Hepatite C crônica em serviço de referência no nordeste do Brasil: um estudo retrospectivo de dezoito anos de acompanhamento

Chronic Hepatitis C is the leading cause of chronic liver disease in advanced final stage of hepatocellular carcinoma (HCC) and of death related to liver disease. Evolves progressively in time 20-30 years. Evolutionary rates vary depending on factors virus, host and behavior. This study evaluated the impact of hepatitis C on the lives of patients treated at a referral service in Hepatology of the University Hospital Onofre Lopes - Liver Study Group - from May 1995 to December 2013. A retrospective evaluation was performed on 10,304 records, in order to build a cohort of patients with hepatitis C, in which all individuals had their diagnosis confirmed by gold standard molecular biological test. Data were obtained directly from patient charts and recorded in an Excel spreadsheet, previously built, following an elaborate encoding with the study variables, which constitute individual data and prognostic factors defined in the literature in the progression of chronic hepatitis C. The Research Ethics Committee approved the project. The results were statistically analyzed with the Chi-square test and Fisher's exact used to verify the association between variable for the multivariate analysis, we used the Binomial Logistic regression method. For both tests, it was assumed significance p < 0.05 and 95%. The results showed that the prevalence of chronic hepatitis C in NEF was 4.96 %. The prevalence of cirrhosis due to hepatitis C was 13.7%. The prevalence of diabetes in patients with Hepatitis C was 8.78 % and diabetes in cirrhotic patients with hepatitis C 38.0 %. The prevalence of HCC was 5.45%. The clinical follow-up discontinuation rates were 67.5 %. The mortality in confirmed cases without cirrhosis was 4.10% and 32.1% in cirrhotic patients. The factors associated with the development of cirrhosis were genotype 1 (p = 0.0015) and bilirubin > 1.3 mg % (p = 0.0017). Factors associated with mortality were age over 35 years, abandon treatment, diabetes, insulin use, AST> 60 IU, ALT> 60 IU, high total bilirubin, extended TAP, INR high, low albumin, treatment withdrawal, cirrhosis and hepatocarcinoma. The occurrence of diabetes mellitus increased mortality of patients with hepatitis C in 6 times. Variables associated with the diagnosis of cirrhosis by us were blood donor (odds ratio 0.24, p = 0.044) and professional athlete (odds ratio 0.18, p = 0.35). It is reasonable to consider a revaluation in screening models for CHC currently proposed. The condition of cirrhosis and diabetes modifies the clinical course of patients with chronical hepatitis C, making it a disease more mortality. However, being a blood donor or professional athlete is a protective factor that reduces the risk of cirrhosis, independent of alcohol consumption. Public policies to better efficient access, hosting and resolution are needed for this population.

Prevalência da infecção pelo Papilomavírus humano, Chlamydia Trachomatis e Herpes Simples do tipo 2 em adolescentes atendidas em unidades de saúde pública de Natal

This study assessed the level of knowledge, attitude and practice of Pap smear and human papillomavirus (HPV), in addition to analyzing the prevalence of genital HPV infection, Herpes Simplex Type 2 (HSV-2) and Chlamydia trachomatis in teenagers. The study consisted of two approaches, one based only on interviews conducted with adolescents enrolled in public schools or in public health facilities in the city of Natal. The other approach involved only a group of 132 adolescents enrolled among those admitted to two health units in Natal-RN. This second group of participants two specimens were collected for laboratory analysis: one was directed to prepare the blade for the Pap test, and other processed for DNA extraction for molecular analysis, focusing on the detection of HPV, HSV-2 and C . trachomatis. The presence of DNA of the three pathogens was investigated by the technique of polymerase chain reaction (PCR). The presence of each of the three pathogens was analyzed in terms of socio-demographic characteristics, as well as sexual and reproductive activity to identify risk factors for infection and development of lesions of the uterine cervix. The results show that the adolescents in this study had levels of knowledge and attitude very low, both in relation to cytology to HPV as though they have made a reasonable percentage of adequate practice exam and prevention of HPV infection. The overall prevalence of HPV infection was 54.5% and 48.2% in adolescents with normal cytology and 86.4% in those with abnormal cytology. We observed a higher proportion of cases of infection in the age group of 18 to 21. The prevalence of HPV infection was slightly higher among pregnant teenagers. The overall prevalence of HSV-2 infection was 13.6% and 11.8% in women with normal cytology and 22.7% in those with abnormal cytology. A higher proportion of cases of infection was found in the age group from 14 to 17, with a slightly higher prevalence among pregnant women. The C. trachomatis was found with an overall prevalence of 19.7% and 21.8% in adolescents with normal cytology and 9.1% in those with abnormal cytology. The prevailing rate was highest in the age group 18 to 21 years and in nonpregnant

Biodistribuição do pertecnetato de sódio após desvio gástrico em Y de Roux (técnica de capella)

O desvio gástrico em Y de Roux é a técnica cirúrgica mais utilizada no tratamento da obesidade mórbida. Esta operação reduz o volume do estômago e o comprimento do intestino delgado, gerando alterações estruturais e metabólicas que podem influenciar no resultado de exames cintilográficos de pacientes operados. Com o objetivo de avaliar a biodistribuição pós-operatória do pertecnetato de sódio (Na99mTc) em órgãos de ratos Wistar submetidos à técnica do bypass (desvio) gástrico em Y de Roux (BGYR), foram utilizados 12 ratos distribuídos aleatoriamente em grupo tratado (n=6), submetido à cirurgia do BGYR e o grupo controle (C; n=6). No 15º dia de pós-operatório foi administrado 0,1 mL via plexo orbital de Na99mTc aos animais dos dois grupos, com atividade radioativa média de 0,66MBq. Após 30 minutos, os ratos foram mortos e retirados fragmentos de tireóide, coração, pulmão, fígado, estômago, rim e fêmur. As amostras foram lavadas com solução salina 0,9%, pesadas e submetidas ao Contador Gama 1470, WizardTM Perkin-Elmer-Finlândia para determinação do percentual de atividade radioativa total por grama (%ATI/g) de cada órgão. Empregou-se o teste t de Student para análise estatística, considerando-se significantes as diferenças das médias quando p<0,05. Redução significante na média de %ATI/g foi observada no fígado, estômago e fêmur dos animais submetidos à cirurgia de BGYR comparada ao grupo controle (p<0,05). Nos demais órgãos não houve diferença estatisticamente significativa entre os grupos. Em conclusão, a cirurgia BGYR em ratos modificou a biodistribuição do Na99mTc em alguns órgãos, podendo ter implicações clínicas na interpretação de exames cintilográficos. Este estudo xi teve um caráter multidisciplinar com a participação de pesquisadores das áreas de Cirurgia Experimental, Farmácia, Radiobiologia, Medicina Nuclear e Estatística

Doença de Chagas: caracterização de formas clínicas e estratificação do risco de morte no Oeste do Estado do Rio Grande do Norte

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES