Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C

ABSTRACT Background: Hepatitis E virus (HEV) infection in patients with pre-existing liver disease has shown high morbidity and lethality. The consequences of HEV superinfection in patients with chronic hepatitis C virus (HCV) infection are not fully understood. This study aimed to evaluate the association between the presence of anti-HEV antibodies, liver cirrhosis, and insulin resistance. Methods: A total of 618 patients chronically infected with HCV were included from three reference centers for viral hepatitis in São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: The seroprevalence of anti-HEV in patients with cirrhosis was significantly higher than in patients without cirrhosis (13.2% vs 8%, OR = 1.74, p = 0.04). Seropositivity for anti-HEV, adjusted for sex, age, and HCV genotype showed an association trend with hepatic cirrhosis (aOR = 1.75, p = 0.059). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (aOR: 4.39; p = 0.045). Conclusion: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in Brazil. The trend toward association between cirrhosis and previous HEV infection suggests that it may accelerate liver fibrosis in patients with chronic hepatitis C. In addition, previous infection by HEV is independently associated with insulin resistance in the studied population, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection, and may contribute to fibrosis progression.

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.

Seroprevalence of hepatitis E virus in chronic hepatitis C in Brazil

ABSTRACT Background and aims: Hepatitis E virus infection in patients with underlying chronic liver disease is associated with liver decompensation and increased lethality. The seroprevalence of hepatitis E virus in patients with chronic hepatitis C in Brazil is unknown. This study aims to estimate the seroprevalence of hepatitis E virus in patients with chronic hepatitis C and to describe associated risk factors. Methods: A total of 618 patients chronically infected with hepatitis C virus from three reference centers of São Paulo, Brazil were included. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: Out of the 618 patients tested, 10.2% turned out positive for anti-HEV IgG (95% CI 8.0-12.8%). Higher seroprevalence was found independently associated with age over 60 years (OR = 2.04; p = 0.02) and previous contact with pigs (OR = 1.99; p = 0.03). Conclusions: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in São Paulo. Contact with pigs is a risk factor for the infection, suggesting a possible zoonosis with oral transmission.

Absence of the predisposing factors and signs and symptoms usually associated with overreaching and overtraining in physical fitness centers

OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7) or signs and symptoms (8-13) was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching). A mean score was calculated ranging from 1 (completely absent) to 5 (severe) for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60). CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60).

Prevalencia de la co-infección con hepatitis B y C en pacientes HIV positivos y factores de riesgo asociados / Prevalence of co-infection with hepatitis B and C in HIV-positive patients and associated risk factors

Los virus de la hepatitis B (HBV) y C (HCV) son, frecuentemente, causa de enfermedad hepática crónica en pacientes infectados por el HIV (HIV +), ya que tienen las mismas rutas de transmisión. Se ha informado de prevalencias variables de co-infección, dependiendo de la población bajo estudio. El objetivo de este estudio fue determinar la prevalencia y los factores de riesgo asociados a la infección por HBV y HCV en pacientes HIV+ en el Hospital Universitario Oswaldo Cruz (HUOC) de Recife, Brasil, entre julio y spetiembre de 2004.

Hepatitis B and C are highly prevalent among HIV infected patients, resulting of shared transmission routes. Prevalences of HIV and hepatitis co-infections vary depending on the population studied. The main goal was to assess the prevalence and associated risk factors for HBV and HCV among HIV-infected patients. HIV infected patients at the Hospital Universitário Oswaldo Cruz (HUOC), Recife, Brazil, were studiend from July through September 2004.

