Infecção cervical e anal pelo HPV em mulheres vivendo com HIV/AIDS: uma série de casos / Cervical and anal HPV infection in women living with HIV/AIDS: a series of cases

Introdução: Mulheres que vivem com o vírus da imunodeficiência humana (MVHIV) possuem risco aumentado de coinfecção pelo papilomavírus humano (HPV). A infecção persistente pelo HPV nos órgãos genitais de MVHIV pode resultar em câncer cervical e/ou anal. O objetivo deste estudo foi determinar a frequência da infecção por HPV cervical e anal em MVHIV e estabelecer relações epidemiológicas com os genótipos virais e dados clínicos e sociodemográficos. Métodos: Vinte e três mulheres foram avaliadas. Amostras do colo do útero e do ânus foram coletadas e analisadas por citologia convencional e para detecção do tipo do HPV pela técnica de nested-PCR e sequenciamento. Resultados: O HPV foi detectado em 39,1% das amostras do colo uterino e 47,8% do ânus. Dez tipos de HPV foram identificados, sendo cinco de alto risco e cinco de baixo risco para câncer. O HPV 11 foi o mais prevalente em todas as amostras analisadas. A detecção do HPV foi associada com situação conjugal, níveis linfócitos TCD4+, carga do HIV, citologias cervical e anal anormais. Anormalidade cervical e anal foi observada em 43,5% e 17,4% das mulheres, respectivamente, sendo o genótipo 11 o mais encontrado nesses casos. Conclusão: Tipos de HPV de alto e baixo risco para câncer foram identificados nas amostras. Os resultados destacam a importância da triagem citológica e molecular em MVHIV, mesmo em casos com tipos de HPV de baixo risco.

Introduction: Women living with HIV (WLHIV) have an increased risk of co-infection with human papillomavirus (HPV). Persistent HPV infection in the genital organs of WLHIV may result in cervical and/or anal cancer. The objective of this study was to determine the frequency of cervical and anal HPV infection in WLHIV and establish epidemiological relationships with viral genotypes and clinical and sociodemographic data. Methods: Twenty-three women were evaluated. Cervical and anal samples were collected and analyzed using conventional cytology. HPV type was determined by nested polymerase chain reaction and sequencing. Results: HPV was detected in 39.1% and 47.8% of cervical and anal samples, respectively. Ten types of HPV were identified, of which 5 had high (16, 35, 45, 53, and 56) and 5 had low (11, 44, 61, 70, and 84) oncogenic risk. HPV-11 was the prevalent type among analyzed samples. HPV detection was associated with marital status, CD4+ T lymphocyte count, HIV burden, and abnormal cervical and anal cytology. Cervical and anal abnormalities were observed in 43.5% and 17.4% of women, respectively, with genotype 11 being the most common in these cases. Conclusions: High- and low-oncogenic risk HPV were identified in the samples. The results highlight the importance of cytological and molecular screening in WLHIV, even in cases of low-risk HPV types.

Incidência e fatores de risco associados à falha na ventilação não invasiva em pacientes pediátricos / Incidence and risk factors associated with noninvasive ventilation failure in pediatric patients

Introdução: O suporte ventilatório é usado para o tratamento de pacientes com insuficiência respiratória aguda (IRpA) ou crônica agudizada. A ventilação não-invasiva (VNI) na IRpA pediátrica é amplamente usada em bebês prematuros e crianças, porém até a data atual os estudos têm sido escassos. Portanto, o objetivo do presente estudo foi determinar os fatores de risco associados à falha na VNI em uma unidade de terapia intensiva pediátrica.Métodos: Coorte retrospectiva a partir de prontuários de pacientes admitidos na unidade de terapia intensiva (UTI) Pediátrica de um Hospital de Caxias do Sul, entre maio de 2017 e outubro de 2019, que utilizaram VNI.Resultados: A incidência de falha na VNI foi de 33%. Asma (RR = 1,36; IC95% = 1,08-1,72), uso de VNI em pacientes pós-extubação (RR = 1,97; IC95% = 1,17-3,29), uso contínuo da VNI (RR = 2,44; IC95% = 1,18-5,05), encerramento à noite (RR = 2,52; IC95% = 1,53-4,14), modalidade final ventilação mandatória intermitente sincronizada (SIMV) (RR = 4,20; IC95% = 2,20-7,90), pressão expiratória positiva final (PEEP) no início da ventilação (6,8 ± 1,1; p < 0,01) e fração inspiratória de O2 (FIO2) final (53,10 ± 18,50; p < 0,01) foram associados à falha. Adicionalmente, a pressão arterial sistólica (PAS) inicial (118,68 ± 18,68 mmHg; p = 0,02), a frequência respiratória inicial (FR) (47,69 ± 14,76; p = 0,28) e final (47,54 ± 14,76; p < 0,01) foram associados a falha.Conclusão: A modalidade ventilatória final SIMV, demostra ser o melhor preditor de risco de falha, seguido do turno em que a VNI é finalizada, onde à noite existe maior risco de falha. Além disso, foram preditores de falha, porém com menor robustez, a pressão positiva inspiratória (PIP) final e a FR final.

