Atualização das Recomendações da Sociedade Brasileira de Hepatologia para o Tratamento Sistêmico do Carcinoma Hepatocelular / Brazilian society of hepatology updated recommendations for systemic treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC.

Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity: A joint position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Hepatology (SBH), and Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso)

ABSTRACT Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity.

Dinâmica da água em áreas de recarga de nascentes em dois ambientes na Região Alto Rio Grande, Minas Gerais / Water dynamics in springs recharge areas in two environments in the alto Rio Grande Region, Minas Gerais

RESUMO Apesar da importância da água na Terra, pouco se conhece sobre sua dinâmica no solo e, consequentemente, poucas são as informações sobre sua preservação em quantidade e qualidade. Diante disso, objetivou-se, neste trabalho, gerar informações que dessem subsídio ao entendimento da dinâmica da água no solo em áreas de recarga de nascentes. Para tanto, realizou-se o monitoramento da vazão e da precipitação nas áreas de recarga de duas pertencentes, verificando a relação existente entre os atributos físico-hídricos do solo intimamente relacionados à recarga subterrânea, além das características pedológicas, do uso do solo, da cobertura vegetal e da declividade. Os resultados mostraram que a sinalização de que os Cambissolos apresentam maior capacidade de infiltração e, consequentemente, recarga, em relação aos Latossolos, não se confirmou neste trabalho. Mesmo havendo uma grande discrepância nas classes de relevo entre as áreas de recarga das nascentes, esse efeito não foi suficiente para reduzir o processo de recarga. As condições de uso do solo não foram substancialmente diferentes a ponto de influenciar o processo de infiltração. O grande diferencial entre as áreas de recarga das nascentes em relação à capacidade de gerar deflúvio base se explica pelos atributos físico-hídricos e pelo índice pluviométrico, que, neste caso, resultaram em uma associação mais efetiva na área da nascente L1. A elevada capacidade de retenção de água no Latossolo, reflexo da maior microporosidade associada a sua maior profundidade, é uma característica desfavorável para o processo de recarga quando comparado ao Cambissolo, que tem horizonte B incipiente e menores profundidades.

ABSTRACT Despite the importance of water on earth, little is known about its dynamics in the soil, and consequently, there is little information about its preservation in quantity and quality. Therefore, the objective of this research was to generate information to support the understanding of water dynamics in soil springs in recharge areas. Thus, we carried out monitoring flow and precipitation in the areas of two belonging clearance, verifying the relationship between the physical and water attributes of the soil closely related to groundwater recharge, in addition to soil characteristics, land use, cover vegetation and slope. The results showed that the signaling that Cambisoils have higher infiltration capacity and consequently clearance in relation to Latosols was not confirmed in this study. Even though there is a large discrepancy in relief classes between the recharge areas of springs, this effect was not sufficient to reduce the recharge process. Land use conditions were not substantially different as to influencing the infiltration process. The big difference between the recharge areas of the springs on the ability to generate runoff base is explained by physical-water attributes and rainfall, which in this case resulted in a more effective association in the area of ​​spring L1. The higher water retention capacity of the Oxisol, reflecting the higher microporosity associated with its greater depth, is an unfavorable feature for the recharge process, when compared to Inceptisol, which has an incipient B horizon and lower depths.

Hepatite C no sistema público de saúde brasileiro: impacto da doença / Hepatitis c in the brazilian public health care system: burden of disease

ABSTRACT BACKGROUND: Infection by hepatitis C virus is one of the leading causes of chronic hepatitis C and cause severe burden for patients, families and the health care system. OBJECTIVE: The aims of this research were to assess the severity of liver fibrosis, comorbidities and complications of hepatitis C virus; to examine health-related quality of life (HRQoL), productivity loss and resource use and costs in a sample of Brazilian chronic hepatitis C, genotype 1, patients. METHODS: This was a cross-sectional multicenter study performed in genotype-1 chronic hepatitis C patients to assess disease burden in the Brazilian public health care system between November 2014 and March 2015. Patients were submitted to a liver transient elastography (FibroScan) to assess liver fibrosis and answered an interview composed by a questionnaire specifically developed for the study and three standardized questionnaires: EQ-5D-3L, HCV-PRO and WPAI:HepC. RESULTS: There were 313 subjects enrolled, with predominance of women (50.8%), caucasian/white (55.9%) and employed individuals (39.9%). Mean age was 56 (SD=10.4) years old. Moreover, 42.8% of patients who underwent FibroScan were cirrhotic; the most frequent comorbidity was cardiovascular disease (62.6%) and the most frequent complication was esophageal varices (54.5%). The results also showed that "pain and discomfort" was the most affected HRQoL dimension (55.0% of patients reported some problems) and that the mean HCV-PRO overall score was 69.1 (SD=24.2). Regarding productivity loss, the most affected WPAI:HepC component was daily activity (23.5%) and among employed patients, presenteeism was more frequent than absenteeism (18.5% vs 6.5%). The direct medical costs in this chronic hepatitis C sample was 12,305.72USD per patient in the 2 years study period; drug treatment costs represented 95.9% of this total. CONCLUSION: This study showed that most patients are cirrhotic, present high prevalence of cardiometabolic diseases and esophageal varices, reduced HRQoL mainly in terms of pain/discomfort, and work productivity impairment, especially presenteeism. Additionally, we demonstrated that hepatitis C virus imposes an economic burden on Brazilian Health Care System and that most of this cost is due to drug treatment.

RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (HCV) é uma das principais causas de hepatite C crônica e provoca implicações graves para pacientes, familiares e sistema de saúde. OBJETIVO: Os objetivos deste estudo foram: analisar a gravidade da fibrose hepática, comorbidades e complicações da hepatite C; examinar a qualidade de vida relacionada à saúde (QVRS), a perda de produtividade e o uso de recursos e custos no sistema público por pacientes brasileiros com hepatite C crônica, genótipo tipo 1. MÉTODOS: Foi realizado um estudo transversal, multicêntrico em pacientes com hepatite C crônica genótipo-1 para avaliar a carga da doença no sistema público de saúde brasileiro entre novembro de 2014 e março de 2015. Os pacientes foram submetidos a uma elastografia hepática transitória (FibroScan) para avaliar a fibrose e a uma entrevista composta por um questionário desenvolvido para o estudo e cinco questionários padronizados: EQ-5D-3L, HCV-PRO, e WPAI:HepC. RESULTADOS: Foram recrutados 313 pacientes. A amostra foi composta predominantemente por mulheres (50,8%), caucasianos/brancos (55,9%) e indivíduos empregados (39,9%). A média de idade foi 56 (DP=10,4) anos. Em média, os pacientes com HCV esperaram 40,6 (DP=49,6) meses entre o diagnóstico e o primeiro tratamento. Ademais, 42,8% dos pacientes que realizaram o FibroScan tinham cirrose; a comorbidade mais frequente foi doença cardiovascular (62,6%) e a complicação mais comum as varizes esofágicas (54,5%). Os resultados também mostraram que "dor e desconforto" foi a dimensão de QVRS mais afetada (55,0% dos pacientes relataram alguns problemas) e que a média do escore do HCV-PRO foi 69,1 (DP=24,2). Em relação à perda de produtividade, o componente do WPAI:HepC mais afetado foi atividade diária (23,5%) e entre os pacientes empregados, presenteísmo foi mais frequente do que absenteísmo (18,5% vs 6,5%). Os custos diretos médicos totais com essa amostra foi de 12.305,72USD por paciente em um período de dois anos; o tratamento medicamentoso representou 95% desse total. CONCLUSÃO Esse estudo mostrou a maioria dos pacientes possui cirrose, apresenta alta prevalência de doenças cardiometabolicas e varizes esofágicas, QVRS reduzida principalmente em termos de dor/desconforto e dano na produtividade, especialmente presenteísmo. Adicionalmente, nós demonstramos que o HCV impõe uma carga econômica no sistema de saúde brasileiro e que os medicamentos correspondem à maioria dos custos.

Detection of occult hepatitis B in serum and oral fluid samples

In occult hepatitis B infection (OBI), hepatitis B virus DNA (HBV DNA) can be detected in serum samples; however, oral fluid collection for detection of HBV DNA has not yet been explored, despite the availability of collection devices. Serum and oral fluid samples from 45 hepatitis B core antibody (anti-HBc)-positive patients were collected for the amplification of the HBV polymerase gene. HBV DNA was detected in five serum and four oral fluid samples (the detection limit for oral fluid was 1.656 log IU/mL in paired serum). In conclusion, simple methodologies of sample collection and in-house polymerase chain reaction (PCR) allowed detection of HBV DNA, and these could be used to improve the diagnosis of OBI, especially in locations with limited resources.

Spatial distribution of the litter carbon stock in the Cerrado biome in Minas Gerais state, Brazil / Distribuição espacial do estoque de carbono na serrapilheira de fragmentos do bioma Cerrado em Minas Gerais, Brasil

ABSTRACT Litter corresponds to the layer of decomposing dead organic matter present on the soil surface. This layer is very important for nutrient cycling and contributes with organic matter accumulation in the soil, besides the carbon stock. The objective herein was to quantify the carbon biomass, both content and stock, and map the litter C-stock in the Cerrado biome, which is formed by Savanna Grassland (SG), Cerrado Stricto Sensu (CE) and Forest Savanna (FS), in Minas Gerais state, southeastern Brazil. The data were collected in 26 fragments in Minas Gerais state, totaling 210 sampling locations. A variographic study was conducted and, for mapping, the ordinary kriging method was used for delimitation of homogeneous zones. It was possible to detect high variability in the carbon biomass, carbon content and C-stock in the Cerrado biome litter in Minas Gerais state. The carbon content presented lower variability, ranging from 40 to 44%, so that it is not responsible for explaining the variability of the litter C-stock. Savanna Grassland and Savanna Forest present, respectively, the lowest and highest C-stocks. C-stock presented a considerable spatial structure dependence, allowing to use the geostatistical procedures for mapping it in the Cerrado biome of the Minas Gerais state. The C-stock kriging map showed good accuracy, allowing to verify that the lowest C-stocks in the litter are found from the center to the northern of the Minas Gerais since the highest air temperatures are also verified in this direction.

