Chronic hepatitis C: hepatic iron content does not correlate with response to antiviral therapy

The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia and parenteral iron therapy were excluded. The iron related markers and HIC were compared between those who achieved an SVR and non-responders (NR) patients. The mean age was 45.7 years and the proportion of patients' gender was not different between SVR and NR patients. The median serum iron was 138 and 134 µg/dL (p = 0.9), the median serum ferritin was 152.5 and 179.5 ng/mL (p = 0.87) and the median HIC was 9.9 and 8.2 µmol/g dry tissue (p = 0.51), for SVR and NR patients, respectively. Thus, hepatic iron concentration, determined by a reliable quantitative method, was not a negative predictive factor of SVR in patients with chronic hepatitis C presenting mild to moderate hepatic iron accumulation.

Acute pancreatitis associated with acute viral hepatitis: case report and review of literature

This case report, along with the review presented, describes a patient diagnosed with acute viral hepatitis, who developed a framework of intense abdominal pain and laboratorial alterations compatible with acute pancreatitis. The association of acute pancreatitis complicating fulminant and non-fulminant acute hepatitis virus (AHV) has been reported and several mechanisms have been proposed for this complication, but so far none is clearly involved. As acute hepatitis is a common disease, it is important to stimulate the development of other studies in order to determine local incidence and profile of patients presenting this association in our environment.

Hepatitis C virus genotypes in hemodialysis patients in the Federal District, Brazil

Hepatitis C virus (HCV) genotypes and subtypes were determined in hemodialysis patients in the Federal District, Brazil, by sequencing of the 5' noncoding (NC) and nonstructural 5B (NS5B) regions. From 761 patients, 66 anti-HCV-positive samples were tested for HCV RNA. All 51 HCV RNA-positive samples by PCR of the 5' NC region were genotyped as genotypes 1 (90.2%) and 3 (9.8%). Subtype 1a (82.3%) was the most prevalent, followed by subtypes 3a (9.8%), 1b (5.9%) and 1a/1b (2.0%). Forty-two samples could be amplified and genotyped in the NS5B region: 38 (90.5%) as genotype 1, subtypes 1a, and 8 (9.5%) as genotype 3, subtype 3a. For the 42 samples sequenced in both regions, the genotypes and subtypes determined were concordant in 100% and 95.2% of cases, respectively. Two samples presented discrepant results, with the 5' NC region not distinguishing correctly the subtypes 1a and 1b. These findings indicate that the HCV genotype 1, subtype 1a, is the most prevalent among hemodialysis patients in the Federal District, Brazil.

The effects of the experimental infection from a focus of transmission of Schistosoma mansoni in a population of Biomphalaria tenagophila (D'Orbigny, 1835) in the region of "Vale do Ribeira de Iguape", Brazil

To observe the effects of the parasitic infection on the biology of B. tenagophila, field and laboratory populations of this mollusk from Itariri, in Vale do Ribeira, Brazil, were experimentally infected. Each mollusk received 10 miracidia of Schistosoma mansoni (SJ lineage) and was observed throughout the parasite's development. The biological variables were compared according to the criteria "group" and "infectious phase". The main damage caused by the parasitic infection manifested itself in reproduction, longevity and lesions on the shell of the mollusks in the patent phase. An infection rate of 58.8% was observed. Microanatomical study of the mollusk's digestive gland and ovotestis revealed the presence of evolving larval forms and cercariae. It was concluded that the effects of the parasitic infection on both populations were moderate, despite the low survival rate of the infected mollusks, the damage did not prevent either reproduction or the elimination of cercariae, which continued for a long time.

A real-time quantitative assay for hepatitis B DNA virus (HBV) developed to detect all HBV genotypes

Hepatitis B virus (HBV) is a major cause of chronic liver disease worldwide. Besides genotype, quantitative analysis of HBV infection is extensively used for monitoring disease progression and treatment. Affordable viral load monitoring is desirable in resource-limited settings and it has been already shown to be useful in developing countries for other viruses such as Hepatitis C virus (HCV) and HIV. In this paper, we describe the validation of a real-time PCR assay for HBV DNA quantification with TaqMan chemistry and MGB probes. Primers and probes were designed using an alignment of sequences from all HBV genotypes in order to equally amplify all of them. The assay is internally controlled and was standardized with an international HBV panel. Its efficacy was evaluated comparing the results with two other methods: Versant HBV DNA Assay 3.0 (bDNA, Siemens, NY, USA) and another real-time PCR from a reference laboratory. Intra-assay and inter-assay reproducibilities were determined and the mean of CV values obtained were 0.12 and 0.09, respectively. The assay was validated with a broad dynamic range and is efficient for amplifying all HBV genotypes, providing a good option to quantify HBV DNA as a routine procedure, with a cheap and reliable protocol.

