The impact of hepatitis E infection on hepatic fibrosis in liver transplanted patients for hepatitis C infection

ABSTRACT Hepatitis E Virus (HEV) is an infection known worldwide for its asymptomatic and self-limited course in most cases. Some cases progressing to chronicity have been described in immunosuppressed patients, especially in recipients of solid organ transplants. We evaluated laboratory parameters of HEV infection (HEV RNA, anti-HEV IgM and anti-HEV IgG) through enzyme-linked immunosorbent assay (Elisa), confirmed by immunoblotting, in a cohort of 294 patients who received liver transplants at the HCFMUSP (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo). Laboratory and demographic data were collected from the entirety of the transplanted population. Hepatic biopsies of 122 patients transplanted due liver failure secondary to hepatitis C (HCV), with or without serological or molecular markers of HEV, were analyzed according to METAVIR score. Out of 24 (8.2%) patients tested positive for anti-HEV IgG, six (2%) were positive for anti-HEV IgM and 17 (5.8%) for HEV RNA. Of the patients transplanted because of HCV infection, 95 (77.8%) had received treatment including ribavirin for at least six months before blood sample collection. Among patients transplanted due to HCV cirrhosis who tested positive for anti-HEV IgG, only three (37.5%) showed fibrosis beyond stage 2, while five (41.7%) of the HEV RNA-positive patients had liver fibrosis beyond stage 2. Overall, the prevalence of HEV in the post-hepatic transplant scenario appears to be low, and, at least histologically, seemingly not harmful. We conclude that, although some studies reported a risk of HEV chronification, patients who had their livers transplanted due to HCV and showed serological or molecular markers of HEV did not have higher levels of fibrosis compared to patients who showed no indications of HEV infection at the time of the analysis.

Os esportes coletivos na escola: reflexões sobre as atividades curriculares desportivas / Collective sports in school: reflections on sports curricular activities

Na educação escolar pública do estado de São Paulo, além do momento de aprendizagem do esporte nas aulas regulares de Educação Física, desde o ano de 2001 os alunos também têm a possibilidade de participar das turmas de Atividades Curriculares Desportivas (ACDs). Imerso no contexto do esporte escolar, os objetivos do presente estudo foram identificar e analisar as ACDS de esportes coletivos, desenvolvidas nas escolas pertencentes a uma diretoria de ensino do interior de São Paulo, em relação: às modalidades ofertadas/aos gêneros das turmas/às faixas etárias, às práticas de ensino dos docentes e às expectativas de professores e alunos. A pesquisa, de abordagem qualitativa, envolveu análise documental, entrevista semiestruturada com 17 professores e aplicação de questionário a 292 alunos, todos estes envolvidos nas turmas de ACDs. Os resultados foram organizados em três categorias de análise, a saber: i. Circunscrevendo as ACDs (modalidades, gênero e faixa etária); ii. Metodologias de ensino; iii. Expectativas em relação às ACDs. O futsal é a modalidade mais presente nas escolas (51%), as turmas masculinas são mais frequentes (71,1%) e existem mais turmas para as faixas etárias de 13 a 17 anos (95%). As metodologias de ensino baseiam-se majoritariamente em práticas tradicionais/técnicas de ensino (88%). As expectativas dos docentes estão mais relacionadas à obtenção de bons resultados nos jogos escolares (70%), enquanto as dos alunos se assentam no gosto pelo esporte que praticam (89%). Considerando que a legislação paulista correspondente às ACDs defende uma formação cidadã, entendemos que os dados expressam reduzida variedade de ofertas de modalidades, precário atendimento do gênero feminino e de determinadas faixas etárias dos alunos, carência de metodologias de ensino inovadoras e divergência entre as expectativas dos professores e dos alunos....(AU)

In São Paulo state public schools, apart from learning about a sport in regular Physical Education classes, since 2001 the students also have the possibility to participate in the classes of Sports Curricular Activities (SCA). According to the context of school sports, the aims of the present study were to identify and to analyze the SCA of team sports developed at schools which belongs to a teaching board of interior of São Paulo in relation to: the modalities offered / to the gender of the classes /to the age groups/to the teaching practices and the expectations of teachers and students. This study was based on a qualitative research involving a documental analysis, a semistructured interview with 17 teachers and a questionnaire to 292 students, all of them involved in the classes of SCA. The results were organized into three categories of analysis, namely: i. Circumscribing the SCA (modalities, gender and age group); ii. Teaching methodologies; iii. Expectations regarding to SCA. The indoor soccer is the most present form of sport in schools (51%), male classes are more frequent (71.1%), and there are more classes for the ages of 13 to 17 years old (95%). The teaching methodologies are mostly based on traditional/technical teaching practices (88%). The expectations of teachers are more related to obtaining good results in school games (70%), while the expectations of the students are based on the taste for the sport they practice (89%). Considering that São Paulo legislation which corresponds to the SCA advocates a citizen education, we believe that the data express a reduced variety of modality offers, precarious attendance of the female gender and determined age range of the students, a lack of innovative teaching methodologies and divergence between the teachers and students' expectations....(AU)