Treatment of chronic hepatitis C in non-responsive patients with pegylated interferon associated with ribavirin and thalidomide: report of six cases of total remission

Hepatitis C virus (HCV) infection is an important public health issue worldwide. It is estimated that over 170 million people are infected with the virus. The present study reports six cases in which patients did not respond to combination therapy with pegylated interferon and ribavirin. However, after the addition of thalidomide to the therapy, the patients presented negative RNA PCR. The use of thalidomide combined with pegylated interferon and ribavirin for the treatment of hepatitis C is described here for the first time in the related literature.

Fatores associados às formas evolutivas graves da infecção crônica pelo vírus da hepatite C

Com o objetivo de descrever os fatores epidemiológicos e clínicos-laboratoriais e avaliar os fatores associados ao desenvolvimento de fibrose moderada e grave, realizou-se a revisão de 426 prontuários médicos de pacientes com infecção crônica pelo vírus da hepatite C, atendidos na Clínica de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, no período de 01/01 a 31/12/2000. Dos pacientes incluídos no estudo, 56,3% eram do sexo masculino e 43,7% do sexo feminino. A idade deles variou de 18 a 69 anos. A hemotransfusão foi a forma mais freqüente de transmissão do vírus da hepatite C, encontrada em 128 (30%) dos casos e em 187 (43,9%) pacientes não foi encontrado nenhum fator de risco. A distribuição dos pacientes quanto à alteração arquitetural visto na biópsia hepática foi: grau 0 (14,1%), grau 1 (51,2%), grau 2 (20,6%), grau 3 (8%) e grau 4 (6,1%). Na análise multivariada, encontramos associação positiva entre intensidade da fibrose e idade maior que 40 anos na data da biópsia hepática, níveis séricos de albumina abaixo do limite inferior normal, gama-glutamiltransferase maior ou igual a duas vezes o limite superior da normalidade, plaquetas em número menor que 150.000/mm³ e alta atividade necro-inflamatória. Os dados foram inconclusivos para testar a associação entre gravidade da fibrose e alcoolismo.

Importância da proteína C-reativa no diagnóstico e no prognóstico intra-hospitalar em pacientes com dor torácica na sala de emergência

OBJETIVO: Testar os valores diagnóstico e prognóstico imediatos da proteína C-reativa (PCR) nos pacientes admitidos na sala de emergência (SE) com dor torácica (DT) e sem elevação do segmento ST no eletrocardiograma (ECG). MÉTODOS: De janeiro de 2002 a dezembro de 2003, 980 pacientes consecutivos foram atendidos com DT suspeita de síndrome coronariana aguda na SE (idade = 64,9 ± 14,3 anos, homens = 55%, diabéticos = 18%, ECG normal = 84%). Dosou-se a PCR na admissão, a creatinofosfoquinase MB fração massa (CKMB) e a troponina I seriadas, além de se registrar ECG seriados. As medidas da PCR foram padronizadas (PCR-p) pelo valor do limite superior da normalidade (LSN) do teste utilizado (3,0 mg/L para a PCR de alta sensibilidade-PCR-AS e 0,1 mg/dl para PCR titulada-PCR-t). RESULTADOS: Foi diagnosticado infarto agudo do miocárdio (IAM) em 125 pacientes, e seus valores para a PCR-p foram 1,31 ± 2,90 (mediana = 0,47) versus 0,79 ± 1,39 (0,30) nos sem IAM (p = 0,031). A PCR-p > 1,0 apresentou sensibilidade de 30%, especificidade de 80,4%, valores preditivos positivo e negativo de 6,1% e de 96,7%, para o diagnóstico de IAM. Houve quarenta eventos cardíacos intra-hospitalares (óbitos = dezesseis, revascularizações de urgência = 22, IAM = dois). No 1º quartil da PCR-p (< 0,10) registraram-se três eventos, enquanto no 4º quartil (> 0,93) ocorreram quinze eventos (p = 0,003). Na regressão logística foram preditores independentes para eventos cardíacos a insuficiência ventricular esquerda, o sexo masculino e a PCR-p > 0,32, com razão de chances de 7,6, 2,8 e 2,2, respectivamente. CONCLUSÃO: Nos pacientes atendidos com DT na SE, a PCR-p: 1) Não foi um bom marcador de IAM, apesar de um valor normal praticamente afastar esse diagnóstico; 2) Um valor superior a um terço do seu limite superior da normalidade (LSN) (>1 mg/L da PCR-AS ou >0,33 mg/dl da PCR-t) foi preditor de eventos cardíacos adversos intra-hospitalares.

