A Educação Física e seus processos de trabalho nas Residências em Saúde no Estado do Ceará

Essa é uma pesquisa de natureza qualitativa como parte de um estudo de dissertação de mestrado e tem como objetivo enunciar a atuação dos profissionais de educação física nas residências multiprofissionais em saúde no estado do Ceará. Participaram da pesquisa doze profissionais de educação física que concluíram a sua formação na residência no ano de 2019. Os profissionais foram convidados voluntariamente a participar de uma entrevista semiestrutura após a assinatura do Termo de Consentimento Livre e Esclarecido. Convencionou-se após a análise dos dados, a formação de quatro categorias empíricas: intersetorialidade, grupos terapêuticos, atenção básica e saúde mental. Os principais resultados apontam que a residência em saúde oportuniza ao profissional de educação física, vivências na atenção básica e na saúde mental a partir da intersetorialidade, das ferramentas de cuidado, do trabalho colaborativo e dos grupos terapêuticos. Compreende-se, a partir desta pesquisa que a atuação do profissional de educação física nas residências multiprofissionais em saúde no estado do Ceará tem o propósito de fortalecer os caminhos já trilhados, problematizar novas possibilidades de cuidado e de espaços para a categoria na saúde pública.

Planning and support in the work process of PHC teams in the Northeast: analysis of the PMAQ-AB (3rd cycle). / Planejamento e apoio no processo de trabalho das equipes de atenção básica no Nordeste: análise do PMAQ-AB (3º ciclo).

This paper aims to describe the indicators related to planning and support in the work process reported by the Family Health Teams, from the 3rd cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the Brazilian Northeast. This cross-sectional study employed secondary data from the external evaluation of the 3rd cycle of the PMAQ-AB. Sixteen indicators were used to ascertain the teams' work process actions, and 14,489 family health teams that adhered to the program were evaluated. Among the indicators assessed, we found that the teams held a meeting and planned actions and self-evaluated, monitored, and analyzed health indicators to reorganize the work process, highlighting the determining and conditioning factors. Health surveillance and the Extended Family Health Center (NASF) stand out in the indicators of institutional support and multidisciplinary support for solving complex cases. We identified improvements in the work process of the teams in the Northeast region, but the reality of fragmented and vertical work still requires a change to promote an outlook of shared teamwork, directly influencing the work process.

O objetivo deste artigo é descrever os indicadores referentes ao planejamento e apoio no processo de trabalho reportados pelas Equipes de Saúde da Família, a partir do 3º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) na região Nordeste do Brasil. Estudo transversal, utilizando dados secundários da avaliação externa do 3º ciclo do PMAQ-AB. Dezesseis indicadores foram utilizados para averiguar as ações do processo de trabalho das equipes. Avaliaram-se 14.489 equipes de saúde da família que aderiram ao programa. Dentre os indicadores avaliados, verificou-se que as equipes realizaram reunião e planejamento das ações, autoavaliação, monitoramento e análise dos indicadores de saúde para reorganização do processo de trabalho, evidenciando os fatores determinantes e condicionantes. Nos indicadores de apoio institucional e apoio matricial para resolução de casos complexos, destacam-se a vigilância em saúde e o Núcleo Ampliado de Saúde da Família (NASF). Identificou-se que ocorreram melhorias no processo de trabalho das equipes na região Nordeste, porém, ainda precisa mudar a realidade de trabalho fragmentada e verticalizada, favorecendo um panorama de trabalho em equipe e compartilhado, influenciando diretamente no processo de trabalho.

Planejamento e apoio no processo de trabalho das equipes de atenção básica no Nordeste: análise do PMAQ-AB (3º ciclo) / Planning and support in the work process of PHC teams in the Northeast: analysis of the PMAQ-AB (3rd cycle)

Resumo O objetivo deste artigo é descrever os indicadores referentes ao planejamento e apoio no processo de trabalho reportados pelas Equipes de Saúde da Família, a partir do 3º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) na região Nordeste do Brasil. Estudo transversal, utilizando dados secundários da avaliação externa do 3º ciclo do PMAQ-AB. Dezesseis indicadores foram utilizados para averiguar as ações do processo de trabalho das equipes. Avaliaram-se 14.489 equipes de saúde da família que aderiram ao programa. Dentre os indicadores avaliados, verificou-se que as equipes realizaram reunião e planejamento das ações, autoavaliação, monitoramento e análise dos indicadores de saúde para reorganização do processo de trabalho, evidenciando os fatores determinantes e condicionantes. Nos indicadores de apoio institucional e apoio matricial para resolução de casos complexos, destacam-se a vigilância em saúde e o Núcleo Ampliado de Saúde da Família (NASF). Identificou-se que ocorreram melhorias no processo de trabalho das equipes na região Nordeste, porém, ainda precisa mudar a realidade de trabalho fragmentada e verticalizada, favorecendo um panorama de trabalho em equipe e compartilhado, influenciando diretamente no processo de trabalho.