Tradução e validação de um questionário de avaliação de qualidade de vida em AIDS no Brasil / Brazilian-Portuguese translation and validation of the HIV/AIDS-Targeted Quality of Life Instrument

OBJETIVO: Traduzir para português brasileiro, adaptar culturalmente e avaliar as propriedades psicométricas (validade e confiabilidade) de um questionário de qualidade de vida (HIV/AIDS-Targeted Quality of Life Instrument, HAT-QoL) específico para pacientes infectados pelo HIV. MÉTODO: Estudo transversal realizado no ambulatório de infectologia da Escola Paulista de Medicina da Universidade Federal de São Paulo. Coletaram-se características sociodemográficas e clínicas de 106 indivíduos infectados pelo HIV, que responderam os questionários de qualidade de vida HAT-QoL e SF-36. O coeficiente de correlação de Pearson aferiu a validade de construto. Para avaliar a confiabilidade foram calculados o alfa de Cronbach e o coeficiente de correlação intraclasse. RESULTADOS: A proporção de homens na amostra foi de 70,8 por cento. A média de idade foi 39,9 anos. Dos participantes, 40,5 por cento eram homo ou bissexuais. Onze (10,4 por cento) pacientes tinham contagem de células CD4 < 200 células/mm3. Entre os nove domínios do HAT-QoL, sete (função geral, satisfação com a vida, preocupações com a saúde, preocupações com a medicação, aceitação do HIV, confiança no profissional e função sexual) apresentaram efeito teto substancial. O domínio "função sexual" foi o que apresentou efeito teto mais alto (63,2 por cento). O domínio preocupações financeiras apresentou efeito chão substancial (30,2 por cento). Associações estatisticamente significativas foram observadas entre os domínios do HAT-QoL e características sociodemográficas e clínicas e domínios do questionário SF-36. A consistência interna foi satisfatória (alfa de Cronbach = 0,73 a 0,90). A reprodutibilidade inter e intraobservador foi muito alta (0,87 a 0,98 e 0,82 a 0,97, respectivamente). CONCLUSÃO: O HAT-QoL em português brasileiro é um instrumento válido, confiável e que pode contribuir para avaliar o impacto da infecção pelo HIV sobre a qualidade de vida de pacientes brasileiros.

OBJECTIVES: To translate the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) into Brazilian Portuguese, culturally adapt it, and evaluate its psychometric properties (validity and reliability) as a Brazilian version. METHODS: This cross-sectional study was carried out at the laboratory of infectious diseases at Escola Paulista de Medicina (Universidade Federal de São Paulo). Data were collected on clinical and sociodemographic characteristics of 106 HIV-infected individuals who answered the HAT-QoL and the SF-36®. Pearson's correlation coefficient was used to measure construct validity. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients. RESULTS: The sample was 70.8 percent male. The mean age was 39.9 years, with 40.5 percent of the participants being homosexual or bisexual. Eleven (10.4 percent) patients had a CD4 cell count < 200 cells/mm3. A substantial ceiling effect was observed in 7 of 9 HAT-QoL domains (overall function, life satisfaction, health worries, medication worries, HIV acceptance, provider trust, and sexual function). Sexual function was the domain with the highest ceiling effect (63.2 percent). A substantial floor effect (30.2 percent) was observed for financial worries. Statistically significant associations were observed between the HAT-QoL domains and clinical and sociodemographic characteristics, as well as with SF-36 domains. Internal consistency was satisfactory (Cronbach's alpha = 0.730.90). Inter- and intra-observer reproducibility was very high (0.870.98 and 0.820.97, - respectively). CONCLUSION: The Brazilian Portuguese version of the HAT-QoL is valid, reliable, and may contribute to evaluating the impact of HIV infection on the quality of life of patients in Brazil.

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit

Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most Brazilian Hospitals, and there are few studies which show the efficacy of control measures in such situations. This study evaluated intensive care unit (ICU) patients, in two years divided in control, intervention and post-intervention group. Intervention measures: hands-on educational programs for healthcare workers; early identification of MRSA infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. The hospital infection rates in the control period were compared to the ones in the post-intervention period. Hospital infection rates were found by means of the NNISS methodology The incidence coefficients of MRSA hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and MRSA-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). Nasal colonization in both intervention and post-intervention periods was of 30.9 percent and 22.1 percent among the hospitalized patients, respectively 54.4 percent and 46.1 percent of whom were already MRSA-positive when admitted to the unit. In the intervention period, most of those MRSA infected patients (76.2 percent) were nasal carrier. Mortality rates were, respectively 26.6 percent; 27.3 percent and 21.0 percent (p<0.001). Nasal carriers, both patients (93.7 percent) and healthcare professionals (88.2 percent), were successfully treated with topical mupirocin. Intervention measures for the prevention and control of MRSA infections in ICUs, have been efficient in the reduction of the bloodstream and MRSA-originated hospital infections incidence, and reduced the overall mortality rate significantly.