RESUMO A serrapilheira corresponde à camada de matéria morta em decomposição presente sobre o solo. Esta camada é de grande importância na ciclagem de nutrientes e aporte de matéria orgânica sobre o solo, além de estocar carbono. Objetivou-se quantificar a biomassa, teor e estoque de carbono e espacializar o estoque de C da serrapilheira do Cerrado de Minas Gerais. Os dados foram coletados em 26 fragmentos de Cerrado no Estado de MG, totalizando 335 pontos amostrados em todo estado. Foi realizado o estudo variográfico e, para o mapeamento, utilizou-se a Krigagem, para delimitação de zonas homogêneas. Foi possível detectar alta variabilidade nas características avaliadas, biomassa, teor e estoque de carbono na serrapilheira do Cerrado em Minas Gerais, Brasil. O teor de C foi a característica que apresentou menor variabilidade, com intervalo de 40-44%, de modo que não é um atributo crítico para explicar o estoque de C na serrapilheira. O Campo Cerrado tem o mais baixo estoque de C, e o Cerradão o mais alto. O estoque de C apresenta considerável dependência da estrutura espacial, permitindo o uso de procedimentos geoestatísticos para mapeá-lo no bioma Cerrado do estado de Minas Gerais. O mapa de krigagem de estoque de C mostrou boa precisão e com base nele, foi possível verificar que os estoques de menor teor de carbono na serrapulheira são encontrados do centro para o norte do estado de Minas Gerais, onde tem-se as maiores temperaturas médias anuais.

Land-use effect on hydropedology in a mountainous region of Southeastern Brazil / Efeito do uso do solo na hidropedologia em uma região montanhosa do sudeste do Brasil

ABSTRACT In Brazil, the Mantiqueira Range, southeastern region, shelters the last remnants of the ecologically important Upper Montane Tropical Forest. since extensive exploration that has been taking place in this biome for decades, the influence of land-use changes on hydropedology in these areas must be investigated once major land-use changes have been observed. This study aims to evaluate the land-use influence on soil drainable porosity (SDP) in a headwater watershed located in the Mantiqueira Range region, and to validate the proposed methods based on micromorphological and hydrological indicators. The native vegetation of the study area is Atlantic forest that occupies 62% of the area, and the remaining 38% has been used for pasture. Thirty nine combinations of environmental variables were tested, each one generating a map for predicting SDP. The performance of the spatial prediction of SDP was assessed using 20% of the data from the total number of samples collected throughout the watershed. The least values of SDP are due to the process of removal of native forest and replacement by pasture. Areas with high to moderate SDP are associated with native forest fragments demonstrating the effects of the Atlantic Forest on the water infiltration and groundwater recharge processes, given by the greater contribution of baseflow in a forested catchment located within the studied watershed. The analysis of soil micromorphological images provided useful supporting information on the soil porosity system and along with hydrological properties of the watershed helped understand the SDP behavior on subsurface and groundwater storage capacity.

RESUMO No Brasil, a Serra da Mantiqueira, abriga um dos últimos remanescentes da Floresta Tropical de Altitude. Devido a grande exploração que vem ocorrendo neste bioma há décadas, a influência na hidropedologia decorrente das mudanças do uso do solo deve ser investigada. O objetivo deste estudo foi avaliar a influência do uso do solo na porosidade drenável do solo (PDS) em uma bacia hidrográfica localizada na região da Serra da Mantiqueira e validar os métodos propostos com base em indicadores micromorfológicos e hidrológicos. A vegetação nativa da área de estudo é a Mata Atlântica que ocupa 62% da área, e com os 38% restantes utilizados para pastagem. Trinta e nove combinações de variáveis ​​ambientais foram testadas, cada uma gerando um mapa para predizer a PDS. O desempenho da predição espacial da PDS foi avaliado utilizando 20% dos dados do número total de amostras coletadas em toda a bacia hidrográfica. Os menores valores de PDS são devidos ao processo de remoção de floresta nativa e substituição por pastagem. Áreas com altos a moderados valores de PDS estão associadas a fragmentos de florestas nativas que demonstram os efeitos da Mata Atlântica nos processos de infiltração de água e de recarga de água subterrânea na região da Mantiqueira, dada a maior contribuição do fluxo base em áreas florestadas. A análise micromorfológica do solo forneceu informações úteis sobre o sistema poroso do solo e as propriedades hidrológicas da bacia hidrográfica, ajudando a entender o comportamento da PDS e a capacidade de armazenamento em subsuperfícíe.