Abstract This paper aims to describe the indicators related to planning and support in the work process reported by the Family Health Teams, from the 3rd cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the Brazilian Northeast. This cross-sectional study employed secondary data from the external evaluation of the 3rd cycle of the PMAQ-AB. Sixteen indicators were used to ascertain the teams' work process actions, and 14,489 family health teams that adhered to the program were evaluated. Among the indicators assessed, we found that the teams held a meeting and planned actions and self-evaluated, monitored, and analyzed health indicators to reorganize the work process, highlighting the determining and conditioning factors. Health surveillance and the Extended Family Health Center (NASF) stand out in the indicators of institutional support and multidisciplinary support for solving complex cases. We identified improvements in the work process of the teams in the Northeast region, but the reality of fragmented and vertical work still requires a change to promote an outlook of shared teamwork, directly influencing the work process.

A novel JAK/ROCK inhibitor, CPL409116, demonstrates potent efficacy in the mouse model of systemic lupus erythematosus.

Systemic lupus erythematosus is a chronic inflammatory disease, in which treatment is still limited due to suboptimal efficacy and toxicities associated with the available therapies. JAK kinases are well known to play an important role in systemic lupus erythematous. There is growing evidence that ROCK kinases are also important in disease development. In this paper, we present the results of the development of CPL409116, a dual JAK and ROCK inhibitor. The studies we performed demonstrate that this molecule is an effective JAK and ROCK inhibitor which efficiently blocks disease progression in NZBWF1/J mouse models of systemic lupus erythematous.

Hardware Realization of the Pattern Recognition with an Artificial Neuromorphic Device Exhibiting a Short-Term Memory.

Materials exhibiting memory or those capable of implementing certain learning schemes are the basic building blocks used in hardware realizations of the neuromorphic computing. One of the common goals within this paradigm assumes the integration of hardware and software solutions, leading to a substantial efficiency enhancement in complex classification tasks. At the same time, the use of unconventional approaches towards signal processing based on information carriers other than electrical carriers seems to be an interesting trend in the design of modern electronics. In this context, the implementation of light-sensitive elements appears particularly attractive. In this work, we combine the abovementioned ideas by using a simple optoelectronic device exhibiting a short-term memory for a rudimentary classification performed on a handwritten digits set extracted from the Modified National Institute of Standards and Technology Database (MNIST)(being one of the standards used for benchmarking of such systems). The input data was encoded into light pulses corresponding to black (ON-state) and white (OFF-state) pixels constituting a digit and used in this form to irradiate a polycrystalline cadmium sulfide electrode. An appropriate selection of time intervals between pulses allows utilization of a complex kinetics of charge trapping/detrapping events, yielding a short-term synaptic-like plasticity which in turn leads to the improvement of data separability. To the best of our knowledge, this contribution presents the simplest hardware realization of a classification system capable of performing neural network tasks without any sophisticated data processing.

NADPH Oxidase 5 Is a Pro-Contractile Nox Isoform and a Point of Cross-Talk for Calcium and Redox Signaling-Implications in Vascular Function.