Introduction: Ventilatory support is used for the treatment of patients with acutely chronic or acute respiratory failure (ARF). Noninvasive ventilation (NIV) in pediatric ARF is widely used in preterm infants and children, but studies to date have been limited. Therefore, the aim of the present study was to determine the risk factors associated with NIV failure in a pediatric intensive care unit.Methods: This retrospective cohort study was based on medical records of patients admitted to the pediatric intensive care unit of a hospital in Caxias do Sul, southern Brazil, between May 2017 and October 2019, who used NIV.Results: The incidence of NIV failure was 33%. Asthma (relative risk [RR] = 1.36; 95% confidence interval [CI] = 1.08-1.72), post-extubation use of NIV (RR = 1.97; 95% CI = 1.17-3.29), continuous use of NIV (RR = 2.44; 95% CI = 1.18-5.05), completion at night (RR = 2.52; 95% CI = 1.53-4.14), final mode synchronized intermittent mandatory ventilation (SIMV) (RR = 4.20; 95% CI = 2.20-7.90), positive end-expiratory pressure at the beginning of ventilation (6.8 ± 1.1; p < 0.01), and final fraction of inspired oxygen (53.10 ± 18.50; p < 0.01) were associated with failure. Additionally, initial systolic blood pressure (118.68 ± 18.68 mmHg; p = 0.02), initial respiratory rate (IRR) (47.69 ± 14.76; p = 0.28), and final respiratory rate (47.54 ± 14.76; p < 0.01) were associated with failure.Conclusion: The final ventilatory mode SIMV proves to be the best failure risk predictor, followed by the shift in which NIV is completed, as there is a greater risk of failure at night. In addition, final positive inspiratory pressure and final respiratory rate were less robust predictors of failure.

COVID-19: hypernatremia is a significant predictor of mortality

Introduction: Coronavirus disease 2019 (COVID-19) pandemic spread rapidly, creating a worrisome scenario worldwide. In hospitalized patients, dysnatremia (hyponatremia and/or hypernatremia) is the most common electrolyte disturbance, reported in 30­40% of cases and associated with a poor prognosis. This study aimed to evaluate the association between dysnatremia and mortality in hospitalized patients infected with SARS-COV-2. Methods: Retrospective longitudinal study that analyzed data from hospital records of 1,000 patients with COVID-19 (median age, 62.5 years; 57.1% men), including 109 (10.9%) deaths. Kaplan-Meier survival curves and Cox proportional hazard models with Hazard Ratio (HR) with 95% confidence intervals (95%CI) were applied to confirm the association between dysnatremia (hyponatremia and/or hypernatremia) and death. Results: Hypernatremia was detected in 83 (76.1%) of the patients who died, with a cumulative reduction in survival (p < 0.01) and a 2.42-fold increased mortality risk (95%CI: 1.45­2.91). In the multivariable analysis, hypernatremia was the main factor associated with increased mortality (HR: 1.50; 95%CI: 1.23­1.81). Long length of stay (LOS) (HR: 1.54; 95%CI: 1.21­1.78), old age (HR: 1.63; 95%CI: 1.28­1.88), and chronic kidney disease (HR: 1.77; 95%CI: 1.21­3.30) were also associated with death. Conclusion: Hypernatremia during hospitalization is an important risk factor for poor prognosis and an increased mortality risk. LOS, old age, and chronic kidney disease could also be used for risk stratification in patients with COVID-19.

Caracterização epidemiológica das neoplasias do sistema nervoso central em pacientes da região Norte do Brasil / Epidemiological characterization of central nervous system tumors in patients from Northern Brazil

Introdução: A incidência de neoplasias que acometem o Sistema Nervoso Central (SNC) tem aumentado gradativamente no mundo. No Brasil, as neoplasias encefálicas primárias são classificadas como a sétima causa de morte entre as neoplasias malignas. O objetivo do presente estudo foi caracterizar o perfil epidemiológico dos pacientes acometidos por neoplasias do SNC em um estado do Norte do Brasil.Métodos: Estudo retrospectivo, onde 196 prontuários, entre 2012 e 2016, de dois hospitais na região Norte do Brasil foram analisados.Resultados: O glioblastoma multiforme foi predominante (30,6%) entre as neoplasias primárias, seguido pelo astrocitoma (12,2%). As neoplasias secundárias, identificadas como metástases encefálicas, corresponderam a 29,9% da amostra, principalmente derivadas de neoplasias do pulmão e mama. A gravidade histológica das lesões neoplásicas foi mais frequente nos homens (p= 0,01). Foi observado que as neoplasias ocorreram com maior frequência a partir da 4º década de vida, exceto nos casos de astrocitoma e meduloblastoma, que foram detectadas principalmente em crianças e adultos jovens.Conclusão: A caracterização dos casos de neoplasias do SNC é de importante para a compreensão da situação atual deste problema de saúde pública na região norte do Brasil.