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p<0.001) and a higher incidence of serious adverse events (50.7% vs. 34.8%, p<0.001). Multivariate analysis revealed that sustained viral response was associated with the absence of cirrhosis, viral recurrence after previous treatment, pretreatment platelet count greater than 100,000/mm3, and achievement of a rapid viral response. Female gender, age>65 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.

Distribuição espacial da erosão potencial e atual do solo na Bacia Hidrográfica do Rio Sapucaí, MG / Spatial distribution of the potential and current soil erosion for the Sapucaí River Basin, MG, Brazil

RESUMO Este estudo avalia a distribuição espacial do potencial natural e atual do solo à erosão hídrica na Bacia do Rio Sapucaí, sul de Minas Gerais, utilizando a equação universal de perda de solos revisada, através de modelagem cartográfica, para a obtenção da erosão potencial (EP) e da erosão atual (EA). Os resultados indicaram que a EP para a Bacia do Rio Sapucaí variou de "Muito forte", na sua região de cabeceira (Serra da Mantiqueira), a "Fraca", nas áreas com topografia mais suavizada e menor erosividade da chuva. Em relação à EA, mais de 55,17 % da Bacia do Rio Sapucaí apresenta perdas de solo abaixo de 10 t.ha-1.ano-1, significando baixo potencial atual de erosão. A identificação de áreas de risco associadas à erosão acelerada, realizadas neste estudo, fornecem subsídios fundamentais para medidas associadas ao manejo, conservação e planejamento do uso do solo.

ABSTRACT This study was carried out with the purpose to assess the natural and current soil erosion for the Sapucaí river basin using the revised universal soil loss equation (RUSLE) through cartographic modeling to obtain the natural soil erosion potential (EP) and the current soil erosion (EA). Results have indicated that the Sapucaí river basin has soils with EP varying from "Very strong", in its headwater region (Mantiqueira Range) to "Weak" potential, in areas with smoothing topography and smaller rainfall erosivity. Regarding EA, more than 55.17 % of the basin area present soil losses smaller than 10 t.ha-1.year-1, meaning low current soil erosion vulnerability. The identification of accelerated soil erosion areas, obtained by this study, can be very useful for supporting soil conservation management and planning.

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients / Osteossíntese do dedo em martelo com placa e parafuso: avaliação de 25 pacientes

To evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. METHODS: Twenty-five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow-up was 18 months. RESULTS: The results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty-one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). CONCLUSION: Surgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Avaliar os resultados do tratamento cirúrgico de pacientes com lesão de dedo em martelo com o uso de placa-gancho e parafuso. MÉTODOS: Foram analisados 25 pacientes entre 20 e 35 anos, 19 do sexo masculino e seis do feminino, de maio de 2008 a dezembro de 2012. Os pacientes foram submetidos à avaliação de acordo com os critérios de Crawford e o acompanhamento médio foi de 18 meses. RESULTADOS: Os resultados obtidos foram excelentes em 10 pacientes (40%) e bons em 15 (60%); 21 pacientes (84%) não referiram dor no 18° mês de pós-operatório. Foi verificada ausência de limitação da amplitude de movimento em 14 casos (56%), limitação da extensão em sete (28%) e limitação da flexão em quatro (16%). CONCLUSÃO: O tratamento cirúrgico com redução aberta e fixação interna com placa-gancho e parafuso demonstrou ser uma ótima opção de tratamento nas fraturas em martelo e é considerado um método seguro e eficaz.

Inosine triphosphatase allele frequency and association with ribavirin-induced anaemia in Brazilian patients receiving antiviral therapy for chronic hepatitis C

Inosine triphosphatase (ITPA) single nucleotide polymorphisms (SNPs) are strongly associated with protection against ribavirin (RBV)-induced anaemia in European, American and Asian patients; however, there is a paucity of data for Brazilian patients. The aim of this study was to evaluate the ITPA SNP (rs7270101/rs1127354) frequency in healthy and hepatitis C virus (HCV)-infected patients from Brazil and the association with the development of severe anaemia during antiviral therapy. ITPA SNPs were determined in 200 HCV infected patients and 100 healthy individuals by sequencing. Biochemical parameters and haemoglobin (Hb) levels were analysed in 97 patients who underwent antiviral therapy. A combination of AArs7270101+CCrs1127354 (100% ITPase activity) was observed in 236/300 individuals. Anaemia was observed in 87.5% and 86.2% of treated patients with AA (rs7270101) and CC genotypes (rs1127354), respectively. Men with AA (rs7270101) showed a considerable reduction in Hb at week 12 compared to those with AC/CC (p = 0.1475). In women, there was no influence of genotype (p = 0.5295). For rs1127354, men with the CC genotype also showed a sudden reduction in Hb compared to those with AC. Allelic distribution of rs7270101 and rs1127354 shows high rates of the genotypes AA and CC, respectively, suggesting that the study population had a great propensity for developing RBV-induced anaemia. A progressive Hb reduction during treatment was observed; however, this reduction was greater in men at week 12 than in women.

