Influence of human t-cell lymphotropic virus type 1 (HTLV-1) Infection on laboratory parameters of patients with chronic hepatitis C virus

Hepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) share routes of transmission and some individuals have dual infection. Although some studies point to a worse prognosis of hepatitis C virus in patients co-infected with HTLV-1, the interaction between these two infections is poorly understood. This study evaluated the influence of HTLV-1 infection on laboratory parameters in chronic HCV patients. Twelve HTLV-1/HCV-coinfected patients were compared to 23 patients infected only with HCV, in regard to demographic data, risk factors for viral acquisition, HCV genotype, presence of cirrhosis, T CD4+ and CD8+ cell counts and liver function tests. There was no difference in regard to age, gender, alcohol consumption, smoking habits, HCV genotype or presence of cirrhosis between the groups. Intravenous drug use was the most common risk factor among individuals co-infected with HTLV-1. These patients showed higher TCD8+ counts (p = 0.0159) and significantly lower median values of AST and ALT (p = 0.0437 and 0.0159, respectively). In conclusion, we have shown that HCV/HTLV-1 co-infected patients differs in laboratorial parameters involving both liver and immunological patterns. The meaning of these interactions in the natural history of these infections is a matter that deserves further studies.

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 ��g/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 ��mol/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.

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.

Imunodefici��ncia Combinada Grave ��� O Diagn��stico Precoce �� Importante?

Introdu����o: Os doentes com Imunodefici��ncia Combinada Grave (SCID) n��o diagnosticados evoluem inexoravelmente para a morte no primeiro ano de vida. Um elevado ��ndice de suspei����o �� fundamental para o diagn��stico precoce, o factor mais importante para a sobrevida destas crian��as. Objectivo: Apresentam-se tr��s casos cl��nicos ilustrativos da import��ncia da precocidade diagn��stica no prognóstico final. Casos cl��nicos: Caso cl��nico 1: Lactente do sexo masculino, com antecedentes de infec����es respirat��rias de repeti����o, internado aos sete meses na UCIP do HDE por pneumonia a Adenov��rus com insufici��ncia respirat��ria. Necessitou de ventila����o mec��nica e de duas transfus��es de concentrado eritrocit��rio na primeira semana de internamento. Teve exantema exuberante, interpretado como toxidermia. Evoluiu para doen��a pulmonar sequelar grave. Aos nove meses foi feito o diagn��stico de SCID hipomorfa com doen��a do enxerto contra o hospedeiro p��s-transfusional, controlada com imunossupress��o (ciclosporina e glucocorticoides). N��o foi transplantado com c��lulas progenitoras hematopoi��ticas por n��o reunir condi����es cl��nicas. Na sequ��ncia de uma intercorr��ncia respirat��ria veio a falecer aos 14 meses. Caso cl��nico 2: Lactente do sexo masculino, internado aos 6 meses no HDE por pneumonia intersticial hipoxemiante. Isolado P. jiroveci no lavado bronco-alveolar e feito o diagn��stico presuntivo de BCGite disseminado em crian��a com SCID T-B+NK-. Ap��s estabiliza����o cl��nica e esplenectomia foi transplantado com c��lulas progenitoras hematopoi��ticas de dador fenoid��ntico n��o aparentado. Dada a BCGite disseminada necessitou de v��rios ciclos de infus��o de c��lulas do dador para uma reconstitui����o imunit��ria lenta e progressiva. Seis meses p��s-transplante est�� clinicamente bem, com quimerismo linf��ide T e NK completo. Caso cl��nico 3: Lactente do sexo masculino, internado aos 17 dias de vida por infec����o respirat��ria alta e bacteri��mia a M. catarrhalis. Reinternado quinze dias depois por s��psis a MRSA e linfop��nia. A avalia����o efectuada permitiu o diagn��stico de SCID T-B+NK- por defeito na cadeia gamma comum. Transplantado com c��lulas progenitoras hematopoi��ticas de dador genoid��ntico aos 4 meses, sem condicionamento. Clinicamente bem, seis meses p��s-transplante, com reconstitui����o imunit��ria satisfat��ria. Conclus��o: Esta doen��a tem uma preval��ncia n��o negligenci��vel e apenas com elevado indice de suspei����o se pode estabelecer um plano de tratamento eficaz.