Food Co-ops Toolkit

More and more communities are setting up food co-ops so they can get good food atan affordable price and have more control over where their food comes from. Co-operation is all about two or more people joining forces and working together to achieve something they probably couldn't do on their own. In the case of food co-ops a group of people join forces in order to be able to buy foodsthey may otherwise find it hard to get hold of at aprice they can afford.By volunteering their time and pooling their buying power they cangetproducedirect from local farmers or wholesalers. This toolkit was produced as part of the Big Lottery fundedMaking Local Food Work programmeto help morecommunitiesset up their own food co-ops and buying groups.The Food Co-ops project has now ended but the toolkit and other resources will all remain on-line.To find moreabout food co-opsyou can visit our main website www.foodcoops.org

Preliminar evaluation of cytokines in the hepatitis C-schistosomiasis co-infection

Evaluation of hepatic fibrosis is usually performed by histopathological examination of biopsies. However, this is an invasive and potentially dangerous procedure. Several studies have proposed serum biological markers of hepatic fibrosis. This communication evaluates the use of serum cytokines as markers of hepatic fibrosis in hepatitis C, schistosomiasis, and co-infection.

Automatic low baseline stereo in urban areas

In this work we propose a new automatic methodology for computing accurate digital elevation models (DEMs) in urban environments from low baseline stereo pairs that shall be available in the future from a new kind of earth observation satellite. This setting makes both views of the scene similarly, thus avoiding occlusions and illumination changes, which are the main disadvantages of the commonly accepted large-baseline configuration. There still remain two crucial technological challenges: (i) precisely estimating DEMs with strong discontinuities and (ii) providing a statistically proven result, automatically. The first one is solved here by a piecewise affine representation that is well adapted to man-made landscapes, whereas the application of computational Gestalt theory introduces reliability and automation. In fact this theory allows us to reduce the number of parameters to be adjusted, and tocontrol the number of false detections. This leads to the selection of a suitable segmentation into affine regions (whenever possible) by a novel and completely automatic perceptual grouping method. It also allows us to discriminate e.g. vegetation-dominated regions, where such an affine model does not apply anda more classical correlation technique should be preferred. In addition we propose here an extension of the classical ”quantized” Gestalt theory to continuous measurements, thus combining its reliability with the precision of variational robust estimation and fine interpolation methods that are necessary in the low baseline case. Such an extension is very general and will be useful for many other applications as well.

Cracking and Seating to Retard Reflective Cracking - Hamilton County, HR-277, 1993

The crack and seat (C & S) method of rehabilitating concrete pavements has been proposed to reduce the incidence of reflective cracking in asphalt overlays. These cracked pieces help reduce the thermal effects on lateral joint movement while the seating of slab pieces reduces vertical movement. This 1986 project demonstrated that a 0.6 m x 0.9 m (2 ft x 3 ft) cracking pattern was optimal to retard reflective cracking in an asphalt overlay. The best performance among three C & S test sections was section 4 with a 0.6 m x 0.9 m (2 ft x 3 ft) cracking pattern and 7.6 cm (3 in) overlay. Structural ratings determined from the Road Rater™ indicated little difference between each C & S section with varying AC thicknesses and crack spacings. Although reflection cracking is reduced in the early years after construction, the effectiveness of the C & S method diminishes over time.

Investigation of Rapid Thermal Analysis Procedures for Prediction of the Service Life of PCCP Carbonate Coarse Aggregate: Phase I, Progress Report, HR-337, 1992

The major objective of this research project is to utilize thermal analysis techniques in conjunction with x-ray analysis methods to identify and explain chemical reactions that promote aggregate related deterioration in Portland cement concrete. The first year of this project has been spent obtaining and analyzing limestone and dolomite samples that exhibit a wide range of field service performance. Most of the samples chosen for the study also had laboratory durability test information (ASTM C 666, method B) that was readily available. Preliminary test results indicate that a strong relationship exists between the average crystallite size of the limestone (calcite) specimens and their apparent decomposition temperatures as measured by thermogravimetric analysis. Also, premature weight loss in the thermogravimetric analysis tests appeared to be related to the apparent decomposition temperature of the various calcite test specimens.

