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3.
Rev. Ciênc. Plur ; 8(2): e24290, mar. 2022. ilus, tab
Article in Portuguese | LILACS, BBO | ID: biblio-1367904

ABSTRACT

Introdução:O Serviço de Assistência Especializada é um serviço responsável pela assistência ambulatorial às pessoas vivendo com HIV/AIDSe Hepatites Virais. Em meio à importância desses serviços, é primordial instituir estratégias de avaliação do seu desempenho.Objetivo:Assim, objetivou-se construir e validar um modelo lógico para o Serviço de Atenção Especializada do município de Natal.Metodologia:Para tanto, desenvolveu-se um estudo metodológico para validação de um modelo lógicoconstruído com técnicas de abordagem qualitativa. Os profissionais participaram da fase de construção e validação do modelo. Para construção do modelo lógico foram realizadas duas técnicas; revisão de literatura para uma construção prévia ao grupo focal eo grupo focal para viabilizar a construção participativa do modelo e posterior validação de conteúdo. Os dados colhidos foram analisados de forma qualitativa, buscando identificar nos discursos, a pertinência dos elementos do modelo, bem como a possível inserção de outros elementos. Resultados:O modelo construído com base na Revisão de literatura foi aprovado por consenso dos participantes, não sendo sugeridas modificações. No caso, a missão, recursos, processos, resultados, contexto foram considerados adequados e o modelo ilustrativo do funcionamento esperado. Conclusões:O modelo lógico pretende viabilizar uma auto avaliação do serviço, auxiliando a administração e os profissionais a identificarem problemas, buscando estratégias de melhoria. Espera-se que a reflexão propiciada no grupo focal possa sensibilizar os profissionais para buscar estratégias de enfrentamento das dificuldades elencadas e aprimoramento dos pontos positivos (AU).


Introduction:The Specialized Care Service is a service responsible for outpatient care for people living with HIV/AIDSand Viral Hepatitis. In the midst of the importance of these services, it is essential to institute performance evaluation strategies.Objective:Thus, the objective was to build and validate a logical model for the Specialized Care Service of the municipality of Natal.Methodology:Therefore, a methodological study was developed to validate a logical model built with qualitative approach techniques. Theprofessionals participated in the model construction and validation phase. To build the logical model, two techniques were performed; literature review for prior construction of the focus group and focus group to enable participatory model construction and subsequent content validation. The collected data were analyzed qualitatively, seeking to identify in the speeches, the pertinence of the model elements, as well as the possible insertion of other elements.Results:The model constructed based on the literature review was approved by consensus of the participants, and no modifications were suggested. In this case, the mission, resources, processes, results, context were considered adequate and the illustrative model of the expected functioning. Conclusions:The logical model aims to enable a self-assessment of the service, helping management and professionals to identify problems, seeking improvement strategies. It is hoped that the reflection provided in the focus group can sensitize professionals to seek strategies to cope with the difficulties listed and improvement of positive points (AU).


Introducción: El Servicio de Asistencia Especializada es un servicio responsable de la atención ambulatoria para personas que viven con VIH / SIDA y Hepatitis Virales. En medio de la importancia de estos servicios, es fundamental establecer estrategias para evaluar su desempeño. Objetivo: Así, el objetivo fue construir y validar un modelo lógico para el Servicio de AtenciónEspecializada del municipio de Natal. Metodología: Para ello se desarrolló un estudio metodológico para validar un modelo lógico construido con técnicas de enfoque cualitativo. Profesionales participaron en la fase de construcción y validación del modelo. Se utilizaron dos técnicas para construir el modelo lógico; revisión de la literatura para una construcción previa al focus group y al focus group que posibilite la construcción participativa del modelo y posterior validación de contenido. Los datos recolectados fueron analizados de manera cualitativa, buscando identificar en los discursos, la pertinencia de los elementos del modelo, así como la posible inserción de otros elementos.Resultados: El modelo construido a partir de la revisión de la literatura fue aprobado por consenso de los participantes, sin que se sugirieran modificaciones. En este caso se consideró adecuado la misión, recursos, procesos, resultados, contexto y el modelo ilustrando el funcionamiento esperado. Conclusiones: El modelo lógico pretende posibilitar una autoevaluación del servicio, ayudando a la dirección y profesionales a identificar problemas, buscando estrategias de mejora. Se espera que la reflexión brindada en el grupo focal pueda sensibilizar a los profesionales para buscar estrategias para enfrentar las dificultades enumeradas y mejorar los puntos positivos (AU).