Estimativas de custo da hepatite crônica B no sistema único de saúde Brasileiro em 2005 / Cost estimates of chronic hepatitis B virus for the Brazilian unified health system in 2005

OBJETIVO: O objetivo deste estudo foi estimar o padrão de tratamento, a utilização de recursos e os gastos para cada estágio da HCVB, no ambiente do Sistema Único de Saúde (SUS) do Brasil, no ano 2005. MÉTODOS: Foi desenvolvido painel Delphi de especialistas para obter informação sobre o padrão de tratamento da HCVB no Brasil. Os dados foram coletados com dez médicos especialistas em hepatologia e doenças infecciosas. A valoração dos recursos foi obtida predominantemente das tabelas de pagamentos do Sistema Único de Saúde e tabelas de preços de medicamentos. As estimativas de custo tiveram a perspectiva do pagador público. Os dados foram analisados estatisticamente pelo programa SPSS 12.0 para Windows. RESULTADOS: Os gastos estimados dos pacientes foram separados em cada estágio da HCVB. O gasto estimado anual por paciente foi: R$ 980,89 para hepatite B crônica, sem cirrose e sem tratamento antiviral; R$ 1.243,17 para cirrose compensada sem tratamento antiviral; R$ 22.022,61 para cirrose descompensada; R$ 4.764,95 para o carcinoma hepatocelular; e R$ 87.372,60 para o transplante hepático. CONCLUSÃO: Os gastos estimados com procedimentos e medicamentos, excluindo antivirais, representaram os principais componentes do gasto da HCVB. Neste modelo, os gastos aumentam dramaticamente nos estágios mais avançados, sugerindo que retardar a progressão da doença poderá reduzir o gasto no longo prazo.

BACKGROUD: Chronic Hepatitis B Virus (CHBV) is a disease that places a large financial burden on healthcare systems and society. OBJECTIVE: The aim of this study was to estimate patient management patterns, and associated medical resource utilization and expenses, for each of the four stages of chronic HBV infection in the public unified healthcare system settings, in 2005. METHODS. An expert panel comprised of ten physicians, leading specialists in hepathology and infectious diseases, was convened to obtain information regarding management of CHBV patients in Brazil. Expense inputs were mainly obtained from government fee schedules and pharmaceutical price tables. Costs were estimated under the perspective of the public health system. Data were analyzed using Windows SPSS version 12.0. RESULTS: Estimated patient expenses were calculated for the four stages of CHBV infection. The estimated annual expenses per patient were: R$ 980.89 (US$ 392) for chronic hepatitis B with no cirrhosis and without antiviral therapy; R$ 1,243.17 (US$ 496) for compensated cirrhosis without antiviral therapy; R$ 22,022.61 (US$ 8809) for decompensated cirrhosis; R$ 4,764.95 (US$ 1,905) for hepatocellular carcinoma; and R$ 87,372.60 (US$ 34,948) for liver transplant. CONCLUSION: Estimated expenses associated with drugs and procedures represented the main components of the expenses of CHBV infection. In this model, expenses increase dramatically as the disease progresses to more advanced stages, suggesting that over the long term delaying progression may reduce costs.