Frequency of hepatitis B immunity and occupational exposures to body fluids among brazilian medical students at a public university

In the present study the frequencies of immunity against hepatitis B (HB) and of potentially contaminating accidents among medical students of a Brazilian public university were evaluated. Of all the 400 students who should have been immunized, 303 (75.7%), 66.3% of whom were women, answered an anonymous, self-administered questionnaire. Serum anti-HBs were determined in 205 of them and titers > 10 UI/L were considered to be protective. A total of 86.8% of students had received three doses of HB vaccine. The frequency of immunity among women (96.4%) was higher (p = 0.04) than that among men (87.7%). Among those who did not have immunity, 12/13 (92.3%) had been vaccinated before entering medical school. Only 11% of the students with complete vaccination had previously verified serological response to the vaccine. A total of 23.6% reported having been somehow exposed to blood or secretions. Among final-year students, this frequency was 45.0%, being similar among men (47.8%) and women (43.2%). Of all these accidents, 57.7% were due to body fluids coming in contact with mucosa and 42.3% due to cut and puncture accidents. The results from this study show that: 1) the frequency of immunity against HB is high among the evaluated medical students, although verification of response to vaccination is not a concern for them; 2) anti-HBs titers should be verified after complete vaccination and on a regular basis, especially by men; and 3) the frequency of potentially contaminating accidents is high.

Ethno-pragmatique et prosodie. Présentation d'une hypothèse de recherche pluridisciplinaire dans le domaine des sciences du langage et de la culture

L'hypothèse de recherche que nous souhaitons vous présenter ici a pour objet l&s fonctions pragmatiques de Ia prosodie. L'ensemble de notre Projet de Recherche s'organise en effet autour d'une seule (mais fondamentale) hypothèse de travail: c'est dans et par Ia prosodie que pour Vessentiel le langage contribue activement à Ia construction du lien social. La formulation de cette hypothèse resulte des travaux que nous avons menés dans le champ de FAnthropologie des rites, étudiés dans une perspective sémiologique (au sens large), visant à mieux saisir dans quelle mesure et selon quelles modalités, dans et par le rite, Vordre du signe est signe de 1'ordreK Le rite constitue un système complexe de comrpunication symbolique qui contribue en effet activement à definir sur le plan sémantique et à structurer sur le plan dramaturgique les situations d'interaction sociale.

Demographic and Clinical Characteristics of Human Immunodeficiency Virus-Infected Patients Receiving Dialysis in Portugal: a Nationwide Multicentre Survey

Background: Data on human immunodeficiency virus (HIV) infected patients receiving dialysis in Portugal is scarce. Methods: This nationwide epidemiological survey retrospectively evaluates HIV-infected patients on chronic dialysis in Portugal between 1997 and 2002. Results: Sixty-six patients were evaluated (mean age: 39.1±1.6 years, 47 men, 35 black African). Sixty-two patients started dialysis and 4 patients who were receiving dialysis had HIV seroconversion. Eighty-five percent of patients were treated in Lisbon. The annual incidence of HIV-infected patients on chronic dialysis was 0.5% in 1997 and 0.9% in 2002. Seventy-eight percent of patients were HIV-1 infected , 13% had hepatitis B and 31% hepatitis C. Sexual contact was the mode of transmission of HIV in 53% of cases. Four patients had biopsy-proved HIV-associated nephropathy. Ninety-five percent of patients were on chronic hemodialysis. Fifty percent of patients had acquired immunodeficiency syndrome. At follow-up, 12 patients died. HIV-infected CKD patient survival after starting dialysis was 80% at 3 years. Conclusion: The incidence of HIV-infected patients on chronic dialysis in Portugal has almost doubled. Widespread use of highly active antiretroviral therapy and the increasing number of black Africans from former overseas Portuguese colonies now living in Portugal are possible reasons for this large increase.