Introduction: The incidence of central nervous system (CNS) cancer has gradually increased worldwide. In Brazil, primary brain tumors are the seventh leading cause of death among malignant tumors. The objective of the present study was to characterize the epidemiological profile of patients with CNS cancer from a state in northern Brazil.Methods: This retrospective study analyzed 196 medical records between 2012 and 2016 from two hospitals in northern Brazil.Results: Glioblastoma multiforme was predominant (30.6%) among primary tumors, followed by astrocytoma (12.2%). Secondary cancer, defined as brain metastases, accounted for 29.9% of the sample and was mostly associated with lung and breast cancer. The histological severity of neoplastic lesions was more frequent in men (p = 0.01). Cancer occurred more frequently after the fourth decade of life, except in cases of astrocytoma and medulloblastoma, which mostly affected children and young adults.Conclusion: The characterization of CNS tumors is important for understanding the current situation of this public health problem in northern Brazil.

Desfecho da aplicação da ventilação mecânica não invasiva na bronquiolite / Outcome of the application of noninvasive mechanical ventilation in bronchiolitis

A bronquiolite é uma infecção viral que pode levar a insuficiência ventilatória, nestes casos a aplicação de ventilação não invasiva é uma opção ao tratamento convencional. O objetivo deste estudo é identificar o desfecho da aplicação de ventilação não invasiva em crianças com bronquiolite. Trata-se de uma revisão da literatura, com busca de artigos nas bases de dados Biblioteca Virtual em Saúde, Cochrane Library, PEDro, Pubmed, Scielo e Science Direct, sem restrição de período, a partir das palavras chave Noninvasive ventilation AND Bronchiolitis. De um total de 1.192 artigos encontrados, 11 foram inclusos no presente estudo, quatro abordaram o desfecho relacionado à aspectos clínicos gerais (aumento no uso de VNI; menor tempo de internação; redução da frequência respiratória e fração inspirada de oxigênio) e sete relataram o índice de sucesso ou falha, e apesar da diferença entre as médias (sucesso 88,5 versus falha 15,1) não houve diferença significativa. Conclui-se que o desfecho de falha tem alta prevalência (11,5%), apesar disso, os estudos encontraram diferentes benefícios advindos do incremento na aplicação de VNI (redução da necessidade de ventilação mecânica invasiva, menor tempo de permanência em UTI, redução da mortalidade, melhora da frequência respiratória e da fração inspirada de oxigênio). (AU)

Bronchiolitis is a viral infection that can lead to ventilatory failure. In such cases, the application of noninvasive ventilation (NIV) is an alternative to conventional treatment. The aim of this study is to identify the outcome of the application of NIV in children with bronchiolitis. This is a literature review whose search for articles included the Virtual Health Library, Cochrane Library, PEDro, PubMed, SciELO, and Science Direct databases, with no date restriction, based on the keywords Noninvasive ventilation AND Bronchiolitis. Of a total of 1192 articles found, 11 were included in the present study. Four addressed the outcome related to general clinical aspects (increased use of NIV, shorter hospital stay, and reduced respiratory rate and inspired oxygen fraction) and seven reported the success or failure rate. Despite the difference between the means (success 88.5 versus failure 15.1) there was no significant difference. In conclusion, the failure outcome has a high prevalence (11.5%); however, studies have found different benefits arising from the increased application of NIV (reduced need for invasive mechanical ventilation, shorter intensive care unit stay, reduced mortality, and improved respiratory rate and inspired oxygen fraction). (AU)

Improvement of Mycobacterium tuberculosis detection in sputum using DNA extracted by sonication

Abstract Tuberculosis (TB) is one of the infectious diseases with high mortality in the world. DNA amplification techniques have been used to overcome barriers to the diagnosis of this disease. However, the success of these methodologies is highly dependent on the DNA obtained from the sample. This study was carried out to verify whether the DNA extracted by sonication (in house method) could yield suitable DNA for amplification by real-time PCR (qPCR). Sixty sputum samples were submitted to DNA extraction using sonication compared to a commercial method (Detect-TB kit, Labtest/MG-Brazil). All DNA samples were amplified by qPCR for IS6110 region (IS6110-qPCR/SYBR Green assay). Out of 60 samples, 40 were positive for TB; of these, all had positive results when extracted by sonication (100%) and 80% when extracted by the commercial method. The limit of detection (LOD) of Mycobacterium tuberculosis (H37Rv strain) by qPCR was 14CFU/mL when the DNA was extracted by sonication, compared to countless colonies when extracted by commercial kit. In conclusion, the sonication protocol (without purification step) proved to be a simple, fast, and suitable method for obtaining DNA for use in qPCR from sputum samples.