Disease burden of chronic hepatitis C in Brazil

Background: Hepatitis C virus infection is a major cause of cirrhosis; hepatocellular carcinoma; and liver transplantation. The aim of this study was to estimate hepatitis C virus disease progression and the burden of disease from a nationwide perspective.Methods: Using a model developed to forecast hepatitis C virus disease progression and the number of cases at each stage of liver disease; hepatitis C virus-infected population and associated disease progression in Brazil were quantified. The impact of two different strategies was compared: higher sustained virological response and treatment eligibility rates (1) or higher diagnosis and treatment rates associated with increased sustained virological response rates (2).Results: The number of infected individuals is estimated to decline by 35% by 2030 (1,255,000 individuals); while the number of cases of compensated (n= 325,900) and decompen- sated (n= 45,000) cirrhosis; hepatocellular carcinoma (n= 19,100); and liver-related deaths (n= 16,700) is supposed to peak between 2028 and 2032. In strategy 2; treated cases increased over tenfold in 2020 (118,800 treated) as compared to 2013 (11,740 treated); with sustained virological response increased to 90% and treatment eligibility to 95%. Under this strategy; the number of infected individuals decreased by 90% between 2013 and 2030. Compared to the base case; liver-related deaths decreased by 70% by 2030; while hepatitis C virus-related liver cancer and decompensated cirrhosis decreased by 75 and 80%; respectively.Conclusions: While the incidence and prevalence of hepatitis C virus in Brazil are decreasing; cases of advanced liver disease continue to rise. Besides higher sustained virological response rates; new strategies focused on increasing the proportion of diagnosed patients and eligibility to treatment should be adopted in order to reduce the burden of hepatitis C virus infection in Brazil.

Peginterferon plus ribavirin and sustained virological response rate in HCV-related advanced fibrosis: a real life study

Background: Tolerance and response to antiviral HCV treatment is poor in advanced fibrosis. The aim of this study was to assess SVR rate and its predictive factors in HCV advanced fibrosis patients treated in real life with full dose PEG-IFN plus RBV and to evaluate the adverse events related to treatment. Methods: A multicentric, retrospective study was conducted at six university hospitals. METAVIR F3 and F4 HCV monoinfected patients who were treated with PEG-IFN and RBV had their data analyzed. A stepwise logistic regression analysis was performed to identify the variables independently related to SVR. Adverse events were recorded during treatment. Results: 308 patients were included, 75% genotype 1 and 23% genotype 3. METAVIR F3 was present in 39% and F4 in 61% of patients. The median Child Pugh score for F4 patients was 5 (5–9). The global SVR rate was 34%, 11% were relapsers and 55% were nonresponders. SVR rates were similar between patients treated with PEG-IFN alfa 2a or alfa 2b (p = 0.24). SVR rates according to Child–Pugh score were 26% (Child A) and 18% (Child B). The independent factors related to SVR in F4 patients were genotype 3, RVR and fewer Child Pugh score points. Treatment interruption occurred in 31% patients and death occurred in 1.9%, all with liver cirrhosis. Conclusion: Treatment of HCV in patients with advanced fibrosis should not be postponed. However, a very careful evaluation of cirrhotic patients must be performed before treatment is indicated and careful monitoring is required during treatment. .

Interferon-induced depression in patients with hepatitis C: an epidemiologic study / Depressão induzida por interferon em pacientes com hepatite C: um estudo epidemiológico

Objective To assess the incidence rate and severity of depressive symptoms in different time points (12, 24 and 48 weeks) in Brazilian patients with HCV treated with PEG IFN plus ribavirin. Methods We conducted an observational prospective study using the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression Scale (CES-D). Results Fifty patients were included. The assessments with either scale showed the highest score of depressive symptoms in the 24th week of treatment; the mean BDI score before treatment was 6.5 ± 5.3 and the mean CES-D was 10.9 ± 7.8. After 24 weeks, the mean BDI was 16.1 ± 10.2 and mean CES-D was 18.6 ± 13.0; 46% were diagnosed with depression according to combined BDI and CES-D scores. The somatic/psychomotor subscales were highly correlated with overall scale scores . Subjects with history of substance and alcohol abuse had higher risk for IFN-induced depression. Conclusion Treatment with PEG IFN was associated with a high incidence rate of depressive symptoms in this sample of Brazilian patients, as measured by CES-D and BDI. Alcohol and substance abuse increase the risk of PEG IFN-induced depression. .

