IMPACT OF THE PEGYLATED-INTERFERON AND RIBAVIRIN THERAPY ON THE TREATMENT-RELATED MORTALITY OF PATIENTS WITH CIRRHOSIS DUE TO HEPATITIS C VIRUS

Although the protease inhibitors have revolutionized the therapy of chronic hepatitis C (CHC), the concomitant use of pegylated-interferon (PEG-IFN) and ribavirin (RBV) is associated to a high rate of adverse effects. In this study, we evaluated the consequences of PEG-IFN and RBV and their relationship with mortality in patients with cirrhosis. METHODS: Medical records of CHC who underwent treatment with PEG-IFN and RBV in a public hospital in Brazil were evaluated. All the patients with cirrhosis were selected, and their clinical and laboratory characteristics, response to treatment, side effects and mortality were evaluated. RESULTS: From the 1,059 patients with CHC, 257 cirrhotic patients were evaluated. Of these, 45 (17.5%) achieved sustained viral response (SVR). Early discontinuation of therapy occurred in 105 (40.8%) patients, of which 39 (15.2%) were due to serious adverse effects. The mortality rate among the 257 cirrhotic patients was 4.3%, occurring in 06/242 (2.4%) of the Child-A, and in 05/15 (33.3%) of the Child-B patients. In conclusion, the treatment of patients with cirrhosis due to HCV with PEG-IFN and RBV shows a low SVR rate and a high mortality, especially in patients with liver dysfunction.

Evaluation of CSF Neurotransmitters and Folate in 25 Patients with Rett Disorder and Effects of Treatment

Background: Rett disorder (RD) is a progressive neurodevelopmental entity caused by mutations in the MECP2 gene. It has been postulated that there are alterations in the levels of certain neurotransmitters and folate in the pathogenesis of this disease. Here we re-evaluated this hypothesis. Patients and Methods: We evaluated CSF folate, biogenic amines and pterines in 25 RD patients. Treatment with oral folinic acid was started in those cases with low folate. Patients were clinically evaluated and videotaped up to 6 months after therapy. Results: CSF folate was below the reference values in 32% of the patients. Six months after treatment no clinical improvement was observed. Three of the four patients with the R294X mutation had increased levels of a dopamine metabolite associated to a particular phenotype. Three patients had low levels of a serotonin metabolite. Two of them were treated with fluoxetine and one showed clinical improvement. No association was observed between CSF folate and these metabolites, after adjusting for the patients age and neopterin levels. Conclusion: Our results support that folinic acid supplementation has no significant effects on the course of the disease. We report discrete and novel neurotransmitter abnormalities that may contribute to the pathogenesis of RD highlighting the need for further studies on CSF neurotransmitters in clinically and genetically well characterized patients.

Pre-treatment of different types of lignocellulosic biomass using ionic liquids

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau Mestre em Biotecnologia

Monitoring and modelling of membrane bioreactors for wastewater treatment incorporating 2D fluorescence spectroscopy

Dissertação para obtenção do Grau de Doutor em Engenharia Química e Bioquímica, Especialidade em Engenharia Bioquímica

Aquaponics and its potential aquaculture wastewater treatment and human urine treatment

The main objective of this thesis is to study the developing fields of aquaponics and its potential for aquaculture wastewater treatment and human urine treatment. Aquaponics is a food production system which combines fish farming (aquaculture) with soilless crop farming (hydroponics). In this thesis the concept of aquaponics and the underlying processes are explained. Research on aquaculture wastewater and human urine wastewater is reviewed and its potential application with aquaponic systems is studied. An overview of the different types of aquaponic systems and current research on the field is also presented. A case study was conducted in a farm in Askeröd, Sweden, which involved building two aquaponic systems (System 1 and System 2) and a human urine-based aquaponic system (System 3), with different degrees of component complexity and sizes. The design, building and monitoring of System 1, System 2 and System 3 was documented and described in detail. Four day experiments were conducted which tested the evolution in concentration of Total Ammonia Nitrogen (NH4+/NH3), Nitrite (NO2-), Nitrate (NO3-), Phosphate (PO43-), and Dissolved Oxygen (O2) after an initial nutrient input. The goal was to assess the concentrations of these parameters after four days and compare them with relevant literature examples in the aquaculture industry and in source-separated urine research. Neither of the two aquaponic systems (System 1 and System 2) displayed all of the parameter concentrations in the last day of testing below reference values found in literature. The best performing of the aquaponic systems was the more complex system (System 2) combining the hydroponic Nutrient Film Technique with a Deep Water Culture component, with a Total Ammonia Nitrogen concentration of 0,20 mg/L, a Nitrite concentration of 0,05 mg/L, a Nitrate concentration of 1,00-5,00 mg/L, a Phosphate concentration of <0,02 mg/L and a Dissolved Oxygen concentration of 8,00 mg/L. The human urine-based aquaponic system (System 3) underperformed in achieving the reference concentration values in literature for most parameters. The removal percentage between the higher recorded values after the input addition and the final day of testing was calculated for two literature examples of separated urine treatment and System 3. The system had a removal percentage of 75% for Total Ammonia Nitrogen, 98% for Nitrite, 25% for Nitrate and 50% for Phosphate. These percentages still underperformed literature examples in most of the tested parameters. The results gathered allowed to conclude that while aquaculture wastewater treatment and human urine treatment is possible with aquaponics systems, overall these did not perform as well as some examples found in recirculating aquaculture systems and source-separated urine treatment literature. However, better measuring techniques, longer testing periods and more research is recommended in this field in order to draw an improved representative conclusion.