Rapid detection of Mycobacterium tuberculosis DNA and genetic markers for Isoniazid resistance in Ziehl-Neelsen stained slides

BACKGROUND Early diagnosis of tuberculosis (TB) and identification of strains of Mycobacterium tuberculosis resistant to anti-TB drugs are considered the main factors for disease control. OBJECTIVES To standardise a real-time polymerase chain reaction (qPCR) assay technique and apply it to identify mutations involved in M. tuberculosis resistance to Isoniazid (INH) directly in Ziehl-Neelsen (ZN) stained slides. METHODS Were analysed 55 independent DNA samples extracted from clinical isolates of M. tuberculosis by sequencing. For application in TB diagnosis resistance, 59 ZN-stained slides were used. The sensitivity, specificity and Kappa index, with a 95% confidence interval (CI95%), were determined. FINDINGS The agreement between the tests was, for the katG target, the Kappa index of 0.89 (CI95%: 0.7-1.0). The sensitivity and specificity were 97.6% (CI95%: 87.7-99.9) and 91.7% (CI95%: 61.5-99.5), respectively. For inhA, the Kappa index was 0.92 (CI95%: 0.8-1.0), the sensitivity and specificity were 94.4% (CI95%: 72.7-99.8) and 97.3% (CI95%: 85.8-99.9), respectively. The use of ZN-stained slides for drug-resistant TB detection showed significant results when compared to other standard tests for drug resistance. MAIN CONCLUSIONS qPCR genotyping proved to be an efficient method to detect genes that confer M. tuberculosis resistance to INH. Thus, qPCR genotyping may be an alternative instead of sequencing.

Associações entre polimorfismos genéticos da álcool: desidrogenase e o transtorno por uso de álcool / Associations between genetic polymorphisms of alcohol: dehydrogenase and alcohol use disorder

O transtorno por uso de álcool (TUA) é influenciado pela genética, principalmente na metabolização do etanol. Os genes da álcool desidrogenase (ADH1B/ADH1C), enzima que transforma o etanol, apresentam SNPs (single nucleotide polymorphisms) que resultam em isoenzimas com diferentes taxas catalíticas. Estudos demonstraram que os SNPs Arg48His, Arg370Cys, Arg272Gln e Ile350Val contribuem para o TUA. Este artigo revisou os estudos que investigaram SNPs em ADH1B (Arg48His/Arg370Cys) e ADH1C (Arg272Gln/Ile350Val), bem como avaliou as variações nas frequências alélicas desses genes e a influência no TUA nas diferentes populações no mundo. As frequências alélicas dos polimorfismos foram comparadas pelos testes qui-quadrado de Pearson e exato de Fisher (p < 0,05). O SNP Arg48His confere proteção para o TUA em euroamericanos, latino-americanos, europeus, brasileiros, asiáticos e australianos. O SNP Arg370Cys confere proteção para o TUA em afrodescendentes. Os SNPs Arg272Gln e Ile350Val predispõem o TUA principalmente em europeus. Os SNPs Arg48His, Arg370Cys e Arg272Gln/Ile350Val foram mais frequentes em amostras de leste-asiáticos (69,7%), africanos (19,1%) e europeus (40,5%), respectivamente (p < 0,01). Os diferentes alelos dos genes ADH1B/ADH1C devido a SNPs têm uma importante contribuição no TUA. As frequências desses alelos variam conforme a população, resultando em diferentes efeitos no TUA. (AU)