Subject(s)
Humans , Male , Female , Health Evaluation , HIV , Health Strategies , Basic Health Services , Hepatitis , Organization and Administration , Brazil , Focus Groups , Qualitative Research , Ambulatory Care , Persons
5.
Article in Chinese | WPRIM | ID: wpr-880827

ABSTRACT

OBJECTIVE@#To investigate the role of NDUFA13 inactivation in the pathogenesis of spontaneous hepatitis in mice and explore the possible mechanisms.@*METHODS@#Hepatocyte-specific NDUFA13 knockout (NDUFA13@*RESULTS@#Liver-specific NDUFA13 heterozygous knockout mice were successfully constructed as verified by PCR results. HE staining revealed severe liver damage in both 4- week-old and 2-year-old NDUFA13@*CONCLUSIONS@#Hepatocytes-specific NDUFA13 ablation can trigger spontaneous hepatitis in mice possibly mediated by the activation of ROS/NF-κB/NLRP3 signaling.


Subject(s)
Animals , Hepatitis , Inflammasomes , Mice , NF-kappa B/metabolism , NLR Family, Pyrin Domain-Containing 3 Protein/genetics , Signal Transduction
7.
Rev. chil. infectol ; 37(5): 531-540, nov. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1144247

ABSTRACT

Resumen Introducción: Para los pacientes receptores de trasplante hepático (TH) la hepatitis por citomegalovirus (CMV) constituye una entidad de difícil diagnóstico. Nuestro objetivo fue determinar la real incidencia de hepatitis por CMV aplicando técnicas diagnósticas más específicas. Material y Métodos: Estudio retrospectivo/ prospectivo, en un centro de trasplante hepático. Período de estudio: años 2009 al 2019. Se incluyeron los TH que presentaron elementos sugestivos y/o específicos de CMV en la histopatología de la punción biopsia hepática (PBH), a los que se les realizó inmunohistoquimica (IHQ) en la PBH. Población control n = 17. Resultados: 41 casos cumplieron los criterios de inclusión. La IHQ fue positiva en n = 6 (14,6%). En la población control, la IHQ fue negativa en el 100% de los casos. Esto traduce un valor predictor negativo de 100% para la histopatología en el diagnóstico de hepatitis por CMV, con un valor predictor positivo de 14,6%. En 85% de los pacientes con IHQ negativa, hubo diagnósticos alternativos. La terapia antiviral en la fase retrospectiva se indicó en 48% y en la prospectiva en 21%. Conclusiones: Combinar la histopatología con la IHQ optimiza el diagnóstico de hepatitis por CMV; lo que permite la racionalización del uso de antivirales de alto costo y la búsqueda de etiologías diferenciales.


Abstract Background: Cytomegalovirus (CMV) hepatitis constitutes a challenging diagnostic entity in liver transplant (LT) recipients. Aim: To determine the real incidence of CMV hepatitis using more specific diagnostic tools as those currently used before. Methods: Retrospective/prospective study conducted in a hepatic transplant unit from 2009 to 2019. LT recipients with CMV specific or suggestive elements in histopathology of hepatic biopsies were included. Immunohistochemistry (IHQ) was performed in tissue samples of the studied cohort as well as in a control one. Results: 41 patients met the inclusion criteria. IHQ was diagnostic in 6 (14.6%), and was negative in 100% of the control population. The negative predictive value of the histopathology for CMV hepatitis diagnosis was 100% and the positive predictive value was 14.6%. 85% of patients in whom the IHQ was negative had alternative diagnosis Antiviral therapy in the retrospective analysis was indicated in 48% of patients and in 21% of the prospectively analyzed cohort. Conclusions: Histopathology and IHQ combination improves the diagnostic accuracy of CMV hepatitis which translates into a rational us of expensive antiviral therapy and to search for differential diagnosis