Etiological treatment of young women infected with Trypanosoma cruzi, and prevention of congenital transmission

The objective was to detect Trypanosoma cruzi infection in 32 children in Salta, Argentina, born to 16 chronically infected young women who were treated with benznidazole. Tests were performed to assess the efficacy of treatment after 14 years. At the end of the follow up, 87.5% of the women were non-reactive to EIA tests, 62.5% to IHA and 43.8% to IFA. 62.5% of the women were non-reactive according to two or three serological tests. No infected children were detected among the newborns of mothers treated before their pregnancy.

Treatment and education reduce the severity of schistosomiasis periportal fibrosis

Introduction This study evaluates the factors associated with the development of severe periportal fibrosis in patients with Schistosoma mansoni. Methods A cross-sectional study was conducted from April to December 2012 involving 178 patients infected with S. mansoni who were treated in the Hospital das Clínicas of Pernambuco, Brazil. Information regarding risk factors was obtained using a questionnaire. Based on the patients' epidemiological history, clinical examination, and upper abdomen ultrasound evaluation, patients were divided into 2 groups: 137 with evidence of severe periportal fibrosis and 41 patients without fibrosis or with mild or moderate periportal fibrosis. Univariate and multivariate analyses were conducted using EpiInfo software version 3.5.5. Results Illiterate individuals (30.1%) and patients who had more frequent contact with contaminated water in towns in the Zona da Mata of Pernambuco (33.2%) were at greater risk for severe periportal fibrosis. Based on multivariate analysis, it was determined that an education level of up to 11 years of study and specific prior treatment for schistosomiasis were preventive factors for severe periportal fibrosis. Conclusions The prevailing sites of the severe forms of periportal fibrosis are still within the Zona da Mata of Pernambuco, although there has been an expansion to urban areas and the state coast. Specific treatment and an increased level of education were identified as protective factors, indicating the need for implementing social, sanitary, and health education interventions aimed at schistosomiasis to combat the risk factors for this major public health problem.

Surgical treatment of type I neuritis in a teenage boy with borderline tuberculoid leprosy

Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.

Laparoscopic treatment of retroperitoneal fibrosis: report of two cases and review of the literature

OBJECTIVES: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen. CASE REPORT: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case. CONCLUSIONS: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation.

Diseño y evaluación de alternativas de manejo sustentable para la recuperación y conservación de bosques degradados de la región del Espinal en la provincia de Córdoba. Design and evaluation of sustainable management alternatives for the recovery and conservation of degraded forest in the Espinal Region in Córdoba province.

El avance de la frontera agropecuaria y la urbanización han reducido la superficie boscosa del Espinal en Córdoba a fragmentos que son sumamente valiosos como relictos del ambiente original del Algarrobal y como barreras frente a la acción erosiva del agua y los vientos. Por su estructura, degradada y enmarañada, el productor agropecuario generalmente los visualiza como una molestia ya que le restan superficie apta para el cultivo y resultan poco aprovechables para el pastoreo de los animales. Bajo pautas de manejo adecuadas estos bosquecillos podrían rehabilitarse para el aprovechamiento del ganado y otros usos complementarios. Para que el productor local cuente con herramientas de manejo sustentable de sus recursos naturales es necesario generar información confiable para la zona. En ese contexto, se plantea la siguiente Hipótesis General: Existen alternativas de manejo que, aplicadas sobre los bosques del Espinal, permiten recuperar y conservar la biodiversidad a la vez que mejoran la rentabilidad del productor. El Objetivo General es diseñar y evaluar, en términos ecológicos, tecnológicos y socio-económicos, alternativas de manejo sustentable de bosques degradados del Espinal de la provincia de Córdoba tendientes a su recuperación y conservación. El proyecto se localizará en el bosque fragmentado del Campo Escuela de la FCA-UNC. Se establecerán parcelas con distintos niveles de cobertura arbustiva en las que se medirán el efecto de los arbustos sobre la regeneración de especies arbóreas deseables, la producción y calidad de la pastura, el crecimiento de los árboles y las condiciones edáficas del sistema. Además, la incidencia del ganado vacuno sobre la regeneración de especies arbóreas deseables, la riqueza y abundancia de especies forrajeras deseables y las condiciones edáficas del sistema. Se hará enriquecimiento con plantines de tres especies de Prosopis tanto en el bosque con distintos anchos de fajas como en suelo desmontado, para evaluar su comportamiento. También se probará la diseminación y establecimiento posterior de estas especies por medio de la ingesta del ganado vacuno. Se relevarán especies medicinales, aromáticas, melíferas, tintóreas y ornamentales nativas, y se las valorará económicamente según su uso actual y potencial en esta y otras zonas de la provincia y el país. Se efectuará la caracterización socio-económica y ambiental del área circundante al Campo Escuela y mediante encuestas se determinará el grado de valorización del bosque que tienen los pobladores zonales. Se realizará el análisis económico y financiero del sistema propuesto versus el sistema sin proyecto, considerando bienes producidos y servicios ambientales del bosque y se socializará el proyecto a través de encuestas y reuniones participativas con los productores zonales. Para el análisis de toda la información se usará el software INFOSTAT 2007. Se harán tablas y gráficos de estadística descriptiva para visualizar la distribución de datos. Se usará análisis de correlación, análisis de regresión lineal múltiple, ANAVA y test a posteriori. Se espera generar pautas preliminares de manejo, sencillas y económicas, fácilmente adoptables por los productores de la región, que aseguren la persistencia de estos fragmentos boscosos, relictos de la vegetación original del Espinal.