Alcohol use disorder (AUD) is influenced by genetics, especially in the metabolism of ethanol. The ethanol dehydrogenase genes (ADH1B/ADH1C), which convert ethanol, have single nucleotide polymorphisms (SNPs) that result in isoenzymes with different catalytic rates. Studies have shown that the Arg48His, Arg370Cys, Arg272Gln, and Ile350Val SNPs contribute to AUD. This article reviewed the studies that investigated SNPs in ADH1B (Arg48His/Arg370Cys) and ADH1C (Arg272Gln/Ile350Val) and evaluated variations in the allele frequencies of these genes and their influence on AUD in different populations worldwide. The allele frequencies of the polymorphisms were compared by Pearson's chi-square and Fisher's exact tests (p < 0.05). The Arg48His SNP provides protection against AUD in Euro-Americans, Latin Americans, Europeans, Brazilians, Asians, and Australians. The Arg370Cys SNP provides protection against AUD in Afro-descendants. The Arg272Gln and Ile350Val SNPs predispose to AUD mainly in Europeans. The Arg48His, Arg370Cys, and Arg272Gln/Ile350Val SNPs were more frequent in East Asians (69.7%), Africans (19.1%), and Europeans (40.5%), respectively (p < 0.01). The different alleles of the ADH1B/ADH1C genes due to SNPs make an important contribution to AUD. The frequencies of these alleles vary among different populations, resulting in different effects on AUD..(AU)

Increasing prevalence and dissemination of invasive nontyphoidal Salmonella serotype Typhimurium with multidrug resistance in hospitalized patients from southern Brazil

ABSTRACT Introduction: Nontyphoidal Salmonella serotypes are the main cause of human food-borne infection, including several hospitalization cases in the developing countries. Aim: To detect the main serotypes and to characterize the antibiotic resistance of human non-enteric and enteric nontyphoidal Salmonella from clinical isolates in Brazil. Methods: Salmonella serotypes were identified by microbiological and molecular methods. Susceptibility testing to antibiotics was performed by agar disk diffusion. Real-time PCRs were carried out for the detection of the genus Salmonella as well as serotypes Typhimurium and Enteritidis. Results: A total of 307 nontyphoidal Salmonella were isolated from 289 different patients in a reference laboratory (LACEN-RS) from Southern Brazil in a six-year period (2010-2015). There were 45 isolates from emerging cases and 244 from sporadic cases in hospitalized patients. Non-enteric isolates were detected in 42.6% of the patients from sources such as urine, blood and other clinical fluids. Serological and PCR-specific tests demonstrated that Typhimurium (48.4%) and Enteritidis (18.3%) were the most frequent serotypes. Typhimurium isolates were generally resistant to three or more antibiotic classes, while Enteritidis isolates to one or two classes. Typhimurium was the most frequent serotype in all samples (48.4%), mainly among the hospitalized patients (55.6%), and presented the highest rates of multidrug resistance (59.3% of the isolates of this serotype). Further, the prevalence of this serotype increased along the years of the study in comparison to other nontyphoidal Salmonella serotypes. Conclusion: Greater public health attention should be given to prevent salmonellosis in the community and in hospital settings to reduce the rates of Typhimurium strains with multidrug resistance.

HBV epidemiology and genetic diversity in an area of high prevalence of hepatitis B in southern Brazil

ABSTRACT Background Hepatitis B virus (HBV) infection is a major public health problem in Brazil. HBV endemicity is usually moderate to low according to geographic regions, and high prevalence of this virus has been reported in people of some specific Brazilian counties, including those with a strong influence of Italian colonization in southern Brazil. Analysis of HBV diversity and identification of the main risk factors to HBV infection are necessary to understand hepatitis B epidemiology in these high prevalence regions in southern Brazil. Objective To investigate epidemiological characteristics and HBV genotypes and subgenotypes circulating in a specific city with high HBV prevalence. Methods A cross-sectional study was performed with 102 HBV chronically infected individuals, recruited in reference outpatient clinics for viral hepatitis in a city of high HBV prevalence (Bento Gonçalves) in Rio Grande do Sul state, Brazil between July and December 2010. Socio-demographic, clinical and behavior-related variables were collected in a structured questionnaire. HBV serological markers (HBsAg, anti-HBc), viral load, genotypes/subgenotypes and drug resistance were evaluated and comparatively analyzed among all patients. Results The HBV infected subjects had a mean age of 44.9 (±12.2) years, with 86 patients (84.3%) reporting to have a family history of HBV infection, 51 (50.0%) to share personal objects, and were predominantly of Italian descendants (61; 64.9%). There was a predominance of genotype D (49/54; 90.7%), but genotype A was also detected (5/54; 9.3%). Subgenotypes D1 (1; 4.7%), D2 (3; 14.3%), and D3 (17; 81.0%) were identified. LAM-resistant mutation (rtM204I) and ADV-resistant mutations (rtA181V) were detected in only one patient each. Conclusions These results demonstrate a pivotal role of intrafamilial transmission for HBV spreading in this population. Furthermore, there is a high prevalence of HBV genotype D in this region.