Palvelusopimukset tienpidon hankinnoissa

Infrarakentamisen toimintaympäristö on muuttumassa. Aikaisemmin julkinen sektori hallitsi toimialaa, mutta markkinat ovatavautumassa. Teknologian kehittäminen siirtyy julkiselta tilaajataholta yksityisille ja osaaminen yritysten kilpailutekijänä korostuu. Julkisen sektorin tehtävänä on luoda edellytyksiä tällaiselle toiminnalle. Toimintoja tullaan Tiehallinnossa ulkoistamaan yhä enemmän. Uusissa palvelusopimusmalleissa yhdistetään tieverkon tai tuotteen kunnon hallinta, toimenpiteiden ohjelmointi sekä palvelujen hankinta. Tästä muodostuu yhtenäinen prosessi, josta palvelun tuottaja vastaa. Nykyisin käytössä olevassa hankintamallissa edellä mainitut toiminnot on hajautettu useammalle eri vastuutaholle. Tämän työn tavoitteena on tarkastella palvelusopimusmallin soveltuvuutta hankintamenettelyjen eräänä vaihtoehtona. Lähtökohtana on tehdä ajallisesti pidempiä, sisällöllisesti laajempia sopimuksia. Palvelusopimusmallia voidaan soveltaa moniin hankintoihin. Tässä työssä tarkastellaan palvelusopimusmallia päällystetyn tieverkon ylläpidon hankinnassa. Uusien toimintatapojen käyttöönotossa on tärkeää saada alan toimijat yhdessä kehittämään näitä malleja. Työssä on haastateltu alan toimijoita ja heidän mielipiteet on otettu huomioon suunniteltaessa palvelusopimuksen sisältöä. Uusi sopimusmalli motivoi innovatiivisiin ratkaisuihin. Niiden syntymistä edesauttaa yritysten verkostomainen toiminatapa ja kumppanuuden syventäminen. Jokainen yritys voi tällöin keskittyä omaan ydinosaamiseensa. Samalla toimintojen kokonaistuottavuutta voidaan parantaa. Riskien hallinta on eräs tärkeimmistä asioista palvelusopimusmallin mukaisen toiminnan onnistumiselle. Riskien tunnistaminen ja niiden jakaminen eri osapuolten kesken oikeuden mukaisesti tulee sopimusmallissa hallita. Merkittävänä riskitekijöinä nousivat tässä työssä esiin, vaikeasti hallittavat, pitkän sopimusajan tuomat uhat.

Testing website usability in Spanish-Speaking Academia through heuristic evaluation and cognitive walkthroughs

Although usability evaluations have been focused on assessing different contexts of use, no proper specifications have been addressed towards the particular environment of academic websites in the Spanish-speaking context of use. Considering that this context involves hundreds of millions of potential users, the AIPO Association is running the UsabAIPO Project. The ultimate goal is to promote an adequate translation of international standards, methods and ideal values related to usability in order to adapt them to diverse Spanish-related contexts of use. This article presents the main statistical results coming from the Second and Third Stages of the UsabAIPO Project, where the UsabAIPO Heuristic method (based on Heuristic Evaluation techniques) and seven Cognitive Walkthroughs were performed over 69 university websites. The planning and execution of the UsabAIPO Heuristic method and the Cognitive Walkthroughs, the definition of two usability metrics, as well as the outline of the UsabAIPO Heuristic Management System prototype are also sketched.

Simultaneous determination of Cd and Pb in antibiotics used in sugar-cane fermentation process by GFAAS

A method has been developed for the simultaneous determination of Cd and Pb in antibiotics used in sugar-cane fermentation by GFAAS. The integrated platform of transversely heated graphite atomizer was treated with tungsten to form a coating of tungsten carbide. Six samples of commercial solid antibiotics were analyzed by injecting 20 µL of digested samples into the pretreated graphite platform with co-injection of 5 µL of 1000 mg L-1 Pd as chemical modifier. Samples were mineralized in a closed-vessel microwave-assisted acid-digestion system using nitric acid plus hydrogen peroxide. The pyrolysis and atomization temperatures of the heating program of the atomizer were selected as 600°C and 2200°C, respectively. The calculated characteristic mass for Cd and Pb was 1.6 pg and 42 pg, respectively. Limits of detection (LOD) based on integrated absorbance were 0.02 µg L-1 Cd and 0.7 µg L-1 Pb and the relative standard deviations (n = 10) for Cd and Pb were 5.7% and 8.0%, respectively. The recoveries of Cd and Pb added to the digested samples varied from 91% to 125% (Cd) and 80% to 112% (Pb).