Application of chemicals on Ficus carica L. transplanted

This research deals with the effects of chemicals on, transplantation of Ficus carica L. cv. Roxo de Valinhos. Fig plants were sprayed with Transplantone (naphthaleneacetamide plusnaphtaleneacetic acid) 10 g/1 , Oed green (oxyethylene docosanol) 40 ml/1, Good-rite peps (polyethylene polysulfite) 0,6 ml/1, and Mobileaf 200 ml/1. A check treatment and aereduction to half of leaf area were also established. Reduction of leaf area and application of oxyethylene docosanol promoted higher plant survival. The chemicals did not affect the growth of transplanted plants. Auxins constituents of Transplantone increased leaf number of fig plants.

EVI antibodies in patients with Chagas' disease: relationship with anti-Trypanosoma cruzi immunoglobulins and effects of specific treatment

Antibodies against heart vascular structures and striated muscle cells interstitium (EVI antibodies) persist in Chagas' disease patients who had been cured by specific treatment as demonstrated by negative xenodiagnosis, conventional serology (CS) and complement mediated lysis (CoML). On the other hand, EVI antibodies are either present or absent in treated patients presenting positive CS but negative CoML. Since CoML detects antibodies associated to resistance, EVI antibodies are not likely to participate in the control of T. cruzi infections although they might be induced by cross-reacting antigens of heart cells and the parasite. They are neither necessarily related to antibodies responsible for CS. Absorption with T. cruzi and heart tissue confirms the suggestion that EVI antibodies are induced by a number of antigenic determinants, most from heart structures with a minor participation of T. cruzi antigens.

Conjunctival MALT lymphoma: utility of FDG PET/CT for diagnosis, staging, and evaluation of treatment response.

A 67-year-old woman was referred for staging of a mucosa-associated lymphoid tumor lymphoma involving the left conjunctiva. CT scan had shown paravertebral and pelvic masses, and a breast nodule. FDG PET/CT demonstrated moderately increased uptake in the left ocular conjunctiva and confirmed the paravertebral and pelvic masses and the breast nodule. Moreover, abnormal FDG uptake was shown in 2 breast nodules, the flank, the gluteus maximus, and the gastric cardia. The patient received 6 cycles of rituximab-bendamustine chemotherapy with a complete clinical and metabolic response at the 6-month follow-up PET/CT and remained relapse-free without visual acuity problem after a 36-month follow-up.

Experimental exposure of the blue mussel (Mytilus edulis, L.) to the toxic dinoflagellate Alexandrium fundyense: Histopathology, immune responses, and recovery

Mussels (Mytilus edulis) were exposed to cultures of the toxic dinoflagellate Alexandrium fundyense or the non-toxic alga Rhodomonas sp. to evaluate the effects of the harmful alga on the mussels and to study recovery after discontinuation of the A. fundyense exposure. Mussels were exposed for 9 days to the different algae and then all were fed Rhodomonas sp. for 6 more days. Samples of hemolymph for hemocyte analyses and tissues for histology were collected before the exposure and periodically during exposure and recovery periods. Mussels filtered and ingested both microalgal cultures, producing fecal pellets containing degraded, partially degraded, and intact cells of both algae. Mussels exposed to A. fundyense had an inflammatory response consisting of degranulation and diapedesis of hemocytes into the alimentary canal and, as the exposure continued, hemocyte migration into the connective tissue between the gonadal follicles. Evidence of lipid peroxidation, similar to the detoxification pathway described for various xenobiotics, was found; insoluble lipofuchsin granules formed (ceroidosis), and hemocytes carried the granules to the alimentary canal, thus eliminating putative dinoflagellate toxins in feces. As the number of circulating hemocytes in A. fundyense-exposed mussels became depleted, mussels were immunocompromised, and pathological changes followed, i.e., increased prevalences of ceroidosis and trematodes after 9 days of exposure. Moreover, the total number of pathological changes increased from the beginning of the exposure until the last day (day 9). After 6 days of the exposure, mussels in one of the three tanks exposed to A. fundyense mass spawned; these mussels showed more severe effects of the toxic algae than non-spawning mussels exposed to A. fundyense. No significant differences were found between the two treatments during the recovery period, indicating rapid homeostatic processes in tissues and circulating hemocytes.