Human metapneumovirus in Southern Brazil

INTRODUCTION Infections caused by respiratory viruses are important problems worldwide, especially in children. Human metapneumovirus (hMPV) is a respiratory pathogen and causes severe infections with nonspecific symptoms. This study reports the hMPV occurrence and dissemination in southern Brazil and compares the frequency of occurrence of this virus and the human respiratory syncytial virus (hRSV) in the epidemiological weeks in a three-year period (2009-2011). METHODS: In total, 545 nasopharyngeal (NP) specimens from individuals with Severe Acute Respiratory Syndrome (SARS) who were negative for other seven respiratory viruses were analyzed for the presence of hMPV. Human metapneumovirus was detected by direct immunofluorescence and real-time reverse transcription polymerase chain reaction. RESULTS: hMPV was detected in 109 patients from the main geographic regions of the southernmost state of Brazil, presenting similar overall prevalence in males (46.8%) and females (53.2%). Among children who were less than six years old, hMPV was detected in 99 samples of all age groups, with a higher frequency in infants who were less than one year old (45.7%) compared to all other age groups until six years. hMPV and hRSV infection occurred in almost the same epidemiological weeks (EWs) of each year, with peaks of incidence between EW 31/37 and EW 26/38 for the years 2009 and 2011, respectively. hMPV was further detected in several cases of SARS and it was the only virus detected in three deaths. CONCLUSIONS These findings indicate that hMPV is in circulation in southern Brazil and highlight the importance of diagnosing hMPV for influenza-like illness in the population. (AU)

Avaliação do desempenho de um teste rápido imunocromatográfico no diagnóstico de hanseníase em uma região endêmica no norte do Brasil / Evaluation of the performance of a rapid immunochromatographic test in the diagnosis of leprosy in an endemic region in northern Brazil

Introdução: A hanseníase é de grande importância para a saúde pública, devido à sua epidemiologia e a seu poder incapacitante. A eficiência no diagnóstico desta doença é limitada. O objetivo deste estudo foi o de analisar o desempenho de um teste rápido imunocromatográfico para hanseníase multibacilar (MB) e paucibacilar (PB), em amostras positivas e negativas pela baciloscopia de raspado dérmico em pacientes diagnosticados com hanseníase, comparando analiticamente com os critérios da Organização Mundial da Saúde (OMS). Métodos: O estudo foi realizado no município de Ji-Paraná/RO, entre 2015 e 2016, sendo avaliados 140 indivíduos. A análise comparativa entre os métodos foi realizada pelo cálculo de sensibilidade e especificidade utilizando o software SPSS®. Foi estimado o índice de Kappa (k) para avaliação da concordância entre os métodos. Valores de p <0,05 foram considerados significativos. Resultados: O índice de concordância entre o teste rápido e a classificação da OMS foi de k= 0,94 (p <0,01). Quando comparado a baciloscopia de indivíduos com hanseníase PB e o teste rápido, foi verificada concordância não significante (k= 0,01; p= 0,59). Comparando a concordância entre a baciloscopia de indivíduos com hanseníase MB e o teste rápido, foi detectado um índice de k= 0,64 (p <0,01). Além disso, sensibilidade de 94% e especificidade de 98% foram detectadas para hanseníase PB. Para hanseníase MB a sensibilidade foi de 95% e a especificidade de 98%. Conclusão: O teste rápido avaliado é uma ferramenta útil, rápida e eficaz no auxílio do diagnóstico da hanseníase. (AU)

Introduction: Leprosy is of great importance for public health because of its epidemiology and disabling power. Efficiency in the diagnosis of this disease is limited. The objective of this study was to evaluate the performance of a rapid immunochromatographic test for multibacillary (MB) and paucibacillary (BP) leprosy, in positive and negative samples by skin smear examination in patients with leprosy, and to compare the rapid test analytically with World Health Organization (WHO) criteria. Methods: The study was conducted in the municipality of Ji-Paraná/RO, Brazil, between 2015 and 2016. In total, 140 individuals were evaluated. For a comparative analysis of the methods, sensitivity and specificity were calculated using SPSS® software. The Kappa (k) index was used to evaluate agreement between the methods. A p-value < 0.05 was considered significant. Results: Regarding agreement between the rapid test and WHO classification, k index was 0.94 (p < 0.01). When skin smear of individuals with BP leprosy was compared to the rapid test, agreement was non-significant (k = 0.01; p = 0.59). For agreement between skin smear of individuals with MB leprosy and the rapid test, a k index of 0.64 (p < 0.01) was detected. In addition, for PB leprosy sensitivity was 94% and specificity was 98%, while for MB leprosy sensitivity was 95% and specificity was 98%. Conclusion: The rapid test is a useful tool, fast and effective in aiding the diagnosis of leprosy. (AU)

Association between arteriovenous fistulae and hematomas in a dialysis center in the state of Rio Grande do Sul, Southern Brazil