BACKGROUND: NADPH Oxidase 5 (Nox5) is a calcium-sensitive superoxide-generating Nox. It is present in lower forms and higher mammals, but not in rodents. Nox5 is expressed in vascular cells, but the functional significance remains elusive. Given that contraction is controlled by calcium and reactive oxygen species, both associated with Nox5, we questioned the role of Nox5 in pro-contractile signaling and vascular function. METHODS AND RESULTS: Transgenic mice expressing human Nox5 in a vascular smooth muscle cell-specific manner (Nox5 mice) and Rhodnius prolixus, an arthropod model that expresses Nox5 endogenoulsy, were studied. Reactive oxygen species generation was increased systemically and in the vasculature and heart in Nox5 mice. In Nox5-expressing mice, agonist-induced vasoconstriction was exaggerated and endothelium-dependent vasorelaxation was impaired. Vascular structural and mechanical properties were not influenced by Nox5. Vascular contractile responses in Nox5 mice were normalized by N-acetylcysteine and inhibitors of calcium channels, calmodulin, and endoplasmic reticulum ryanodine receptors, but not by GKT137831 (Nox1/4 inhibitor). At the cellular level, vascular changes in Nox5 mice were associated with increased vascular smooth muscle cell [Ca2+]i, increased reactive oxygen species and nitrotyrosine levels, and hyperphosphorylation of pro-contractile signaling molecules MLC20 (myosin light chain 20) and MYPT1 (myosin phosphatase target subunit 1). Blood pressure was similar in wild-type and Nox5 mice. Nox5 did not amplify angiotensin II effects. In R. prolixus, gastrointestinal smooth muscle contraction was blunted by Nox5 silencing, but not by VAS2870 (Nox1/2/4 inhibitor). CONCLUSIONS: Nox5 is a pro-contractile Nox isoform important in redox-sensitive contraction. This involves calcium-calmodulin and endoplasmic reticulum-regulated mechanisms. Our findings define a novel function for vascular Nox5, linking calcium and reactive oxygen species to the pro-contractile molecular machinery in vascular smooth muscle cells.

Vascular dysfunction in obese diabetic db/db mice involves the interplay between aldosterone/mineralocorticoid receptor and Rho kinase signaling.

Activation of aldosterone/mineralocorticoid receptors (MR) has been implicated in vascular dysfunction of diabetes. Underlying mechanisms are elusive. Therefore, we investigated the role of Rho kinase (ROCK) in aldosterone/MR signaling and vascular dysfunction in a model of diabetes. Diabetic obese mice (db/db) and control counterparts (db/+) were treated with MR antagonist (MRA, potassium canrenoate, 30 mg/kg/day, 4 weeks) or ROCK inhibitor, fasudil (30 mg/kg/day, 3 weeks). Plasma aldosterone was increased in db/db versus db/+. This was associated with enhanced vascular MR signaling. Norepinephrine (NE)-induced contraction was increased in arteries from db/db mice. These responses were attenuated in mice treated with canrenoate or fasudil. Db/db mice displayed hypertrophic remodeling and increased arterial stiffness, improved by MR blockade. Vascular calcium sensitivity was similar between depolarized arteries from db/+ and db/db. Vascular hypercontractility in db/db mice was associated with increased myosin light chain phosphorylation and reduced expression of PKG-1α. Vascular RhoA/ROCK signaling and expression of pro-inflammatory and pro-fibrotic markers were exaggerated in db/db mice, effects that were attenuated by MRA. Fasudil, but not MRA, improved vascular insulin sensitivity in db/db mice, evidenced by normalization of Irs1 phosphorylation. Our data identify novel pathways involving MR-RhoA/ROCK-PKG-1 that underlie vascular dysfunction and injury in diabetic mice.

Adipocyte-Specific Mineralocorticoid Receptor Overexpression in Mice Is Associated With Metabolic Syndrome and Vascular Dysfunction: Role of Redox-Sensitive PKG-1 and Rho Kinase.

Mineralocorticoid receptor (MR) expression is increased in adipose tissue from obese individuals and animals. We previously demonstrated that adipocyte-MR overexpression (Adipo-MROE) in mice is associated with metabolic changes. Whether adipocyte MR directly influences vascular function in these mice is unknown. We tested this hypothesis in resistant mesenteric arteries from Adipo-MROE mice using myography and in cultured adipocytes. Molecular mechanisms were probed in vessels/vascular smooth muscle cells and adipose tissue/adipocytes and focused on redox-sensitive pathways, Rho kinase activity, and protein kinase G type-1 (PKG-1) signaling. Adipo-MROE versus control-MR mice exhibited reduced vascular contractility, associated with increased generation of adipocyte-derived hydrogen peroxide, activation of vascular redox-sensitive PKG-1, and downregulation of Rho kinase activity. Associated with these vascular changes was increased elastin content in Adipo-MROE. Inhibition of PKG-1 with Rp-8-Br-PET-cGMPS normalized vascular contractility in Adipo-MROE. In the presence of adipocyte-conditioned culture medium, anticontractile effects of the adipose tissue were lost in Adipo-MROE mice but not in control-MR mice. In conclusion, adipocyte-MR upregulation leads to impaired contractility with preserved endothelial function and normal blood pressure. Increased elasticity may contribute to hypocontractility. We also identify functional cross talk between adipocyte MR and arteries and describe novel mechanisms involving redox-sensitive PKG-1 and Rho kinase. Our results suggest that adipose tissue from Adipo-MROE secrete vasoactive factors that preferentially influence vascular smooth muscle cells rather than endothelial cells. Our findings may be important in obesity/adiposity where adipocyte-MR expression/signaling is amplified and vascular risk increased.