Objetivo Avaliar a incidência e a gravidade de sintomas depressivos em diferentes intervalos (12, 24 e 48 semanas) em pacientes brasileiros com HCV tratados com PEG IFN mais ribavirina. Métodos Foi feito um estudo prospectivo observacional, usando o Inventário de Depressão de Beck (BDI) e a Escala de Rastreamento Populacional de Depressão (CES-D). Resultados Foram incluídos 50 pacientes. As avaliações com ambas as escalas mostraram os maiores escores de depressão na 24a semana de tratamento; o escore BDI médio antes do tratamento foi de 6,5 ± 5,3 e o CES-D foi 10,9 ± 7,8. Após 24 semanas, o BDI médio foi 16,1± 10,2 e o CES-D foi 18,6 ± 13,0; de acordo com os escores combinados BDI e CES-D, 46% receberam diagnóstico de depressão. As subescalas somática e psicomotora tiveram alta correlação. Indivíduos com história de abuso de substâncias e de álcool apresentaram maior risco de desenvolver depressão por PEG IFN. Conclusão O tratamento com PEG IFN associou-se a uma alta incidência de sintomas depressivos nessa população de pacientes brasileiros, de acordo com a BDI e CES-D. Abuso de álcool e substâncias aumentam o risco de depressão induzida por PEG IFN. .

Tratamento da hepatite crônica pelo vírus C: Novas perspectivas / Treatment of chronic hepatitis C virus: new perspectives

A infecção pelo vírus da hepatite C (HCV) é importante causa de hepatite crônica, cirrose e carcinoma hepatocelular, sendo razão para a indicação de transplante hepático no mundo industrializado (Sherlock, 1995). Várias estratégias de tratamento da hepatite C foram empregadas ao longo dos últimos anos. O interferon peguilado em monoterapia ou combinado à ribavirina tornou-se tratamento padrão. Em 2011, foram introduzidos os inibidores de protease. Em dezembro de 2013, uma nova geração de drogas tem conferido resultados auspiciosos à terapia.

The hepatitis C virus infection (HCV) is an important cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma, which leads indication for liver transplantation in the industrialized world (Sherlock, 1995). Many treatment strategies for hepatitis C were used for the latest years. Pegylated interferon monotherapy or combined to the ribavirin became a standard treatment. In 2011, protease inhibitors were introduced. In December 2013, a new generation drugs have been presented auspicious results to the therapy.

Cirroses hepáticas metabólicas / Hepatic cirrhosis metabolic

A cirrose hepática é importante causa de morbidade e mortalidade em todo o mundo. Entre as principais etiologias destacam-se as hepatites crônicas pelos vírus da hepatite C (HCV) e B (HBV) e o consumo e abuso do álcool. Destacamos, também, as hepatites crônicas e cirroses de natureza autoimune, medicamentosas, dentre outras.

Liver cirrhosis is the most important cause of mortality and morbidity all over the world. Among the mainly etiologies, chronic hepatites highlight due hepatite C (HCV) and B (HBV) and alcohol abuse. We also emphasize chronic hepatitis and cirrhosis from autoimmune and medical origins, among others.

Vazões máximas e mínimas para bacias hidrográficas da região alto Rio Grande, MG / Maximum and minimum discharges for Alto Rio Grande region basins, Minas Gerais state, Brazil

Vazões máximas são grandezas hidrológicas aplicadas a projetos de obras hidráulicas e vazões mínimas são utilizadas para a avaliação das disponibilidades hídricas em bacias hidrográficas e comportamento do escoamento subterrâneo. Neste estudo, objetivou-se à construção de intervalos de confiança estatísticos para vazões máximas e mínimas diárias anuais e sua relação com as características fisiográficas das 6 maiores bacias hidrográficas da região Alto Rio Grande à montante da represa da UHE-Camargos/CEMIG. As distribuições de probabilidades Gumbel e Gama foram aplicadas, respectivamente, para séries históricas de vazões máximas e mínimas, utilizando os estimadores de Máxima Verossimilhança. Os intervalos de confiança constituem-se em uma importante ferramenta para o melhor entendimento e estimativa das vazões, sendo influenciado pelas características geológicas das bacias. Com base nos mesmos, verificou-se que a região Alto Rio Grande possui duas áreas distintas: a primeira, abrangendo as bacias Aiuruoca, Carvalhos e Bom Jardim, que apresentaram as maiores vazões máximas e mínimas, significando potencialidade para cheias mais significativas e maiores disponibilidades hídricas; a segunda, associada às bacias F. Laranjeiras, Madre de Deus e Andrelândia, que apresentaram as menores disponibilidades hídricas.