Introduction: Chronic kidney disease (CKD) is characterized by slow, progressive, and irreversible loss of kidney function. CKD has become a serious public health issue because of its increasing morbidity and mortality rates. The present study aimed to investigate factors associated with hematomas caused by arteriovenous fistula (AVF) at a Renal Replacement Therapy Unit in the state of Rio Grande do Sul, southern Brazil. Methods: In this cross-sectional study, 72 patients with CKD aged 18 years or over, presenting with AVF, and undergoing three hemodialysis sessions per week were evaluated from June 2014 to March 2015. Prevalence ratios (PRs) with 95% confidence intervals (95% CIs) were estimated for identification of risk factors associated with AVF. P-values < 0.05 were considered significant. Results: Sex, age, self-reported skin color, educational level, hypertension, diabetes, nephrotic syndrome, congestive heart failure, and hepatitis C were not associated with hematoma formation (i.e., all estimated PRs had p-values > 0.05). The single factor associated with hematomas was AVF time shorter than 60 days (PR = 2.04; 95% CI: 1.28-3.27; p < 0.01). Conclusion: AVF maturation time was associated with higher prevalence of hematomas at the cannulation site. Therefore, AVF time should be given special attention in patients undergoing renal therapy at dialysis centers. (AU)

Discriminant analyzes for the use of tobacco, alcohol and other drugs among adolescents in an urban center in southern Brazil

Introduction: The consumption of tobacco, alcohol, and illicit drugs is a problem in adolescence, especially in the school context. This study aimed to identify the demographic and social variables that distinguished the students who had used tobacco, alcohol and/or other drugs at some point of their lives from those who had never used these substances. Methods: A school-based cross-sectional study was conducted to evaluate students attending the ninth year of elementary education in the city of Caxias do Sul (n = 1,285). Results: Alcohol was the most consumed drug (74.9%). In all the three discriminant profiles, adolescents who used tobacco throughout their lives presented more family conflict and hierarchy, higher age, greater difficulty in talking to their mother, father, and siblings, and higher school failure rates. The group that reported lifetime use of alcohol showed similar characteristics, and also reported greater loneliness. The group that has used illicit drugs was characterized, as well as other factors, by meeting with friends outside school more often, not having a good friend, being lonely, and having difficulties in talking to their father. Conclusions: Several aspects of the social and family environment can act as factors that propitiate or distance adolescents from drugs. Public policies have a role of fundamental importance in this regard.

Risk factors for hepatitis B transmission in South Brazil

BACKGROUND Hepatitis B virus (HBV) infection is a major public health problem in Brazil. Several risk factors are involved in HBV infection and their identification by a rational and essential approach is required to prevent the transmission of this infection in Brazil. OBJECTIVES To evaluate risk factors associated with HBV infection in South Brazil. METHODS A total of 260 patients with HBV and 260 controls from Caxias do Sul (state of Rio Grande do Sul, Brazil) participated in this study. All participants were given a standard questionnaire to yield the sociodemographic information and to identify HBV risk factors. HBV infection was detected by HBsAg test in all participants. FINDINGS HBV infection in these cases was strongly associated with history of a family member HBV-infected, mainly mother [odds ratio (OR) = 4.86; 95% confidence intervals (CI): 1.69-13.91], father (OR = 5.28; 95% CI: 1.58-17.71), and/or siblings (OR = 22.16; 95% CI: 9.39-52.25); sharing personal objects (OR = 1.40; 95% CI: 1.37-2.38); and having history of blood transfusion (OR = 2.05; 95% CI: 1.10-2.84). CONCLUSIONS HBV infection was strongly associated with having a family member infected with hepatitis B, sharing personal objects, and having history of blood transfusion.

Transtorno por uso de álcool e HIV/AIDS: uma revisão da literatura / A literature review on the relationship between alcohol use disorder and HIV/AIDS

A ingestão de bebidas alcoólicas é um evento socioculturalmente aceito em muitos países. Porém, o consumo frequente e descontrolado deste tipo de bebida configura o transtorno por uso de álcool (TUA). Esta condição causa agravos que podem afetar a sociedade de uma forma geral. O TUA também pode levar os pacientes a contraírem doenças. Entre estas, existe uma relação importante entre TUA e doenças infectocontagiosas, com destaque para a infecção pelo HIV e o posterior desenvolvimento da AIDS. Portanto, a presente pesquisa objetivou realizar uma revisão da literatura sobre as relações entre TUA e HIV/AIDS. A seleção do material científico foi efetuada tendo por base plataformas eletrônicas, tais como: Google Scholar, MEDLINE, LILACS, SciELO, NCBI / PUBMED, Scopus e Science Direct. O entendimento dos fatores relacionados ao TUA, principalmente em pacientes com HIV/AIDS, é de fundamental importância para a formulação e criação de estratégias de políticas públicas que visem reduzir esta possível relação (AU)