Genotipo MLB2 materno influencia a transmissao vertical em crianças brasileiras / MLB2 mothers' genotype influences HIV-1 vertical transmission in Brazilian children

O presente estudo analisa os polimorfismos geneticos no primeiro exon MBL2, em um coorte de 21 pares de maes e filhos infectados por HIV-1 e um coorte de 11 pares constituidos por maes infectadas por HIV-1 e filhos nao infectados, na cidade de Recife(PE), localizada no nordeste do Brasil, com objetivo de avaliar se o genotipo MBL2, de maes infectadas por HIV-1 poderia estar relacionado com transmissibilidade do virus para seus conceptos. Todas criancas nasceram de maes infectadas por HIV-1 que nao haviam recebido nenhum tratamento antiretroviral durante a gravidez e não foram submetidas a parto cesareano para prevenir transmissão. Maes que transmitiram HIV-1 a seus conceptos (MT) tinham frequencia mais alta (14 porcento) de genotipo 00 no MBL2(tipico de maus produtores de MBL) se comparado com frequencia de 0 porcento observada entre maes infectadas que transmitiram o virus para seus filhos (MNT). Esta diferença foi estatisticamente significante. A presença do genotipo 0 e 00 no alelo MBL2 em MT se associou com transmissao viral. O genotipo AA de MBL (associado com produçao normal de MBL) teve frequencia de 82 porcento em MNT, significantemente mais alta que a frequencia de 52 porcento de MT. A presença do alelo A em 91 porcento das MNT conferiu menor risco de transmissao vertical no coorte estudado. Nossos resultados sugerem que a transmissao vertical de HIV-1 depende somente do genotipo MBL2 da crianca e da mae, nas quais os niveis da proteina MBL poderiam desempenhar um importante papel na transmissao do virus

Perfil de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil / Medication use patterns among elderly people in urban area in Northeastern Brazil

OBJETIVO: Descrever o perfil de utilização de medicamentos por idosos residentes em áreas de diferentes níveis socioeconômicos de um centro urbano do Nordeste do Brasil. MÉTODOS: Inquérito domiciliar entre idosos (60 anos ou mais) da cidade de Fortaleza, Ceará, selecionados por amostragem sistemática em múltiplos estágios e estratificada por nível socioeconômico (melhor = área central; intermediário = área intermediária; pior = área periférica). Estatística descritiva foi apresentada pelas percentagens dos respectivos totais para variáveis categóricas e médias (± desvio-padrão) para variável contínua. Realizou-se análise multivariada para identificação de fatores associados a uso de medicamentos prescritos; não-prescritos e inadequados. RESULTADOS: A maioria dos idosos (80,3 por cento na área central) usava pelo menos um medicamento prescrito. Mais de um terço (37,4 por cento) na área periférica usava pelo menos um não-prescrito, e quase 20 por cento pelo menos um inadequado. O uso de medicamentos prescritos foi associado à idade avançada (razão de chances - RR=1,7; IC 95 por cento: 1,1-2,8); sexo masculino (RR=0,5; IC 95 por cento: 0,3-0,7); visitas a serviços de saúde (RR=2,5; IC 95 por cento: 1,9-3,1); doenças crônicas (RR=4,0; IC 95 por cento: 2,5-6,2); e nível socioeconômico (RR=2,0; IC 95 por cento: 1,5-2,6). O uso de medicamentos não prescritos foi associado a comprometimento funcional (RR=1,5; IC 95 por cento: 1,1-2,2) e nível socioeconômico (RR=0,6; IC 95 por cento: 0,5-0,8). O uso de medicamentos inadequados foi associado principalmente a sexo masculino (RR=0,4; IC 95 por cento: 0,2-0,8); doenças crônicas (RR=2,0; IC 95 por cento: 1,2-3,3), e nível socioeconômico (RR=0,7; IC 95 por cento: 0,5-0,9). CONCLUSÕES: As proporções de idosos usando medicamentos prescritos, não-prescritos e inadequados foram significativas, havendo desigualdades particularmente entre aqueles de diferentes níveis socioeconômicos. Os resultados apontam para a necessidade de programas para otimizar o acesso e racionalizar o uso de medicamentos entre idosos no Brasil.