Maximum discharges are applied to hydraulic structure design and minimum discharges are used to characterize water availability in hydrographic basins and subterranean flow. This study is aimed at estimating the confidence statistical intervals for maximum and minimum annual discharges and their relationship wih the physical characteristics of basins in the Alto Rio Grande Region, State of Minas Gerais. The study was developed for the six (6) greatest Alto Rio Grande Region basins at upstream of the UHE-Camargos/CEMIG reservoir. Gumbel and Gama probability distribution models were applied to the maximum and minimum long-term discharges respectively, using Maximum Likelihood estimators. Confidence intervals are important tools for better understand and estimation of water flows, being influenced by the geological characteristics of the basins. Based on the results, we could distinguish two hydrological systems: Aiuruoca, Carvalhos, and Bom Jardim basins, which have produced the greatest maximum and minimum discharges, which means they are more prone to floods, and have more water availability; and F. Laranjeiras, Madre de Deus and Andrelandia basins, which presented smaller water availability.

Levantamento pedológico e sistema de informações geográficas naavaliação do uso das terras em sub-bacia hidrográfica de Minas Gerais / Pedologic survey and geographic information system for evaluation of land use within a small watershed, Minas Gerais State, Brazil

A aptidão agrícola das terras consiste em uma classificação técnica que identifica o potencial agrícola de utilização das mesmas, considerando as limitações do solo em níveis de manejo diferenciados a partir das informações geradas em um levantamento pedológico. O cruzamento dos dados de aptidão agrícola e uso atual das terras em ambiente SIG (Sistema de Informações Geográficas) consiste numa ferramenta adequada de planejamento, pois permite determinar a inadequação entre uso e aptidão agrícola, dando bases sustentáveis à exploração. Neste estudo, foram realizadas a avaliação da aptidão agrícola das terras e seu uso atual com auxílio de imagens de satélite e observações de campo, e a identificação de Áreas de Preservação Permanente (APPs) em uma sub-bacia hidrográfica da Bacia do Alto Rio Grande, MG. Com base no levantamento de solos, a utilização do sensoriamento remoto, por meio de imagens de satélites, aliado ao ambiente SIG, constituem-se em ferramentas adequadas para avaliação da aptidão agrícola e uso atual das terras, e permitem o monitoramento das áreas da sub-bacia hidrográfica. O levantamento pedológico forneceu uma base segura e real para que, com o auxílio de ferramentas de geoprocessamento, os mapas resultantes tivessem melhor qualidade e representassem com acurácia os diferentes ambientes naturais na paisagem da sub-bacia hidrográfica. Ocorreu o predomínio de usos da terra menos intensivos que os das classes de aptidão agrícola encontradas. As Áreas de Preservação Permanente (APPs) estão recebendo os mais diferentes usos agrícolas, caracterizando uma inadequação entre a legislação ambiental e o uso atual da terra.

The land agricultural suitability is a technical classification that identifies the agricultural potential of land use, considering the soil limitations at differential management levels from the information generated in a pedologic survey. The cross reference of data involving land agricultural suitability and land use in Geographical Information System (GIS) is an adequate tool for planning, because it allows to determine the inadequacy between land use and land agricultural suitability, giving bases to sustainable exploration. Therefore, we evaluated in this work the land agricultural suitability and the current use of the land mediated by satellite images and field observations, for the identification of permanent preservation areas (PPAs) in a small watershed from Alto Rio Grande basin - MG. Based on soil survey, the utilization of remote sensing, by means of satellite images, in association with GIS, constitutes adequate tools to evaluate the land suitability and current use, and allows monitoring areas of the small watershed. The pedologic survey supplied a secure and real basis for this purpose and with the help of geoprocessing tools, the resulting maps had better quality and represented with accuracy the different natural environments in the landscape of the hydrographic small watershed. We observed a dominance of less intensive land use in relation to the agricultural suitability classes found here. The permanent preservation areas (PPAs) are receiving a variety of agricultural uses, which characterizes an inadequacy between the environmental legislation and the current land use.

Potencial erosivo da chuva no vale do rio doce, região centro leste do estado de Minas Gerais: primeira aproximação / Erosive potential of rainfall at Rio Doce Valley, central-east region of Minas Gerais state: first approach