The ingestion of alcoholic beverages is socio-culturally accepted in many countries. However, frequent and uncontrolled consumption of this type of beverage constitutes alcohol use disorder (AUD). This condition may be harmful to society in general, and it can lead patients to contract other diseases. There is an important relationship between AUD and infectious diseases, with emphasis on HIV infection and the later development of AIDS. Therefore, the present research aimed to carry out a review of the literature on the relationship between AUD and HIV/AIDS. The selection of the scientific material was based on electronic platforms, such as Google Scholar, MEDLINE, LILACS, SciELO, NCBI/ PUBMED, Scopus and Science Direct. The understanding of the factors related to AUD, especially in patients with HIV/AIDS, is of fundamental importance for the formulation and creation of public policy strategies aimed at reducing this possible relationship (AU)

Fases pré-analítica, analítica e pós-analítica no monitoramento laboratorial da anticoagulação com antagonistas da vitamina K / Pre-analytical, analytical, and post-analytical phases in laboratory monitoring of anticoagulant therapy with vitamin K antagonists

A trombose é uma doença caracterizada por eventos de hipercoagulabilidade. A terapêutica anticoagulante oral com antagonistas da vitamina K (AVKs) é amplamente indicada para prevenção e/ou controle de distúrbios da coagulação. O manuseio de administração dos AVKs é difícil devido à complexidade da definição da dose. Em geral, o monitoramento de indivíduos submetidos à terapêutica com AVK é realizado pela determinação do tempo de protrombina, em que se avalia o grau de anticoagulação através do coeficiente internacional normatizado. Invariavelmente, o fluxo do processamento laboratorial, que compreende as fases pré-analítica, analítica e pós-analítica, é importante para a fidedignidade dos resultados, repercutindo na conduta médica de forma determinante. O objetivo deste estudo foi a realização de uma revisão da literatura científica descritiva utilizando bases de dados eletrônicos para busca de materiais científicos, como Google Scholar, MEDLINE, LILACS, PubMed, SciELO e Science Direct. Abordamos alguns aspectos relacionados ao fluxo analítico da monitoração laboratorial em um laboratório de análises clínicas. Em conclusão, é necessária uma apropriada condução das fases analíticas para que seja possível o sucesso terapêutico com uso dos AVKs (AU)

Thrombosis is a disease characterized by hypercoagulable events. Oral anticoagulant therapy with vitamin K antagonists (VKAs) is widely indicated for prevention and/or control of coagulation disorders. The administration of VKAs is difficult because of the complexity of dose setting. In general, individuals submitted to VKA therapy are monitored by prothrombin time, in which the degree of anticoagulation is assessed by the international normalized ratio. Invariably, the flow of laboratory processing, which comprises pre-analytical, analytical, and post-analytical phases, is of importance to the trustworthiness of results, with significant consequences to the medical practice. The purpose of this study was to carry out a review of the scientific literature using electronic databases to search for scientific materials, such as Google Scholar, MEDLINE, LILACS, PubMed, SciELO, and Science Direct. We discuss some aspects related to the analytical flow of laboratory monitoring in a clinical laboratory. In conclusion, appropriate management of the analytical phases is necessary so that therapeutic success using VKAs is possible (AU)

Cervical human papillomavirus infection and persistence: a clinic-based study in the countryside from South Brazil

Abstract Human papillomavirus (HPV) infection is common in sexually active women and viral persistence may cause intraepithelial lesions and eventually progress to cervical cancer (CC). The present study aimed to investigate epidemiological factors related to HPV infection and to evaluate viral persistence and CC precursor lesions frequencies in women from a city in the countryside of South Brazil. Three hundred women were recruited from a primary public health care clinic. The patients were interviewed and underwent sampling with cervical brushes for HPV-DNA detection/typing by a PCR-based assay and cytological analysis by Pap smear test. HPV was detected in 47 (15.7%) women. HPV infection was significantly associated with young age (<30 years) and low socio-economic status. Seventeen (5.7%) women presented cytological abnormalities, three of them with precursor CC intraepithelial lesions. A subgroup of 79 women had been previously analyzed and thirteen (16.4%) were persistently infected, two with precursor CC intraepithelial lesions and high-risk HPV types infection (both of them without cervical abnormalities in the first exam). In conclusion, HPV infection was associated with young age (<30 years) and low family income; viral persistence was low (16.4%) but related to CC precursor lesions; and HPV-DNA high risk types detection would help to screen CC in the population.