Redox signaling, Nox5 and vascular remodeling in hypertension.

PURPOSE OF REVIEW: Extensive data indicate a role for reactive oxygen species (ROS) and redox signaling in vascular damage in hypertension. However, molecular mechanisms underlying these processes remain unclear, but oxidative post-translational modification of vascular proteins is critical. This review discusses how proteins are oxidatively modified and how redox signaling influences vascular smooth muscle cell growth and vascular remodeling in hypertension. We also highlight Nox5 as a novel vascular ROS-generating oxidase. RECENT FINDINGS: Oxidative stress in hypertension leads to oxidative imbalance that affects vascular cell function through redox signaling. Many Nox isoforms produce ROS in the vascular wall, and recent findings show that Nox5 may be important in humans. ROS regulate signaling by numerous processes including cysteine oxidative post-translational modification such as S-nitrosylation, S-glutathionylation and sulfydration. In vascular smooth muscle cells, this influences cellular responses to oxidative stimuli promoting changes from a contractile to a proliferative phenotype. SUMMARY: In hypertension, Nox-induced ROS production is increased, leading to perturbed redox signaling through oxidative modifications of vascular proteins. This influences mitogenic signaling and cell cycle regulation, leading to altered cell growth and vascular remodeling in hypertension.

Oxidative stress and human hypertension: vascular mechanisms, biomarkers, and novel therapies.

Hypertension is a major cardiovascular risk factor. Of the many processes involved in the pathophysiology of hypertension, vascular damage due to oxidative stress (excess bioavailability of reactive oxygen species [ROS]) is particularly important. Physiologically, ROS regulate vascular function through redox-sensitive signalling pathways. In hypertension, oxidative stress promotes endothelial dysfunction, vascular remodelling, and inflammation, leading to vascular damage. Vascular ROS are derived primarily by nicotinamide adenine dinucleotide phosphate oxidases, which are prime targets for therapeutic development. Although experimental evidence indicates a causative role for oxidative stress in hypertension, human data are less convincing. This might relate, in part, to suboptimal methods to accurately assess the redox state. Herein we review current knowledge on oxidative stress in vascular pathobiology and implications in human hypertension. We also discuss biomarkers to assess the redox state in the clinic, highlight novel strategies to inhibit ROS production, and summarize how lifestyle modifications promote vascular health by reducing oxidative stress.

Crosstalk between adipose tissue and blood vessels in cardiometabolic syndrome: implication of steroid hormone receptors (MR/GR).

Crosstalk between adipose tissue and blood vessels is vital to vascular homeostasis and is disturbed in cardiovascular and metabolic diseases such as hypertension, diabetes and obesity. Cardiometabolic syndrome (CMS) refers to the clustering of obesity-related metabolic disorders such as insulin resistance, glucose and lipid profile alterations, hypertension and cardiovascular diseases. Mechanisms underlying these associations remain unclear. Adipose tissue associated with the vasculature [known as perivascular adipose tissue (PVAT)] has been shown to produce myriads of adipose tissue-derived substances called adipokines, including hormones, cytokines and reactive oxygen species (ROS), which actively participate in the regulation of vascular function and local inflammation by endocrine and/or paracrine mechanisms. As a result, the signaling from PVAT to the vasculature is emerging as a potential therapeutic target for obesity and diabetes-related vascular dysfunction. Accumulating evidence supports a shift in our understanding of the crucial role of elevated plasma levels of aldosterone in obesity, promoting insulin resistance and hypertension. In obesity, aldosterone/mineralocorticoid receptor (MR) signaling induces an abnormal secretion of adipokines, ROS production and systemic inflammation, which in turn contribute to impaired insulin signaling, reduced endothelial-mediated vasorelaxation, and associated cardiovascular abnormalities. Thus, aldosterone excess exerts detrimental metabolic and vascular effects that participate to the development of the CMS and its associated cardiovascular abnormalities. In this review, we focus on the physiopathological roles of corticosteroid receptors in the interplay between PVAT and the vasculature, which underlies their potential as key regulators of vascular function.