Reprodutibilidade do teste de captura híbrida de segunda geração na detecção de HPV de alto risco em material cervicovaginal de autocoleta / Reproductibility of hibrid capture II second generation for high grade HPV detection in cervico-vaginal selfcollecting samples

Objetiva comparar os resultados da captura híbrida II para HPV de alto risco oncogênico em material coletado po médico e o proveniente de autocleta domiciliar

Perfil sociodemográfico e de padröes de uso entre dependentes de cocaína hospitalizados / Epidemiological profile of cocaine users on treatment in psychiatrics hospitals, Brazil

OBJETIVO: Avaliar o perfil sociodemográfico e o padräo de uso da cocaína entre usuários de drogas hospitalizados. MÉTODOS: Estudo transversal com dependentes químicos maiores de 18 anos, internados em alguns hospitais psiquiátricos da regiäo metropolitana da Grande São Paulo, Brasil, com condições clínicas de responder a questionário padronizado e que concordaram em participar do estudo. Foram selecionados seis hospitais psiquiátricos que recebiam, por procura espontânea, pacientes da rede pública e privada de toda a regiäo da Grande São Paulo. A coleta de informações foi feita por meio de entrevistas estruturadas, aplicada individualmente por psicóloga treinada. Para análise estatística utilizou-se do teste t de Sudent e Qui-quadrado, e o nível de significância foi fixado em 5 por cento. RESULTADOS: Encontrou-se maior taxa (38,4 por cento) de usuários de crack e pequena prevalência (1,6 por cento) de usuários de drogas injetáveis. Os dependentes de cocaína fumada apresentavam baixa escolaridade, encontravam-se mais freqüentemente desempregados, haviam morado nas ruas, usavam maiores quantidades de droga e tinham sido presos em maior número de vezes do que aqueles que usavam outras vias de administraçäo da droga. CONCLUSÕES: Os resultados sugerem que o uso de drogas é um grave problema de saúde pública na Grande São Paulo, mostrado pelo número de internações hospitalares por dependência. Os usuários de crack apresentam pior condiçäo socioeconômica e maior envolvimento com a violência e a criminalidade.

Epidemiological profile of tuberculosis infection and disease among cocaine users admitted to hospitals of the Greater São Paulo city

OBJECTIVE: To evaluate the prevalence and the risk factors for tuberculosis (TB) infection and disease among hospitalized cocaine users. METHOD: A cross-sectional study performed on a sample of 440 addicts over 18 years of age, admitted to hospitals of the metropolitan area of the Greater São Paulo city, whose clinical conditions allowed them to answer a standard questionnaire, and who agreed to participate in the study. The prevalence of TB infection was assessed through positive tuberculin testing (PPD), and of TB disease by the finding of M. tuberculosis in the sputum of patients with respiratory symptoms. RESULTS: Respiratory symptoms were present in 21 percent of the patients, the most frequent being weight loss and cough, which disappeared when cocaine use was discontinued. The general prevalence of TB infection was 28 percent. The prevalence of TB disease was 0.6 percent. The factors which were associated with positive PPD were: age, color/race, time spent in prison, and drug use in prison. CONCLUSION: No increased prevalence of TB infection and disease was found in these patients. Older addicts had a higher probability of having TB infection, and so had those who had been in prison.

The biological meaning of anti-HBC positive result in blood donors: relation to HBV-DNA and to other serological markers

In order to assess the potential risk of anti-HBc-positive blood donors for post-transfusional hepatitis and to investigate whether other HBV serological markers are capable of identifying the presence of the virus, 1000 first-time blood donors were enrolled between June and July 1997. These donors were screened using routine Brazilian blood center tests (HIV 1 and 2, HTLV 1 and 2, Chagas disease, Syphilis, HCV, HBsAg, anti-HBc and ALT ). The 120 (12 percent) found to be anti-HBc-positive underwent further tests: HBe, anti-HBe, anti-HBs and HBV-DNA by PCR. Ten cases were HBsAg positive and all were HBV-DNA positive by PCR. Three HBsAg-negative donors were HBV-DNA-positive. Two HBV-DNA-positive donors were also anti-HBs-positive. All the HBV-positive donors had at least one HBV marker other than anti-HBc. Anti-HBc is an important cause of blood rejection. Testing for HBsAg alone is not fully protective and anti-HBc remains necessary as a screening test. The presence of anti-HBs is not always indicative of absence of the virus. The addition of other HBV serological markers could represent an alternative in predicting the presence of the virus when compared with PCR. It is recommended that other studies should be carried out to confirm this finding