Subject(s)
Humans , Liver Transplantation , Cytomegalovirus Infections/diagnosis , Antiviral Agents/therapeutic use , Prospective Studies , Retrospective Studies , Cytomegalovirus , Hepatitis/drug therapy
8.
Article in English | WPRIM | ID: wpr-811418

ABSTRACT

PURPOSE: To evaluate the effect of gluten-free diet (GFD) on hepatitis B surface antibody (HBsAb) concentrations among previously immunized pediatric celiac disease (CD) subjects.METHODS: We retrospectively evaluated pediatric CD subjects in serological remission who were previously immunized for hepatitis B virus as infants. The temporal relationship between HBsAb concentration, the amount of time on a GFD, and age were evaluated.RESULTS: Overall, 373 CD subjects were analyzed: 156 with HBsAb sampled prior to GFD initiation and 217 after initiation of a GFD and in serological remission. Median age at HBsAb concentration measurement for those before and after GFD initiation was 5.3 years (interquartile range [IQR], 3.1–9.2 years) and 7.6 years (IQR, 5.4–10.9 years), respectively (p<0.001). There was no sex difference between the groups. The median time of HBsAb measurement was 2 months (IQR, 0–5.7 months) before and 12.8 months (IQR, 5.3–30.3 months) after initiation of GFD. The HBsAb concentration was low in 79 (50.6%) and 121 (55.7%) subjects before and after GFD initiation, respectively (p=0.350). Age was inversely associated with low HBsAb concentrations. Neither being on a GFD nor sex was associated with low HBsAb concentrations.CONCLUSION: Adherence to a GFD does not affect HBsAb concentration in children with CD. Age is inversely associated with HBsAb concentration.


Subject(s)
Antibodies , Celiac Disease , Child , Diet, Gluten-Free , Glutens , Hepatitis B virus , Hepatitis B , Hepatitis , Humans , Immunization , Infant , Retrospective Studies , Sex Characteristics
9.
Article in English | WPRIM | ID: wpr-811412

ABSTRACT

Giant cell hepatitis with autoimmune hemolytic anemia (AHA) is a rare disease of infancy characterized by the presence of both Coombs-positive hemolytic anemia and progressive liver disease with giant cell transformation of hepatocytes. Here, we report a case involving a seven-month-old male infant who presented with AHA followed by cholestatic hepatitis. The clinical features included jaundice, pallor, and red urine. Physical examination showed generalized icterus and splenomegaly. The laboratory findings suggested warm-type AHA with cholestatic hepatitis. Liver biopsy revealed giant cell transformation of hepatocytes and moderate lobular inflammation. The patient was successfully treated with four doses of rituximab. Early relapse of hemolytic anemia and hepatitis was observed, which prompted the use of an additional salvage dose of rituximab. He is currently in clinical remission.


Subject(s)
Anemia, Hemolytic , Anemia, Hemolytic, Autoimmune , Biopsy , Giant Cells , Hepatitis , Hepatocytes , Humans , Infant , Inflammation , Jaundice , Liver , Liver Diseases , Male , Pallor , Physical Examination , Rare Diseases , Recurrence , Rituximab , Splenomegaly
10.
Article in English | WPRIM | ID: wpr-811068