Um Caso de Sucesso no Tratamento Concomitante de Rotura de Aneurisma Intracraniano e Aneurisma Visceral

A associa����o entre aneurismas intracranianos e viscerais �� extremamente rara, com mau prognóstico. A situa����o de rotura surge habitualmente no contexto de urg��ncia e implica um tratamento imediato. Relata-se o caso de uma doente com rotura de aneurisma da art��ria comunicante anterior e da art��ria pancreaticoduodenal anterior. A actua����o concertada das v��rias especialidades permitiu a abordagem cir��rgica dirigida ao aneurisma visceral, sem o agravamento da hemorragia cerebral que a eventual clampagem da Art��ria Aorta poderia provocar. A manuten����o da estabilidade hemodin��mica foi essencial para a posterior realiza����o de emboliza����o do aneurisma intracraniano.

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.

In vitro and in vivo antileishmanial efficacy of a combination therapy of diminazene and artesunate against Leishmania donovani in BALB/c mice

The in vitro and in vivo activity of diminazene (Dim), artesunate (Art) and combination of Dim and Art (Dim-Art) against Leishmania donovani was compared to reference drug; amphotericin B. IC50 of Dim-Art was found to be 2.28 �� 0.24 ��g/mL while those of Dim and Art were 9.16 �� 0.3 ��g/mL and 4.64 �� 0.48 ��g/mL respectively. The IC50 for Amphot B was 0.16 �� 0.32 ��g/mL against stationary-phase promastigotes. In vivo evaluation in the L. donovani BALB/c mice model indicated that treatments with the combined drug therapy at doses of 12.5 mg/kg for 28 consecutive days significantly (p < 0.001) reduced parasite burden in the spleen as compared to the single drug treatments given at the same dosages. Although parasite burden was slightly lower (p < 0.05) in the Amphot B group than in the Dim-Art treatment group, the present study demonstrates the positive advantage and the potential use of the combined therapy of Dim-Art over the constituent drugs, Dim or Art when used alone. Further evaluation is recommended to determine the most efficacious combination ratio of the two compounds.

Prognostic Factors in Adult Patients with Idiopathic IgA Nephropathy

Introduction. IgA nephropathy is the dominant primary glomerular disease found throughout the majority of the world���s developed countries. Accurately identifying patients who are at risk of progressive disease is challenging. We aimed to characterise clinical and histological features that predict poor prognosis in adults. Patients and Methods. We performed a single-centre retrospective observational study of biopsy-proven IgA nephropathy. The primary outcome was renal survival and death from any cause, and the secondary outcome was proteinuria remission. Results. Data from 49 cases were available for analysis with a median follow-up of 4 years. There were no deaths. Univariable analyses identified acute renal failure, low estimated glomerular filtration rate for ���3 months (low eGFR), arterial hypertension, baseline proteinuria, glomerular sclerosis >50% and interstitial fibrosis >50% as poor prognostic markers. Low eGFR persisted significant by multivariable model that used only clinical parameters. Multivariable models with histopathologic parameters observed that tubular atrophy/interstitial fibrosis >50% was independently associated with the primary outcome. Proteinuria remission throughout follow-up had no prognostic value in our revision. Conclusions. Two independent predictors of poor renal survival at time of biopsy were found: low eGFR and tubular atrophy/interstitial fibrosis >50%.

Evaluation of GBV-C / HVG viremia in HIV-infected women

The present study aimed at standardizing a real-time quantitative polymerase chain reaction assay to evaluate the presence of GBV-C/HGV RNA. A "TaqMan" assay using primers and probe derived from the 5�� NCR region was developed and validated. Two hundred and fifty-three plasma samples from HIV-infected women were tested for GBV-C viremia and antibody against the envelope protein 2. GBV-C RNA was detected in 22.5% of the patients whereas the antibody was identified in 25.3% of the cohort. Detection of viral RNA and of antibodies was mutually exclusive. Viral loads showed a mean of 1,777 arbitrary units / mL, being 1.1 and 13,625 arbitrary units / mL respectively the lowest and highest values measured. We conclude that the real-time quantitative polymerase chain reaction method developed is appropriate for the investigation of GBV-C RNA since it was shown to be highly specific and sensitive, as well as requiring few steps, preventing contamination and providing additional information as to the relative viremia of carriers, a parameter that must be included in studies evaluating the co-factors influencing the clinical outcome of HIV/AIDS.

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.

Fasce��te Necrosante P��s Varicela

A fasce��te necrosante �� uma infec����o pouco frequente, caracterizada por um envolvimento rapidamente progressivo das fascias e tecido celular subcut��neo. Os AA apresentam tr��s casos cl��nicos de fasce��te necrosante que t��m como caracter��sticas comuns: antecedentes pr��ximos de varicela, sinais inflamat��rios repidamente progressivos com marcado ��lgico, compromisso sist��mico sugestuvo de s��ndrome de choque t��xico e isolamento de Streptococcus beta - hemol��tico do grupo A (dois dos tr��s casos): Um precoce diagn��stico diferencial com celulite, antibioterapia de largo espectro, suporte hemodin��mico intensivo e, sobretudo, r��pido e extenso desbridamento cir��rgico, s��o determinantes fundamentais no prognóstico desta patologia, com elevada mortalidade.