Seroprevalence of hepatitis B and C infection markers among children and adolescents in the southern Brazilian region

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases worldwide. The aim of this study was to determine the prevalence of HBV and HCV serological markers among children and adolescents and verify the epidemiology of the HBV infection over than a decade of the introduction of vaccination program. Serologic markers to HBsAg, total anti-HBc and anti-HCV had been tested in 393 samples. The seropositivity for HBsAg was 0.76% and for total anti-HBc was 1.02%. Copositivity between HBsAg and total anti-HBc was verified in 0.76% of the analyzed samples. There was no seropositivity for anti-HCV marker. The seroprevalence of HBV infection markers among children and adolescents in the southern Brazilian region is high compared to that reported in other countries. Preventive measures, such as educational activities in addition to the universal childhood HBV vaccination, should be initiated in order to reduce the morbimortality and the economic burden associated with the disease.

Divertículo da Uretra no Serviço de Cirurgia Pediátrica do Hospital D. Estefânia

Os autores apresentam uma revisão de casos clínicos de crianças, do Serviço de Cirurgia Pediátrica do Hospital D. Estefânia (HDE), com o diagnóstico de divertículo da uretra (DU) num período compreendido entre 1999 e 2005. Foram encontradas 5 crianças com este diagnóstico, 4 do sexo masculino e uma do sexo feminino, com idades (na altura do diagn óstico) compreendidas entre 6º dia de vida e os 11 anos. As primeiras manifestações clínicas incluíam infecções urinárias de repetição, hidronefrose bilateral com alterações da função renal, diminuição da força e calibre do jacto urinário e hematúria total. O diagnóstico foi feito por uretrocistografia permiccional (UCGPM) em três casos e uretroscopiaemdois. Em três casos optou-se por ressecção da porção distal do divertículo. Noutra criança optou-se por espera vigilante, tendo-se efectuado uretrografias periódicas para verificar a variação de volume do díverticulo. A uretroplastia com retalho perineal foi opção terapêutica para uma criança com DU congénito volumoso e obstrução ao esvaziamento vesical muito grave. Quer nas crianças em que se optou pela espera vigilante, quer nas que foram submetidas a tratamento cirúrgico, os resultados foram, globalmente bons: todas as crianças foram capazes de urinar com jacto normal no pós-operatório imediato, a função renal retomou a normalidade nas crianças em que se verificava elevação pré-operatória dos níveis séricos de creatinina e todas as crianças se encontram assintomáticas desde há nove meses.

Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela

Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

Coma Hipocalcémico por Hipervitaminose D

A intoxicação pela vitamina D é uma causa bem conhecida de hipercalcémia e hiperfosfatemia. Nos casos de intoxicação crónica, quando o produto fosfocálcico é superior a 60 mg2/dl2, verifica-se a deposição de cristais de fosfato de cálcio, nos tecidos moles, com subsequente hipocalcémia. Apresenta-se o caso de uma lactente de três meses de idade, com antecedentes pessoais irrelevantes, internada na Unidade de Cuidados Intensivos Pediátricos, por tetania e coma resultante da intoxicação crónica acidental pela vitamina D, desde os dez dias de vida. Apresentava hipocalcémia (cálcio total 4,44mg/dl e cálcio ionizado 0,45 mg/dl) e hiper-fosfatémia (fósforo 17,8 mg/dl) grave, sendo o produto fosfocálcico de 79 mg2/dl2. A intoxicação pela vitamina D e hipocalcémia paradoxal foi confirmada pelo doseamento de 1,25-vitamina D.

A rainha D. Beatriz e a sua casa (1293-1359)

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Doutor em História, na área de especialidade de História Medieval

La construction de l'europe sociale entreprises, territoires, circulation de main d'oeuvre

The building of social Europe: companies, territories, movement of the workforce. For ten years, companies have been obliged to standardize the quality of their products interaationally, which goes along with a dismantling of the landmarks of the territories of political action in France. This article presents some current research about the movement of the labour force in Europe and raise the issue of coordination between the different legitimate categories and the attitude of the various administrations (work, health) concemed by this phenomenon.