Potencial antimicrobiano do óleo de coco no tratamento de feridas / Potential antimicrobial coconut oil in the treatment of wounds

Novos meios de controle da infecção em feridas surgem na saúde pública pelas implicações no cuidado, desenvolvimento de tecnologias e produtos relacionados aos curativos e controle dos microrganismos. A inovação tecnológica no tratamento de feridas pauta-se em plantas com propriedades antimicrobianas e cicatrizantes com relato etnobotânico. Estudo experimental in vitro desenvolvido no Laboratório de Pesquisa em Tratamento de Feridas, entre março e setembro de 2011 que investigou o potencial antimicrobiano do extrato oleoso do coco na perspectiva da prevenção da infecção e tratamento de feridas, utilizando 3 extratos do coco alagoano (dois artesanais e um industrializado) frente a 14 microrganismos para verificação da atividade antimicrobiana. Todos os extratos apresentaram atividade contra Staphylococcus aureus, contudo para o Staphylococcus epidermidis e Enterobacter cloacae apenas com os óleos artesanais. Necessita-se de ensaios para purificação dos extratos e identificação da substância inibidora dos microrganismos bem como a realização de estudos in vivo em feridas utilizando modelo animal.

Satisfacción de los actores del proceso enseñanza aprendizaje en la asignatura Morfofisiología II / Satisfaction of the actors involved in the teaching-learning process in Morphophysiology II subject

La implementación de nuevos programas en las Ciencias Básicas de pregrado para las carreras en Ciencias de la Salud, ha sido una tarea que mantiene inmersos a todos los docentes relacionados con ellas; el máximo exponente de la integración es la asignatura de Morfofisiología. Se proponen herramientas para comprobar la satisfacción de los actores del proceso docente-educativo en la Morfofisiología Humana II para la carrera de Medicina. Con ese propósito se diseñaron encuestas donde, además de recogerse datos generales, se abordan aspectos que evalúan el nivel de satisfacción de estudiantes y asesores que participan en la asignatura. Se utilizó la estadística descriptiva para expresar los resultados. Con respecto a los docentes, solo uno de ellos ejercía la función de facilitador, el resto fueron especialistas en Ciencias Básicas. La totalidad de los asesores encuestados opinaron que los alumnos no terminan la asignatura preparados en los contenidos que se abordan en función del perfil de médico general básico (MGB). Las encuestas a los alumnos arrojaron como resultado que existían problemas con los materiales de apoyo a la docencia (locales, computadoras y bibliografía) y la totalidad de encuestados opinó que hay necesidad de realizar actividades prácticas en las diferentes especialidades que conforman la asignatura. En la muestra estudiada, tanto los docentes como los alumnos quedaron insatisfechos con el proceso de enseñanza- aprendizaje de la Morfofisiología II(AU)

The implementation of new curricular programs in undergraduate basic sciences for the health sciences careers is a task that involves all the faculty related to them and the main example of the integration is the subject called Morphophysiology. This paper submitted some tools to verify the level of satisfaction of the actors involved in the teaching-educational process of human morphophysiology II in the medical studies. To this end, some surveys were designed where not only general data was collected but also those aspects assessing the level of satisfaction of students and advisers to this subject were addressed. The summary statistics was used to show the results. Regarding the faculty , just one of them was facilitator and the rest was specialists in basic sciences. All of the surveyed advisers stated that the students are not duly prepared in the contents addressed in terms of the profile of the Basic General Physician after they finished this subject. The surveys administered to the students yielded that there had been problems in the supply of teaching aid materials (premises, computers and bibliography) and all the surveyed participants believed that it was necessary to undertake practice in the various specialties of this subject. In the studied sample, both the students and the faculty were unsatisfied with the teaching/learning process in the subject Morphophysiology II(AU)

Satisfacción de los actores del proceso enseñanza aprendizaje en la asignatura Morfofisiología II / Satisfaction of the actors involved in the teaching-learning process in Morphophysiology II subject