Staphylococcus aureus bacteremia: comparison of two periods and a predictive model of mortality

Staphylococcus aureus is an important pathogen causing bacteremia, primarily affecting hospitalized patients. We studied the epidemiology of S. aureus bacteremia, comparing two periods (early and mid 1990s) and developed a predictive model of mortality. A nested case-control was done. All 251 patients over 14 years old with positive blood cultures for S. aureus were selected. MRSA (methicillin resistant S. aureus) was isolated in 63 percent of the cases. When comparing the two periods MRSA community-acquired bacteremia increased from 4 percent to 16 percent (p=0.01). There was no significant difference in the mortality rate between the two periods (39 percent and 33 percent, p=0.40). Intravascular catheters provoked 24 percent of the cases of bacteremia and were associated with the lowest rate of mortality. In a logistic regression analysis, three variables were associated with death: septic shock, source of bacteraemia and resistance to methicillin. The probability of dying among patients with MRSA and those with methicillin sensitive S. aureus bacteraemia ranged from 10 percent to 90 percent and from 4 percent to 76 percent, respectively, depending on the source of the bacteraemia and the occurrence of septic shock. The MRSA found in Brazil may be a particularly virulent strain.

The application of latent class analysis for diagnostic test validation of chronic Trypanosoma cruzi infection in blood donors

The main strategy to prevent transfusion-associated Chagas disease is the identification of T. cruzi-infected blood donors by serological screening tests, however there is no perfect serological gold standard. We evaluated an enzyme immunoassay (EIA), an indirect hemaglutination (IHA), and an indirect immunofluorescence (IIF) test for detecting T. cruzi antibodies in Brazilian blood donors. The results were submitted to latent class analysis, and a radioimmunopreciptation (RIPA) test was performed on repeatedly positive samples. Among 1951 donors, 11 (0.56) were positive by EIA, 6 (0.31) by IHA and 16 (0.82) by IIF. Six samples were positive with all tests, while 4 reacted with EIA and IIF. The RIPA was positive in 6 (75.0), 7 (66.6), and 4 (54.0) samples reacting by the EIA, IHA and IIF tests, respectively. The latent class model detected a high sensitivity rate (100) for the EIA and IIF, and a specificity rate of 99.95 and 99.69 for the EIA and IIF tests, respectively. The probability of being case according to the model was 99.92 when both EIA and IIF were positive, and 100 for the association of EIA, IIF, and IHA.

Neurologic complications after heart transplantation

OBJECTIVE: Neurologic complications are known as important cause of morbidity and mortality in orthotopic heart transplantation. Our aim was to identify the frequency and outcome of neurologic complications after heart transplantation in a prospective observational study. METHOD: From September 93 to September 99, as part of our routine heart transplantation protocol all patients with end-stage cardiac failure were evaluated by the same neurologist before and at the time of any neurologic event (symptom or complaint) after transplantation. RESULTS: Out of 120 candidates evaluated, 62 were successfully transplanted (53 male; median age 45.5 years, median follow-up 26.8 months). Fifteen patients (24 percent) had ischemic, 22 (35 percent) idiopathic, 24 (39 percent) Chagas' disease and 1 (2 percent) had congenital cardiomyopathy. Neurologic complications occurred in 19 patients (31 percent): tremor, severe headache, transient encephalopathy and seizures related to drug toxicity or metabolic changes in 13; peripheral neuropathy in 4; and spinal cord compression in two (metastatic prostate cancer and epidural abscess). No symptomatic postoperative stroke was observed. CONCLUSIONS: Although frequent, neurologic complications were seldom related to persistent neurologic disability or death. Most of the complications resulted from immunosuppression, however, CNS infection was rare. The absence of symptomatic stroke in our series may be related to the lower frequency of ischemic cardiomyopathy

Human papillomavirus prevalence, viral load and cervical intraepithelial neoplasia in HIV-infected women

HIV-infected women from S o Paulo city were enrolled in a cross-sectional study on Human Papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN) prevalence and their association with laboratory markers of AIDS, namely HIV viral load and CD(4)(+) cell counts. A cervical specimen was collected and submitted to Hybrid Capture, a test for HPV viral load determination. HPV-DNA was detected in 173 of 265 women (64.5). Twenty (7.5) women were infected by one or more low-risk viruses, 89 (33) by one or more high-risk viruses, and 64 (24) harbored at least one HPV type from each risk group. Abnormal smears were observed in 19 of the patients, though there were no invasive carcinomas. Severely immunosuppressed patients (CD(4)/microL <100) were at the greatest risk of having a cytological abnormality and a high high-risk HPV viral load.