Entre os fatores climáticos que interferem na erosão hídrica, a precipitação pluvial, expressa pela erosividade da chuva, é o de maior importância. Portanto, seu conhecimento torna-se fundamental na recomendação de práticas de manejo e conservação do solo que visem à redução da erosão hídrica. Nesse contexto, os objetivos deste trabalho foram: a) determinar a erosividade da chuva e sua distribuição, na região do Vale do Rio Doce, MG, para nove sub-regiões; b) estimar o índice EI30 mensal, no período de 1969 a 2005, para os municípios de Ferros e Guanhães e c) determinar o tempo de retorno dos índices mensais e anuais de erosividade. O valor médio de erosividade obtido foi de 12.913 MJ mm ha-1 h-1 ano-1, sendo classificado como muito alto. Entre as sub-regiões, os valores de erosividade variaram de 8.243 a 26.676 MJ mm ha-1 h-1 ano-1. O período crítico em relação à erosão hídrica, em razão da ocorrência de chuvas erosivas, é de janeiro-março e novembro-dezembro, contribuindo com 88,6 por cento da erosividade anual. De abril a outubro, praticamente inexiste a ocorrência de erosividade crítica. Os valores máximos individuais estimados para os tempos de retorno de 1, 10, 50 e 150 anos foram de 5.508, 15.534, 18.110, 19.632 e 5.542, 17.653, 20.954, 22.931 MJ mm ha-1 h-1 ano-1, para Ferros e Guanhães, respectivamente. A determinação dos valores de erosividade ao longo do ano permite identificar os meses nos quais os riscos de perdas de solo e água são mais elevados, o que exerce relevante papel no planejamento das práticas conservacionistas.

Among the climatic factors that interfere in water erosion, precipitation, expressed by the rainfall erosivity, is of great importance. Therefore, its knowledge becomes fundamental for the recommendation for soil management and conservation practices that seek the reduction of water erosion. In that context, the objectives of this work were: a) to determine the rainfall erosivity and its distribution at Rio Doce Valley, Minas Gerais State, for nine sub-regions, b) to estimate the monthly EI30 index in the period from 1969 to 2005 for Ferros and Guanhães counties, and c) to determine the return periods of the monthly and yearly erosivity indexes. The average erosivity value obtained was 12.913 MJ mm ha-1 h-1 year-1, being classified as very high. Among the sub-regions, the erosivity values varied from 8.243 to 26.676 MJ mm ha-1 h-1 year-1. The critical periods in relation to water erosion due to the occurrence of erosive rains are January-March and November-December, contributing with 88.6 percent of the annual erosivity. From April to October, the occurrence of critical erosivity practically does not exist. The estimated individual maximum values for the return periods of 1, 10, 50, and 150 years were of 5.508, 15.534, 18.110, 19.632, and 5.542, 17.653, 20.954, 22.931 MJ mm ha-1 h-1 year¹ for Ferros and Guanhães, respectively. The determination of the erosivity values throughout the year allows to identify the months in which the risks of soil and water losses are higher, which is important for planning the conservation practices.

Desempenho de métodos de estimativa da evapotranspiração de referência para a região da Serra da Mantiqueira, MG / Performance of the reference evapotranspiration estimating methods for the Mantiqueira range region, MG, Brazil

Objetivou-se, com o presente trabalho, avaliar o desempenho de métodos de estimativa da evapotranspiração de referência (ETo) nas escalas diária e mensal, durante os períodos chuvoso (outubro a março) e seco (abril a setembro), nos anos de 2007 e 2008, para a bacia hidrográfica do ribeirão Lavrinha, região da Serra da Mantiqueira, Minas Gerais (MG). O método de Penman-Monteith-FAO foi utilizado como referência. Para avaliação do desempenho dos métodos, foram considerados os coeficientes de correlação (r) e determinação (r²), concordância de Willmott (d), desempenho (c) de Camargo & Sentelhas e erro padrão de estimativa (EPE). Em geral, verificou-se que os métodos que envolvem radiação solar foram mais precisos na estimativa da ETo em relação aos métodos que envolvem apenas a temperatura do ar. Foram obtidas melhores estimativas pelos métodos de Jensen-Haise, FAO Radiação, Penman e Blaney-Criddle FAO para ambos os períodos, com coeficientes de desempenho entre "ótimo" e "muito bom". Os métodos Jensen-Haise, FAO Radiação e Blaney-Criddle FAO são mais indicados para estimativas em escala diária, para a região da Serra da Mantiqueira, por apresentarem maior precisão e formulações mais simples, enquanto que o método de Jensen-Haise apresentou o menor EPE nas estimativas em escala mensal.

The objective of this research was to evaluate the performance of reference evapotranspiration (ETo) estimating methods, in daily and monthly intervals, considering the rainy-summer (October to March) and dry-winter (April to September) seasons, in 2007 and 2008, in Mantiqueira range region, MG. To evaluate the performance methods were considered: the correlation (r) and determination (r²) coefficients, Willmott agreement (d), e Camargo & Sentelhas performance (c) and standard error estimate (SEE), taking Penman-Monteith-FAO as reference. It was verified that the methods based on solar radiation were more accurate than those based only on air temperature. Jensen-Haise, Radiation FAO, Penman and Blaney-Criddle FAO have produced better estimates in both seasons, obtaining good reliability on ETo estimate for the region, presenting "high" and "very good" performance. Jensen-Haise, Radiation FAO and Blaney-Criddle FAO are the most indicated methods in daily scale to the Mantiqueira range region due to present simpler mathematical structure and good performance, while the Jensen-Haise method presented the smallest standard error for the monthly scale.