Tiedon hallinta varastonhallintajärjestelmän hankinnassa

Diplomityössä toteutettiin varastonhallintajärjestelmän hankinta prosessoimalla tietoa hallitusti varastonhallinnan kehittämiseksi. Kvalitatiivinen tapaustutkimus tehtiin tietojohtamisen näkökulmasta käyttäjälähtöisen C-CEI –menetelmän avulla haastattelemalla ja havainnoimalla tapausyritystä. Haastatteluja tehtiin 10 kertaa. Tutkimuksessa kartoitettiin ja kilpailutettiin kotimaiset järjestelmätoimittajat, joita löydettiin 15. Näistä toimittajista 6 vastasi vaatimuksia ja teki tarjouksen. Tutkimuksen lopuksi tehtiin järjestelmän hankintaehdotus. Tutkimuksen teoreettinen viitekehys koostui tietojohtamisesta, varastonhallinnasta ja ohjelmistotuotannosta. Tutkimuksessa pääkysymyksenä esitettiin miten tietojohtamisen avulla voidaan tukea varastonhallintajärjestelmän hankintaa. Tutkimuksessa havaittiin, että tietojärjestelmän hankinta varastonhallinnan osalta on moniulotteinen liiketoiminnan kehittämistehtävä. Tietojärjestelmähankinta tulisi siten nähdä liiketoimintaa eteenpäin vievänä mahdollisuutena. Lisäksi loppukäyttäjän vaatimusten kartoittamiseen tulisi sitoutua huolella ja suhtautua kriittisesti eri järjestelmävaihtoehtoihin. Vaatimusmäärittelyn asettaminen ja vaatimusten priorisoiminen ovat haasteellisia tehtäviä. Tiedon hallinnan aikana saatiin selville, että loppukäyttäjän vaatimusten mukainen tarjouspyyntö edesauttaa ensinnäkin tarjousten tekemistä mutta myös niiden prosessointia ja analysointia. Vain oikealla tiedolla ja sen yhteyksillä on merkitystä. Tutkimuksen perusteella tietojärjestelmän hankinta suositellaan tehtäväksi hallitsemalla tietoa systemaattisesti erityisesti sen alkuvaiheen aikana. Tietojohtaminen virtaviivaistaa hankkeen etenemistä ja aikataulutusta, vähentää loppukäyttäjän kustannuksia tehokkaalla kilpailutusmenettelyllä, edistää kilpailukykyä ja luo hyvän lähtökohdan koko tietojärjestelmän hankinnan läpiviemiselle ja yhteistyö-suhteen rakentumiselle kauppakumppaneiden välille.

Kiinteistön elinkaarihankkeen rahoitus ja riskit

Julkisen sektorin kiinteistötuotannossa toteutetaan kasvavassa määrin julkisen ja yksityisen sektorin yhteistyötä, jossa yksityinen yritys ottaa vastuun kiinteistöön liittyvistä suunnittelu-, rakentamis- ja ylläpitotoimista pitkäksi ajanjaksoksi. Työn tavoitteena on arvioida elinkaarimallilla toteuttavien kiinteistöhankkeiden toteutusvaihtoehdot, sekä kartoittaa elinkaarihankkeen sisältämiä riskejä hankkeen suunnitteluvaiheessa. Tutkimus suoritetaan kvalitatiivisena tutkimuksena, jota tuetaan tarvittavilla kvantitatiivista tietoa hyödyntävillä laskelmilla. Tutkimusaineistona käytetään aihepiiriin liittyviä akateemisia julkaisuja ja oppikirjoja. Työn toimeksiantajan YIT:n kautta tutkimukseen on saatu arvokasta asiantuntemusta ja materiaalia. Elinkaarihankkeiden hankintamenettelyksi suositellaan kilpailullista neuvottelumenettelyä. Kilpailullinen neuvottelumenettely mahdollistaa tilaajan ja palveluntuottajien välisen dialogin hankintamenettelyn aikana, jolloin osapuolet voivat yhteistyössä valita sopivimman toteutusmallin. Hankkeiden rahoitus voidaan toteuttaa tilaajan rahoituksella tai yksityisrahoituksella. Rahoituksen näkökulmasta tilaajan oma rahoitus on edullisin, mikä ei kuitenkaan vähennä elinkaarimallista saatavia etuja perinteiseen urakointiin verrattuna. Laskelman perusteella tilaajan rahoituksen ja yksityisrahoituksen keskimääräisessä korkotasossa (WACC) on eroa 2,8 %. Projektiyhtiön perustaminen tekee rahoituksesta entistä kalliimpaa, koska taseeseen kohdistuviin kustannuksiin lisätään projektiyhtiön oman pääoman tuottovaatimusta vastaava korko. Palveluntuottajan kannalta olennaiset riskit ovat rakennusvaiheen viivästyminen, kiinteistön käytettävyyden ja soveltuvuuden puutteista aiheutuvat muutostyöt. Palvelumaksun sitominen huonosti ylläpidon todellista kulurakennetta kuvaavaan elinkustannusindeksiin tulee pitkällä sopimuskaudella vähentämään palveluntuottajan toiminnan kannattavuutta. Kiinteistön ylläpidon kustannusindeksi on vuosina 2005–2011 noussut 2,3 % nopeammin vuodessa kuin elinkustannusindeksi.