ABSTRACT

PURPOSE: The incidence of drug-induced liver injury (DILI) has been increasing; however, few algorithms are available to identify DILI in electronic health records (EHRs). We aimed to identify and evaluate DILI with an appropriate screening algorithm.METHODS: We collected data from 3 university hospitals between June 2015 and May 2016 using our newly developed algorithm for identifying DILI. Among patients with alanine transferase (ALT) ≤ 120 IU/L and total bilirubin (TB) ≤ 2.4 mg/dL in blood test results within 48 hours of admission, those who either had 1) ALT > 120 IU/L and TB > 2.4 mg/dL or 2) ALT > 200 IU/L at least once during hospitalization were identified. After excluding patients with liver disease-related diagnosis at discharge, medical records were retrospectively reviewed to evaluate epidemiological characteristics of DILI.RESULTS: The total number of inpatients was 256,598, of whom 1,100 (0.43%) were selected by the algorithm as suspected DILI. Subsequently, 365 cases (0.14% of total inpatients, 95% confidence interval, 0.13–0.16) were identified as DILI, yielding a positive predictive value of 33.1%. Antibiotics (n = 214, 47.2%) were the major class of causative drug followed by chemotherapeutic agents (n = 87, 19.2%). The most common causative drug was piperacillin-tazobactam (n = 38, 8.4%); the incidence of DILI by individual agent was highest for methotrexate (19.4 cases/1,000 patients administered the drug). Common reasons for excluding suspected DILI cases were ischemic hepatitis and postoperative liver dysfunction.CONCLUSIONS: Using our EHR-based algorithm, we identified that approximately 0.14% of patients developed DILI during hospitalization. Further studies are needed to modify criteria for more accurate identification of DILI.


Subject(s)
Alanine , Anti-Bacterial Agents , Bilirubin , Diagnosis , Chemical and Drug Induced Liver Injury , Drug-Related Side Effects and Adverse Reactions , Electronic Health Records , Hematologic Tests , Hepatitis , Hospitalization , Hospitals, University , Humans , Incidence , Inpatients , Liver , Liver Diseases , Mass Screening , Medical Records , Methotrexate , Pharmacoepidemiology , Retrospective Studies , Transferases
11.
Article in English | WPRIM | ID: wpr-810952

ABSTRACT

BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.CONCLUSION: Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.


Subject(s)
Antiviral Agents , Carcinoma, Hepatocellular , Cohort Studies , DNA , Follow-Up Studies , Half-Life , Hepatitis B Surface Antigens , Hepatitis B virus , Hepatitis B , Hepatitis , Humans , Immunoglobulins , Korea , Liver Transplantation , Liver , Organ Transplantation , Polymerase Chain Reaction , Recurrence , Transplants
12.
Article in English | WPRIM | ID: wpr-826314

ABSTRACT

BACKGROUND@#Physical activity (PA) that includes an accumulated exercise regimen that meets or exceeds a certain intensity reduces intrahepatic fat, leading to the improvement of nonalcoholic fatty liver disease (NAFLD) in afflicted patients. However, whether an increase in comprehensive PA, including activities of daily living, contributes to ameliorating the pathophysiology of NAFLD remains unclear. This study aimed to examine whether PA improves liver function in patients with NAFLD.@*METHODS@#The study included 45 patients with NAFLD who underwent follow-up examinations at least 6 months-but no later than 1 year-after their baseline examinations. The patients were interviewed about their daily activities and exercise habits to determine whether they had engaged in at least 3 metabolic equivalents (METs) per day during the previous 6 months; the quantity of PA, expressed in Ekusasaizu (Ex) units, was calculated as METs multiplied by hours. Patients who had achieved at least a 1-Ex increase in PA per week compared to baseline at the time of their follow-up interview (the PA increase group) were compared to those whose PA was the same or lower at the time of follow-up (the PA non-increase group).@*RESULTS@#There were no significant changes in all blood and biochemical parameters in the PA non-increase group at the time of follow-up when compared with baseline levels. In the PA increase group, aspartate aminotransferase, alanine aminotransferase, and γ-guanosine triphosphate levels were all significantly lower at follow-up than they were at baseline. Body weight did not change significantly from baseline to follow-up in both groups.@*CONCLUSIONS@#In the present study, hepatic inflammation improvement was accompanied by increased PA but not decreased body weight. Increasing PA may be effective for the improvement of hepatic inflammation even without body weight loss. Our results indicate the effectiveness of PA monitoring for the management of NAFLD.@*TRIAL REGISTRATION@#UMIN-CTR, UMIN000038530.