La implementación de nuevos programas en las Ciencias Básicas de pregrado para las carreras en Ciencias de la Salud, ha sido una tarea que mantiene inmersos a todos los docentes relacionados con ellas; el máximo exponente de la integración es la asignatura de Morfofisiología. Se proponen herramientas para comprobar la satisfacción de los actores del proceso docente-educativo en la Morfofisiología Humana II para la carrera de Medicina. Con ese propósito se diseñaron encuestas donde, además de recogerse datos generales, se abordan aspectos que evalúan el nivel de satisfacción de estudiantes y asesores que participan en la asignatura. Se utilizó la estadística descriptiva para expresar los resultados. Con respecto a los docentes, solo uno de ellos ejercía la función de facilitador, el resto fueron especialistas en Ciencias Básicas. La totalidad de los asesores encuestados opinaron que los alumnos no terminan la asignatura preparados en los contenidos que se abordan en función del perfil de médico general básico (MGB). Las encuestas a los alumnos arrojaron como resultado que existían problemas con los materiales de apoyo a la docencia (locales, computadoras y bibliografía) y la totalidad de encuestados opinó que hay necesidad de realizar actividades prácticas en las diferentes especialidades que conforman la asignatura. En la muestra estudiada, tanto los docentes como los alumnos quedaron insatisfechos con el proceso de enseñanza- aprendizaje de la Morfofisiología II

The implementation of new curricular programs in undergraduate basic sciences for the health sciences careers is a task that involves all the faculty related to them and the main example of the integration is the subject called Morphophysiology. This paper submitted some tools to verify the level of satisfaction of the actors involved in the teaching-educational process of human morphophysiology II in the medical studies. To this end, some surveys were designed where not only general data was collected but also those aspects assessing the level of satisfaction of students and advisers to this subject were addressed. The summary statistics was used to show the results. Regarding the faculty , just one of them was facilitator and the rest was specialists in basic sciences. All of the surveyed advisers stated that the students are not duly prepared in the contents addressed in terms of the profile of the Basic General Physician after they finished this subject. The surveys administered to the students yielded that there had been problems in the supply of teaching aid materials (premises, computers and bibliography) and all the surveyed participants believed that it was necessary to undertake practice in the various specialties of this subject. In the studied sample, both the students and the faculty were unsatisfied with the teaching/learning process in the subject Morphophysiology II

[Influence of natural boosters on long-term immunity against hepatitis B]. / Rola naturalnych boosterów w ksztalowaniu dlugotrwalej odpornosci przeciwko wzw B.

BACKGROUND: Incidence of hepatitis B in Poland decreased significantly after implementation of routine immunization in infants. Natural boosters may influence the long-term post vaccination immunity in countries, where endemicity is high. In areas of low incidence this influence may be limited. The aim of the study was to analyze the influence of risk factors for HBV infection (potential natural boosters) on long-term post vaccination immunity against hepatitis B and the possibilityof HBVinfection in previously vaccinated individuals. PATIENTS AND METHODS: In 130 children aged 10-12years, vaccinated with 4 doses ofrecombinantvaccine against hepatitis B in infancy, exposure to risk factors for HBV infection (infection in family members including mother, hospitalization, surgical interventions, blood transfusion, dental treatment, piercing, tattooing) was analyzed. Markers of HBVinfection (anti-HBc and HBsAg) and humoral immunity against hepatitis B were determined. Protective level of anti-HBs antibodies was defined as > or =10 IU/1. RESULTS: Statistically significant influence of dental treatment (p<0.02) andsurgicalinterventions (p<0.05) on possessing very high anti-HBs titer (> or = 1000 IU/) was revealed, which indicates that these factors act as natural boosters. Children, who previously received blood transfusion, statistically more frequently did not have protective level of anti-HBs (p<0.0 I). In all 6 children with confirmed HBV infection there was exposure to risk factors for infection in anamnesis. In children with chronic hepatitis B (positive HBsAg) statistically significantly more frequently surgical interventions were performed (p<0.05). CONCLUSIONS: I. Despite of low incidence of hepatitis B in Poland, natural boosters, especially dental and surgical treatment, may stimulate the post vaccination immunity. 2. Blood transfusion is currently not a source of infection, however, children who received blood transfusion in the neonatal period, may require control of immunization efficacy or a booster dose. 3. HBVinfection and chronic hepatitis B may occur in previously vaccinated children, especially if they underwent surgical intervention.

[Mother-to-infant HCV transmission. Can we influence the frequency and the course of the infection?]. / Zakazenie odmatczyne HCV--czy mozemy miec wplyw na czestosc zakazenia i jego przebieg?