High prevalence of hepatitis C infection in a brazilian prision: identification of risk factors for infection

Hepatitis C virus (HCV) causes infectious hepatitis worldwide. It is transmitted mainly by blood products and sharing of intravenous paraphernalia during illicit drug use. High prevalence rates have been described among specific groups considered to be at higher risk for HCV infection, including prision inmates. The objectives of this study were: to determine the HCV Seroprevalence among inmates of Casa de Detençäo de Säo Paulo; identify risk factors for HCV infection; and to compare the seroprevalence of HCV to other blood borne or sexulally transmitted diseases. From December, 1993, to January, 1994, a total de 779 inmates were interviewed to collect information on sociodemographic status, sexual behavior, and past experience with illict drugs. Blood samples were obtained from 756 inmates for serological tests. 310 (41 percent) blood samples were positive for anti-HCV, 425 (56.2 percent) were negative, and 21 (2.8 percent) showed indeterminate results. In this population, we found a seroprevalence of 13.7 percent for HIV, 3.3 percent for syphylis (VDRL), and 68.1 percent for hepatitis B virus previous infection. Four variables were each identified as associated with a positive anti-HCV serologic test: a positive VDRL (OR = 2.631 IC 95 percent 1.08 to 6.36); a time of current imprisonment longer than 130 months (OR = 2.44 IC 95 percent 1.04 to 5.71); previous incarceration at Casa de Detençäo de Säo Paulo (OR = 1.73 IC 95 percent 1.19 to 2.52) and; illict drug use before admission to the Casa de Detençäo de Säo Paulo (OR = 1.64 IC 95 percent 1.15 to 2.33). The seroprevalence of HCV antibodies among the study populations was high (41 percent), indeed, one of the highest clusters of HCV infection recorded until now. Four variables were each shown to be associated with HCV infection. The simultaneous presence of these 4 analysis indicates most HCV infections occur prior to inprisonment, initiation of control measures to prevent continued transmission after incarceration should be done.

Anti-HIV-1/2 antibody detection by dot-ELISA in oral fluid of HIV positive/AIDS patients and voluntary blood donors

Serology is the primary means for identifying patients with HIV infection and Acquired Immunodeficiency Syndrome (AIDS). Testing of serum by serologic methods has been extensively used since 1985, not only for clinical diagnosis but also for epidemiological surveillance and donor screening in blood banks. Fast serological diagnostic techniques are now being developed, using urine and oral fluid, as an alternative for anti-HIV antibody screening, and many parallel studies are proving its accuracy. The purpose of this study was to evaluate the sensitivity, specificity,accuracy, positive predictive value (PPV) and negative predictive value(NPV) of the ImmunoComb II HIV 1&2 Saliva test from Orgenics(Dot-ELISA) compared to the routine exams (ELISA and Western Blot) of HIV positive/ AIDS patients, undergoing antiretroviral treatment or not, in different stages of the disease's evulution, and compared to serologic testing of known HIV negative patients by the use of serum ELISA (blood donors). To accomplish this, patients of the Immunogenic Deficiencies Control Center (CCDI) and voluntary blood donors of the Blood Bank Center of the Medical School of Säo Paulo/Federal University of Säo Paulo(EPM-UNIFESP) were evaluated. Sensitivity of Dot-ELISA in oral fluid was 100 percent, specificity 97.08 percent, PPV 96.66 percent and NPV 100 percent. The method used in this case study was shown to be highly sensitive and specific, being useful particularly epedemiological sur veillance and screening.