Subject(s)
Activities of Daily Living , Adult , Aged , Aged, 80 and over , Body Weight , Exercise , Female , Hepatitis , Humans , Male , Middle Aged , Non-alcoholic Fatty Liver Disease , Weight Loss , Young Adult
15.
Article in Chinese | WPRIM | ID: wpr-828882

ABSTRACT

OBJECTIVE@#Abnormalities of liver-related indices are common in ICU patients, but the effects of cholestasis and hypoxic hepatitis in critically ill patients remains unclarified. The purpose of this study was to investigate the effects of cholestasis and hypoxic liver dysfunction on the prognosis of ICU patients.@*METHODS@#A retrospective study was conducted based on the data of patients admitted to the ICU for the first time between 2001 and 2011 archived in the MIMIC-Ⅲ database. The patients were divided into cholestasis, hypoxic hepatitis and control groups, and their 28-day case fatality rate as the primary outcome was compared among the groups.@*RESULTS@#A total of 5852 ICU patients were included in the analysis. The incidence of cholestasis and hypoxic liver dysfunction was 31.9% (1869/5852) and 17.9% (1046/5852), respectively. There was no significant difference in 28-day case fatality rate between cholestasis group and the control group. Compared with the control group, the patients with hypoxic hepatitis had a significantly higher 28-day case fatality rate (46% 35%, < 0.01), a higher hospital case fatality rate (40% 31%, < 0.01), and a higher ICU case fatality rate (35.7% 22.2%, < 0.01). Logistic regression analysis showed that lactic acid (LAC), aspartate transaminase (AST), and international standard ratio (INR) were independent risk factors for 28-day case fatality rate.@*CONCLUSIONS@#The incidence of cholestatic liver dysfunction is higher than that of hypoxic hepatitis, but it does not increase the 28-day case fatality rate of the ICU patients, suggesting that cholestatic liver dysfunction may be the early adaptation of the liver to critical diseases.


Subject(s)
Cholestasis , Hepatitis , Humans , Intensive Care Units , Prognosis , Retrospective Studies
16.
Article in Korean | WPRIM | ID: wpr-786182

ABSTRACT

The kidneys are closely connected with several organs, including the liver, and can therefore be negatively affected when the liver is damaged. The most common cause of chronic liver disease is chronic viral hepatitis, resulting from either a hepatitis B virus (HBV) or a hepatitis C virus (HCV). Chronic viral hepatitis often progresses to cirrhosis and hepatocellular carcinoma. However, it can also lead to viral-associated glomerulopathies that can cause chronic kidney disease (CKD), which can then progress to end stage renal disease (ESRD). Additionally, patients with ESRD on hemodialysis are at risk for viral infections because HBV and HCV are hematogenously transmitted. Recently, treatments with oral nucleoside/nucleotide analogues and direct-acting antivirals have yielded excellent results in HBV- and HCV-infected patients with CKD. As a result, a new paradigm for the treatment of chronic viral infections in CKD patients has emerged. This review discusses viral-associated glomerulopathies, antiviral treatments of HBV and HCV infections in patients with CKD, and prevention strategies for the transmission of HBV and HCV in patients with ESRD.


Subject(s)
Antiviral Agents , Carcinoma, Hepatocellular , Chronic Disease , Fibrosis , Hepacivirus , Hepatitis , Hepatitis B virus , Humans , Kidney Diseases , Kidney Failure, Chronic , Kidney , Liver Diseases , Liver , Renal Dialysis , Renal Insufficiency, Chronic
17.
São Paulo; s.n; 2020. 101 p. ilus, map.
Thesis in Portuguese | SES-SP, LILACS, SES-SP, SESSP-CTDPROD, SES-SP, SESSP-TESESESSP, SES-SP | ID: biblio-1146100

