in whom measles, rubella, dengue fever and parvovirus B19 infections were excluded, were studied for anti-HHV-6 IgG and IgM antibodies using an indirect immunofluorescence test. Seventy-one (38.4%) of the children had evidence of primary HHV-6 infection. Taking the IgG avidity test as the "gold standard", the following results for IgM were obtained-sensitivity: 76.1%; specificity: 87.5%; accuracy: 82.4%. This study confirmed the low accuracy of IgM detection for the diagnosis of primary HHV-6 infection.

Influence of a Scientific Initiation Programme on scientific output of professors on a medical course in Brazil.

BACKGROUND: Scientific Initiation Programmes (SIP) are now considered increasingly important in medical courses, and are now being introduced in many medical courses. The School of Medicine at Universidade Federal Fluminense pioneered on optional SIP in 1995. This study aims to compare scientific output of professors who engaged in SIP disciplines (SIP group) with that of professors who did not (non-SIP group). METHODS: Data on the scientific output of both groups was collected from a period that began 4 years before and ended 4 years after the SIP's inception. The average number of papers published or presented in me di cal meetings in both groups was compared. RESULTS: The scientific output of the SIP group was larger than that of the non SIP group (p = 0.0017), except for M.Sc. professors (p = 0.8362). This result did not change when the scientific production of Ph.D. professors was analysed according to the periods before (p = 0.0003) and after (p = 0.0001) SIP's inception. Scientific output of M.Sc. professors of both group were similar in both periods, i.e., before (p = 1.0) and after (p = 0.67) SIP's inception. When scientific output in the periods before and after SIP's inception is compared, it was found that it increased in both groups, SIP (p = 0.0001) and non SIP (p = 0.0086) alike. CONCLUSIONS: After the inception of SIP, all professors had an increase in their scientific output; however, this occurred independently of their engagement in SIP disciplines.

Predictive factors of dengue severity in hospitalized children and adolescents in Rio de Janeiro, Brazil.

INTRODUCTION: Dengue is one of the most important mosquito-borne infections. Severe cases are more frequently observed in adults. However, in 2008, the State of Rio de Janeiro, Brazil, experienced a severe dengue epidemic that primarily affected children and caused many cases of dengue hemorrhagic fever (DHF) and death. METHODS: A cross-sectional analytical study was conducted to examine laboratory diagnosis and clinical epidemiologic factors for confirmed dengue cases in patients aged less than 16 years, from January to June 2008, at a municipal hospital in the City of Rio de Janeiro, Brazil. Variables associated with severe outcomes and P values less than .05 were evaluated by means of a logistic regression model. RESULTS: Of the 419 dengue cases studied, 296 were classified as DHF and 123 as classical dengue. Six patients who had DHF died. In multivariate analysis, some laboratory and clinical variables were independently associated with DHF: age 5 years or older (odds ratio [OR], 4.94; 95% confidence interval [CI], 1.30-18.71), abdominal pain (OR, 8.59; 95% CI, 3.17-23.27), hepatomegaly (OR, 15.87; 95% CI, 5.38-46.85), and positive tourniquet test (OR, 10.84; 95% CI, 3.96-29.71). Hypoalbuminemia occurred more frequently than hemoconcentration in DHF cases, and high aminotransferase levels were associated with severity. CONCLUSIONS: Age greater than 5 years, abdominal pain, painful hepatomegaly, and positive tourniquet test were predictors of DHF. The high frequency of hepatic impairment suggests that acetaminophen should be avoided in severe cases of dengue.

[Aspects related to the use of antiretrovirals in high complexity patients in the state of Rio de Janeiro]. / Aspectos relacionados à utilização de antirretrovirais em pacientes de alta complexidade no estado do Rio de Janeiro, Brasil.

Treatment of AIDS involves the use of the cocktail of drugs that make up the antiretroviral therapy. Its logistic control is monitored by a computerized national system of dispensation, the Logistic Control System of Medication (SICLOM). This study aimed to investigate, by means of SICLOM data, the use of antiretroviral therapy in patients treated at two University Hospitals in the state of Rio de Janeiro. A cross-sectional study was conducted with sociodemographic and dispensation data collected from SICLOM. The evaluation of drug ownership was done by calculating the Proportion of Days Covered (PDC). Five hundred and thirty-eight patients of both genders with active registration in SICLOM and over 18 years of age were included. The ART most used in both hospitals was lamivudine, considering the total of 58 different schemes identified. The mean of possession of groups was 88% (± 0,16). The factor associated with possession of drugs was the ART scheme, with PDC of 91% (p<0,001) for rescue schemes. This study confirmed that SICLOM was a reliable source to establish the profile of the population assisted.

O tratamento da aids implica a utilização de diversos medicamentos que compõem a terapia antirretroviral, sendo o controle logístico monitorado por um sistema nacional informatizado de dispensação, o Sistema de Controle Logístico de Medicamentos (SICLOM). O objetivo foi investigar a utilização da terapia antirretroviral de pacientes de dois hospitais universitários no Estado do Rio de Janeiro a partir do SICLOM. Foi realizado um estudo seccional com coleta de dados sociodemográficos e de dispensação, a partir do SICLOM. A avaliação da posse para estimativa de pacientes não aderidos foi realizada através do indicador de proporção de dias cobertos (PDC). Foram incluídos 538 pacientes com cadastro ativo no SICLOM, maiores de 18 anos de ambos os sexos. O ARV mais utilizado em ambos os hospitais foi lamivudina, dentre 58 esquemas diferentes identificados. A maior parte dos pacientes utilizava esquemas classificados como de primeira linha de tratamento. Em média, a proporção de dias cobertos (posse) pelo tratamento foi 88% (± 0,16). A linha de tratamento mostrou associação estatística com a posse, sendo observado melhor PDC 91% (p < 0,001) para os esquemas resgate. Este estudo corroborou o SICLOM como uma boa fonte para conhecimento do perfil de utilização de ARV.