Miopatia Miotubular Ligada ao Cromossoma X - Caso Cl��nico

Introdu����o:A miopatia miotubular ligada ao cromossoma X e uma miopatia cong��nita grave neonatal que afecta o sexo masculino, com prognóstico reservado. Relato de Caso: Lactente com hipotonia generalizada grave detectada ap��s o nascimento, atrofia muscular generalizada e aboli����o dos reflexos osteotendinosos, cujo estudo etiol��gico espec��fico (bi��psia muscular e estudo de gen��tica molecular) revelo tratar-se de miopatia miotubular ligada ao cromossoma X. Internado em Unidade de Cuidados Intensivos at�� aos oito meses, foi submetido a traqueostomia e gastrotomia, tendo alta para domic��lio. Faleceu aos dez meses, subitamente, de causa indeterminada. Discuss��o: Este caso mostra que, apesar da terap��utica actual ser apenas paliativa, a import��ncia do conhecimento do mecanismo gen��tico �� enorme, abrindo novos horizontes para uma terapia g��nica no futuro.

A guerra numa sociedade democr��tica em crise: Atenas no final do S��c. V a.C.

Falar sobre a Guerra do Peloponeso �� falar sobre a guerra que dividiu a Gr��cia, opondo Esparta e Atenas, com conseq����ncias grav��ssimas para esta ��ltima cidade. Simultaneamente, foi o fim da mais conhecida experi��ncia democr��tica da antiga Gr��cia. No entanto, o nosso objectivo n��o �� falar sobre essa experi��ncia, ou sobre as conseq����ncias da Guerra do Peloponeso, mas sobre o modo como ela foi encarada pelos Atenienses. Importa, em primeiro lugar, recordar a situa����o de Atenas no in��cio da guerra, o que significa ter em conta dois aspectos: a estrutura pol��tica de Atenas e o seu dom��nio mar��timo. Desde S��lon e das suas reformas, que Atenas caminhava no sentido da consolida����o de uma estrutura pol��tica que respeitasse os direitos dos seus cidad��os e o aumento da sua participa����o nos ��rg��os deliberativos da polis. Em 462 a.C, Efialtes (com o apoio de P��ricles) reduziu os poderes do Are��pago, privando-o de quaisquer fun����es legislativas e judiciais e deixando- -Ihe apenas o direito de superintender nos casos de homic��dio e nos delitos de caracter religioso. Na verdade, Efialtes e P��ricles consideravam que, sendo o Are��pago constitu��do por membros vital��cios provenientes das classes mais elevadas, a concentra����o nele de tais poderes judici��rios era contr��ria ao esp��rito democr��tico, afastando assim da constitui����o ateniense os ��ltimos vestigios de privil��gios da aristocracia.

��ndice Proliferativo Ki-67 no Cancro G��strico

Introdu����o: O cancro g��strico representa ainda uma das principais causas de mortalidade por doen��a oncol��gica a n��vel mundial, apesar da evolu����o substancial no seu tratamento. Diversos marcadores biol��gicos t��m sido introduzidos com intuito prognóstico da doen��a. A prote��na Ki-67 atrav��s de t��cnicas imunocitoqu��micas tem sido utilizada como um indicador da actividade proliferativa tumoral. No cancro g��strico o seu valor prognóstico ainda n��o foi estabelecido, sendo os resultados na literatura controversos. Este estudo pretende avaliar o significado biol��gico do ��ndice proliferativo Ki-67 no cancro g��strico. M��todos: Foram estudados 50 doentes com cancro g��strico submetidos a cirurgia ressectiva. A prote��na Ki-67 foi analisada por imunocitoqu��mica nas pe��as operat��rias. O ��ndice proliferativo Ki-67 foi definido como a percentagem de c��lulas tumorais positivas para a prote��na. Resultados: Dos 50 casos estudados foi obtido um ��ndice proliferativo Ki-67 de 68.9 �� 24.1%. Foram correlacionadas as vari��veis sexo, idade, localiza����o e dimens��o tumoral, classifica����o TNM, estadio e tipo histol��gico de Lauren. Apenas esta ��ltima revelou diferen��as estatisticamente significativas entre os respectivos tipos (P = 0.004). Conclus��o: Os achados encontrados n��o permitem definir inequivocamente o valor prognóstico do ��ndice proliferativo Ki-67. Ser�� importante prosseguir o estudo com uma amostra populacional superior, para que conclus��es estatisticamente significativas possam ser elaboradas.