ABSTRACT

Os vírus linfotrópicos de células T humanas dos tipos um e dois (HTLV-1 e HTLV-2) são endêmicos no Brasil. A triagem para HTLV-1/2 é obrigatória em bancos de sangue no país desde 1993, e a partir de 2014 é recomendada ao menos uma vez no acompanhamento de pacientes com HIV/aids, mas não em outras populações consideradas de risco para adquirir/transmitir esta infecção, como por exemplo, gestantes e pacientes com hepatites virais dos tipos B e C. Como o número de indivíduos em risco para adquirir/transmitir os HTLV a serem testados anualmente no Brasil é alto, qualquer estratégia que reduza o custo da triagem sorológica é necessária e bem vinda. O presente estudo avaliou o desempenho e o custo-minimização do uso de pool de soros na triagem sorológica de infecção por HTLV-1/2. Oitenta e uma amostras de soro sabidamente positivas para HTLV-1/2 foram retestadas utilizando dois ensaios imunoenzimáticos na triagem (EIA Murex HTLV I+II, Diasorin, e GOLD ELISA HTLV-1/2, REM) e dois testes confirmatórios [Western blot (WB), HTLV BLOT 2.4, MP Biomedicals e imunoensaio de linha (LIA), INNO-LIA HTLV I/II Score, Fujirebio], e separadas de acordo com os valores de DO/cut-off em: fortemente reagentes (DO/cut-off >12), e moderadamente reagentes (DO/cut-off >2,0 a 12,0). Posteriormente, estas amostras foram diluídas na razão dois em bolsa de plasma negativa para marcadores de banco de sangue até a perda de reatividade, e em seguida diluídas em diferentes pools de soros positivos e negativos para HIV, HBV e HCV, com vistas a determinar, respectivamente, a maior diluição de soro sem perda de sensibilidade e garantir a especificidade da reação. Subsequentemente, amostras com volume suficiente para ensaios de validação de métodos de diagnóstico segundo os parâmetros estabelecidos pelo Instituto Adolfo Lutz (P-SG-0022) foram selecionadas e testadas quanto à estratégia de pool de soros; 40 pools foram utilizados nos testes de acurácia e sete pools nos de precisão. Para o cálculo de redução de custo (custo-minimização), 2.000 amostras de soro/plasma de pacientes com hepatites virais B e C, e 625 amostras de plasma de pacientes com HIV/aids que haviam sido testadas individualmente e cujos resultados haviam sido publicados foram avaliadas em pool. Os resultados obtidos mostraram que o kit Murex foi mais sensível podendo ser diluído na razão 1:5 sem perda de sensibilidade e especificidade diagnóstica, com resultados de exatidão, precisão, sensibilidade, especificidade, valor preditivo positivo e negativo de 100% (coeficiente de correlação Kappa = 1). Em populações de risco, o uso da estratégia de pool de soros mostrou a mesma sensibilidade da análise individual, e uma redução de custo de 70,4% no grupo HBV, 60,7% no grupo HCV e 73,6% no grupo HIV/aids; estando o custo-minimização relacionado à prevalência da infecção nas populações de estudo: 1,9% (HBV), 4,0% (HCV), e 1,1% (HIV/aids). Concluindo, os resultados obtidos permitem sugerir a introdução da triagem sorológica para HTLV-1/2 utilizando pool de cinco soros e o kit Murex em inquéritos epidemiológicos, no acompanhamento de pacientes com outras infecções virais e possivelmente em gestantes no pré-natal.


Subject(s)
Virus Diseases , Serum , Hepatitis , Infections
18.
Rev. Soc. Bras. Med. Trop ; 53: e20200152, 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136830

ABSTRACT

Abstract During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.


Subject(s)
Humans , Male , Adult , Yellow Fever/complications , Hepatitis/complications , Recurrence , Hepatitis/immunology
19.
Rev. Soc. Bras. Med. Trop ; 53: e20200141, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136831