Molecular diversity of human parvovirus B19 during two outbreaks of erythema infectiosum in Brazil.

This study was conducted to provide information on the genetic diversity of human parvovirus B19 (B19V) circulating in the municipality of Niterói, Rio de Janeiro, Southeast Brazil during 1996-2006, a period with two distinct outbreaks of B19V infection: 1999-2000 and 2004-2005. A total of 27 sera from patients with erythema infectiosum and five sera from HIV-infected patients that tested positive for B19V DNA during the study period were analyzed. To genotype B19V strains, a semi-nested PCR for partial amplification of the capsid gene was performed and sequence analysis revealed that 31 sequences belonged to subgenotype 1a (G1a) of the main genotype 1 and one sequence was characterized as subgenotype 3b (G3b). The phylogenetic tree supported the division of the G1a into two well-defined clades with 1.3% of divergence. The low diversity of the G1a strains may be explained by the fact that all patients had acute B19V infection and 30/32 sera were collected during two distinct outbreaks. The G3b strain was from an HIV-infected patient who seroconverted to anti-B19 IgG antibodies in September/2005. This is the first report of G3b in the state of Rio de Janeiro.

CORRELATION OF NON-ALCOHOLIC FATTY LIVER DISEASE AND FEATURES OF METABOLIC SYNDROME IN MORBIDLY OBESE PATIENTS IN THE PREOPERATIVE ASSESSMENT FOR BARIATRIC SURGERY.

Background: Obesity is an epidemic and chronic disease that can bring other comorbidities to the patient. Non-alcoholic fatty liver disease is present in up to 90% of these patients and can progress to hepatitis and hepatocarcinoma. The relationship of this liver disease and obesity is already well known; however, it is possible that some parameters of the comorbidities are more related than others in the pathophysiology of the disease. Aim: Was analyzed the relationship between non-alcoholic fatty liver disease (NAFLD) and the comorbidities of metabolic syndrome in morbidly obese patients. Methods: Was involved ultrasonography and laboratory assessment of obese patients before bariatric surgery. NAFLD was assessed using the same sonography parameters for all patients. Based on the results, the patients were divided into groups with and without NAFLD. Comparisons between them involved clinical and laboratory variables such as fasting blood glucose, insulin, HOMA-IR (homeostasis model assessment - insulin resistance), glycated hemoglobin, total cholesterol and fractions, triglycerides, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, C-reactive protein, albumin and ferritin. Patients who reported alcohol abuse (defined as the consumption of >14 drinks per week) or who had hepatitis were excluded. Results: Eighty-two patients (74 women and 8 men) were studied, of whom 53 (64.6%) had NAFLD and 29 (35.4%) did not. The levels of glycated hemoglobin (p=0.05) and LDL cholesterol (p=0.01) were significantly altered in patients with NAFLD. However, weight, body mass index and excess weight did not differ significantly between the groups (p=0.835, p=0.488 and p=0.727, respectively). Conclusions: Altered LDL cholesterol and glycated hemoglobin levels were related to the presence of NAFLD.

Racional: A obesidade é doença epidêmica e crônica que pode trazer outras comorbidades ao paciente. A doença hepática gordurosa não alcoólica está presente em até 90% desses pacientes e pode evoluir para hepatite e hepatocarcinoma. A relação desta hepatopatia e a obesidade já é bem conhecida; porém, é possível que alguns parâmetros das comorbidades estejam mais relacionados do que outros na fisiopatogenia da doença. Objetivo: Correlacionar a doença hepática gordurosa não alcoólica (DHGNA) com as comorbidades da síndrome metabólica em pacientes obesos mórbidos em pré-operatório de cirurgia bariátrica. Métodos: Avaliação ultrassonográfica e laboratorial de pacientes obesos em pré-operatório para cirurgia bariátrica. Durante o preparo para a operação em todos os pacientes foi avaliada DHGNA através de ultrassonografia. De acordo com o resultado, os pacientes foram separados em dois grupos: sem DHGNA e com DHGNA. Para análise entre os grupos, avaliaram-se as seguintes variáveis clínicas e laboratoriais: insulina, HOMA-IR, hemoglobina glicada, colesterol total e frações, triglicerídeos, transaminase pirúvica, transaminase glutâmico oxalacética, gama glutamil transferase, proteína C reativa, albumina, ferritina. Os pacientes que relataram uso de bebida alcoólica ou que apresentaram hepatite foram excluídos do estudo. Resultados: Avaliou-se um total de 82 pacientes (74 mulheres e 8 homens), sendo 53 (64.6%) com DHGNA e 29 (35.4%) sem. Os níveis de hemoglobina glicada (p=0.05) e de LDL (p=0.01) mostraram-se mais relacionados no grupo de pacientes com DHGNA. Conclusão: A hemoglobina glicada e o LDL tiveram relação com a presença de DHGA.