Effect of iron overload on the severity of liver histologic alterations and on the response to interferon and ribavirin therapy of patients with hepatitis C infection

The objective of the present study was to determine the presence of hepatic iron overload in patients with chronic HCV infection and to correlate it with histologic alterations, HCV genotype and response to therapy. Liver tissue samples from 95 patients with chronic hepatitis C were divided into two groups: group I, presence of iron overload in hepatic tissue (Perls' staining) and group II, no iron overload. Hepatic iron overload was detected in 30 (31.6%) of 95 patients. Of the 69 patients tested by genotyping, 49 (71.01%) were genotype 1 and 20 (28.99%) genotype non-1. Iron overload was detected in 14 (28.6%) patients with genotype 1 and in 6 (30%) with genotype non-1 (P = 0.906). There was a significant difference in fibrosis stage between groups (P = 0.005). In group I (N = 30), one patient had stage F0/F1 of fibrosis, while in group II (N = 65), 22 (33.8%) patients had minimal or no fibrosis. Fibrosis stage F2/F3 was observed in 70% of group I patients compared to 46.2% of group II. Eighty-five patients were treated with a combination of interferon and ribavirin; 29 of them (34.1%) had a sustained virologic response and 8 (27.6%) of them had hepatic iron overload. Iron overload was detected in 18 (32.1%) of the 56 non-responders (P = 0.73). Hepatic iron overload was frequent among patients with chronic hepatitis C and was associated with a more severe stage of liver fibrosis. There was no association between iron overload and HCV genotype and response to interferon and ribavirin therapy.

Prevalence of hepatitis C virus (HCV) infection and HCV genotypes of hemodialysis patients in Salvador, Northeastern Brazil

Hepatitis C virus (HCV) infection has been identified as the major cause of chronic liver disease among patients on chronic hemodialysis (HD), despite the important reduction in risks obtained by testing candidate blood donors for anti-HCV antibodies and the use of recombinant erythropoietin to treat anemia. A cross-sectional study was performed to estimate the prevalence of HCV infection and genotypes among HD patients in Salvador, Northeastern Brazil. Anti-HCV seroprevalence was determined by ELISA in 1243 HD patients from all ten different dialysis centers of the city. HCV infection was confirmed by RT-PCR and genotyping was performed by restriction fragment length polymorphism. Anti-HCV seroprevalence among HD patients was 10.5% (95% CI: 8.8-12.3) (Murex anti-HCV, Abbott Murex, Chicago, IL, USA). Blood samples for qualitative HCV detection and genotyping were collected from 125/130 seropositive HD patients (96.2%). HCV-RNA was detected in 92/125 (73.6%) of the anti-HCV-positive patients. HCV genotype 1 (77.9%) was the most prevalent, followed by genotype 3 (10.5%) and genotype 2 (4.6%). Mixed infections of genotypes 1 and 3 were found in 7.0% of the total number of patients. The present results indicate a significant decrease in anti-HCV prevalence from 23.8% detected in a study carried out in 1994 to 10.5% in the present study. The HCV genotype distribution was closely similar to that observed in other hemodialysis populations in Brazil, in local candidate blood donors and in other groups at risk of transfusion-transmitted infection.