ABSTRACT

Abstract INTRODUCTION: Canine visceral leishmaniasis (CVL) is an endemic disease in Brazil, and integrated control actions have been adopted by the Brazilian Ministry of Health to control its spread. However, the transmission profile is unknown in areas with recent CVL cases, including Itaúna, located in the Brazilian state of Minas Gerais, where the present study was carried out. METHODS: A total of 2,302 dogs from 12 neighborhoods were serologically tested for canine VL using the current diagnostic protocol adopted by the Brazilian Ministry of Health. Test positivity rate (TPR) and CVL prevalence were determined for each neighborhood. The presence of Leishmania was assessed in 60 seropositive dogs which had been recommended for euthanasia. Twenty-two of them (37%) were asymptomatic, and 38 (63%) were symptomatic for CVL. Parasitological (myeloculture and smear/imprint) and molecular (PCR) methods were employed for Leishmania detection in bone marrow, spleen, mesenteric lymph nodes, and ear skin. The infecting Leishmania species was identified by DNA sequencing. RESULTS: CVL prevalence (per 1,000 dogs) varied from 0.0-166.67, depending on the neighborhood, with a mean of 68.96 (SD 51.38). Leishmania DNA was detected in at least one tissue from all seropositive dogs, with comparable TPR among tissues. Leishmania parasites were identified in most (54/60) seropositive dogs, and the infecting parasite was identified as Leishmania infantum in all of these. CONCLUSIONS: Prevalence of CVL is a contributor to the spread of visceral leishmaniasis in Itaúna.


Subject(s)
Humans , Male , Adult , Yellow Fever/complications , Hepatitis/complications , Recurrence , Hepatitis/immunology
20.
Actual. SIDA. infectol ; 28(108): 30-37, 20201000. fig, tab
Article in Spanish | LILACS | ID: biblio-1349405

ABSTRACT

La disfunción inmune asociada a la infección por el virus de la inmunodeficiencia humana (VIH) es generada por una estimulación crónica del sistema inmune secundaria a la imposibilidad del organismo de erradicar el virus. La misma se encuentra exacerbada en el contexto de la coinfección por el virus de la hepatitis C (VHC). La inflamación sistémica producto de la coinfección por ambos virus genera un aumento de la morbilidad y mortalidad en los individuos afectados. Son varios los mediadores solubles de activación inmunológica, como IP-10, TNF-α, IL-6, IL-1ß (marcadores de inflamación sistémica); IL-17 (linfocitos T CD4+ Th17); IL-2, IFN-γ (linfocitos T CD4+ Th1); IL-8 (inducción de neutrofilia); CD23s, ICAMs, CD14s, CD163s (marcadores de activación de monocitos/macrófagos), niveles circulantes de lipopolisacárido (LPS) (translocación bacteriana); entre otros. Actualmente se necesitan más estudios para lograr definir cuáles serían los biomarcadores de progresión óptimos para el seguimiento de los individuos coinfectados por VIH/VHC. El objetivo de esta revisión es realizar una reseña sobre los mecanismos inmunopatológicos de la infección por VIH/VHC involucrados en la inflamación, daño hepático y su impacto en la morbimortalidad de los individuos coinfectados


The immune dysfunction associated with Human Immunodeficiency Virus (HIV) infection is generated by a chronic stimulation of the immune system, because of the inability to eradicate the virus from the host. This immune dysfunction is exacerbated in the context of coinfection with Hepatitis C Virus (HCV). Systemic inflammation caused by coinfection with both viruses generates an increase in morbidity and mortality in affected individuals. There are several soluble mediators of immunological activation, such as IP-10, TNF-α, IL-6, IL-1ß (systemic inflammation markers); IL-17 (CD4+ T cells Th17); IL-2, IFN-γ (CD4+ T cells Th1); IL-8 (neutrophilia); CD23s, ICAMs, CD14s, CD163s, lipopolysaccharide (LPS) (monocyte/macrophage activation markers and bacterial translocation); among others. Currently, more studies are needed to define optimal progression biomarkers for the follow-up of HIV/HCV coinfected individuals. In this review, we focus on the immunopathological mechanisms of HIV/HCV infection involved in inflammation, liver damage and its impact on the morbidity and mortality of affected individuals


Subject(s)
Humans , Biomarkers , HIV Infections/immunology , Hepacivirus/immunology , Coinfection/immunology , Hepatitis/immunology , Immunity , Immune System Diseases , Inflammation/immunology
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