AIM: To estimate the management of HCV infected women and their children. METHODS: Part I/: Blood samples were collected from 544 pregnant women and tested for anti-HCV. Part II/: Data of risk factors of HCV infection, reasons of HCV diagnostics were assessed in 281 mothers infected with HCV, not infected with HIV. 317 children born to HCV infected mothers were observed from birth until age 2.5-10 years (testing of HCV-RNA, ALT). 26 (8.%) of them were infected with HCV. RESULTS: Part I/: 22.02% of tested pregnant women were anti-HCV(+). Part II/: Presence of risk factors for HCV infection in anamnesis was the reason of HCV diagnostics in 34% of women. None of HCV-RNA(-) women transmitted HCV to their child. The rate of HCV infection in infants born to HCV-RNA(+) mothers was 14.1% and was higher in case of natural delivery (19.2%) compared to cesarean section (7.5%). Intrapartum percutaneus exposure to maternal blood increased transmission rates. All children born via elective cesarean section (in 38 Hbd) were HCV-RNA(-). None of infected children had clinical symptoms of hepatitis, however, one of them had mild changes in liver histopathology. CONCLUSIONS: Antenatal screening of anti-HCV is not necessary, however, every woman with risk factors for HCV infection in anamnesis should be tested. Women infected with HCV ought to be treated before pregnancy in order to decrease HCV replication. The protective role of elective cesarean section requires further investigation. A number of children with chronic HCV infection should be considered for early treatment.

[Are teenagers immunized in infancy still protected against hepatitis B?]. / Czy nastolatki szczepione w wieku niemowlcym maja odpornosc przeciwko WZW typu B?

BACKGROUND: Immunization is the best method of protection against hepatitis B. Routine vaccination for newborns and infants was introduced in Poland in 1994-96. Although duration of protection afforded by vaccination remains unknown, no routine boosters are recommended. According to references, up to 50% of 15-year old children had lost the post vaccination immune memory protecting against HBV infection. The aim of the study was to determine the immunity against hepatitis B in 10-12-year old children and to establish indications for routine booster doses. MATERIAL AND METHODS: In 130 children aged 10-12 years, immunized against hepatitis B with recombinant vaccine in infancy (10 microg, according to schedule: 0-1-2-12 months, first dose given at birth) humoral immunity (anti-HBs antibodies) as well as cellular memory (anamnestic response to booster given in children without protective titers of anti-HBs) were determined. Titers of anti-HBs > or = 10 IU/l were considered protective. Anamnestic response was defined as increase in anti-HBs concentration from < 10 IU/l to > or = 10 IU/l 4 weeks after receiving a booster dose. MARKERS OF HBV INFECTION: hepatitis B surface antigen (HBsAg - marker of chronic hepatitis) and antibodies to core antigen (anti-HBc--marker of past HBV infection) were additionally determined. RESULTS: Protective level of anti-HBs was found in 102/130 (78%) children, including 43/130 (33%) with high (100-999 IU/l) and 16/130 (12%) with very high (> or = 1000 IU/l) titers. 28/ 130 (22%) did not have protective level of anti-HBs, in 9/130 (7%) antibodies were undetectable. Immune memory was determined in 9 children--anamnestic response was revealed in eight of them (89%). In 6/130 (4.5%) of participants HBV infection was confirmed according to positive anti-HBc, including 2 (1.5% of the study group) with positive HBsAg. CONCLUSIONS: Most children in the studied group had seroprotection and immune memory against hepatitis B 10-12 years after vaccination. No routine booster seems to be necessary.

[Seroprevalence of anti-HCV in pregnant women. Risk factors of HCV infection]. / Czestosc wystepowania przeciwcial anty-HCV u kobiet ciezarnych. Analiza czynników ryzyka zakazenia HCV.

UNLABELLED: Vertical transmission seems to be an important mode of infection in children. Approximately 6-9% of hepatitis C virus-positive women transmit HCV to their offsprings. AIM: 1. To determine the frequency of HCV infection in pregnant women in central Poland. 2. To estimate knowledge about HCV infection in childbearing women. 3. To identify risk factors for HCV infection among pregnant women. METHODS: Study in two separate parts. Part A: Blood samples were collected from 544 pregnant women, tested with anti-HCV ELISA third generation tests. Part B: Data of risk factors of HCV infection, reason of diagnostics were assessed through structured interview and review of available medical records in 281 women infected with HCV. RESULTS: Part A: 2.02% of tested pregnant women were anti-HCV(+). One of them (1/11) knew about her HCV infection before examination. Part B. 24% of 281 infected women indicate a history of blood products transfusion (all before 1992), 23%- hospitalisation with surgical procedures, 15%--intravenous drug use, 8%--hospitalisation without surgical procedures, 7%--exposures of health care personnel, 3%--infected mother, 3%--sexual partner or other member of family infected with HCV. Histories taken from 17% women did not include any known risk factors. HCV infection in women were diagnosed: before pregnancy in 186 (66%), during pregnancy in 61 (22%), after delivery in 34 (12%). All women were Caucasian, Polish nationality. CONCLUSION: The seroprevalence of anti-HCV in pregnant women was 2.02%. There is a number of childbearing HCV infected women who are not identified as HCV positive. Selective HCV testing to women at high risk of HCV infection and antiviral therapy should be encouraged prior to conception.

[Response to hepatitis B vaccine in infants with mother-to-child HCV infection]. / Odpowiedz na szczepienie przeciw wzw B u niemowlat zakazonych wertykalnie HCV.

UNLABELLED: The aim of the study was to establish the vaccination-induced anti-HBs seroconversion in a group of children with mother-to-child HCV infection. MATERIAL AND METHODS: 105 infants born to HCV infected mothers were vaccinated against hepatitis B virus (10 microg/ml; 0, 1, 6 months). HCV infection (HCV-RNA RT-PCR, Abbot Laboratories, in serum positive infants detected twice in the first year of life) was confirmed in 18 (group A). 87 infants were HCV uninfected (group B). Anti-HBs titers (Ortho-EIA) were measured 1-6 months after the third dose of immunisation. RESULTS: Seroconversion to anti-HBs >10 mIU/ml was achieved in 93 (88.6%) infants: 13/18 (73%) in group A, 80/87 (92%) in group B. Anti-HBs <10 mIU/ml was observed in 12 (11.3%) children: 5 (27%) in group A, and 7 (8%) in group B (p=0.04). CONCLUSION: Response to hepatitis B vaccine in infants infected with HCV was weaker than in nonvaccinated infants.

[Hypocomplementaemia in children with chronic viral hepatitis as a risk factor for invasive encapsulated bacteria infection]. / Hipokomplementemia u dzieci z przewleklymi wirusowymi zapaleniami watroby jako czynnik ryzyka inwazyjnych zakazen bakteriami otoczkowymi.

UNLABELLED: The complement system plays an important role in immunological and inflammatory response. Complement deficiency may increase patient's susceptibility to invasive infections caused by encapsulated bacteria (Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae). One of the causes of reduced production of complement components may be hepatic function disturbances in patients with chronic viral hepatitis. AIM: of this study was to estimate the incidence of complement components deficiency and the risk of hypocomplementaemia as well as the associated risk of invasive bacterial infections in children with chronic viral hepatitis, type B and C. MATERIAL AND METHODS: the studied group consisted of 58 children (45 boys and 13 girls) aged 4 to 18 years (mean 14 +/- 3 years). 35/58 were chronically infected with HBV, 17/58 with HCV while 6/58 had HBV and HCV co-infection. In every child levels of C3 and C4 complement components in serum were determined. Deficiency of C3 component was diagnosed at the level of below 90 g/dl (laboratory normal values: 90-180 g/dl): deficit of C4 component was at the level below 10 g/dl (laboratory normal range 10-40 g/dl). In 43 patients (74%), nasopharyngeal swabs were taken for encapsulated bacteria carrier state. Statistical analysis was carried out using Statistica version 7.1 programme (p<0.05). RESULTS: hypocomplementaemia was observed in 14/58 (24%) of patients: decrease in C3 component was found in 12/58 (20.5%) of cases, decrease in C4 in 2/58 (3.5%). Among children with chronic hepatitis B 6/35 (17%) had C3 deficiency and 2/35 (6%) C4 deficiency. In 5/17 (30%) of HCV-infected children, decreased level of C3 complement component was found. In one child with HBV and HCV co-infection, a decrease in C3 level was observed. Nosopharyngeal swab was positive for Neisseria meningitidis in 2/43 (5%) of patients and for Streptococcus pneumoniae in 1/43 (2.5%). CONCLUSIONS: 1. Hepatic function disturbances in course of chronic viral hepatitis type B and C in children may lead to deficiency of complement components and further to the risk of invasive bacterial infections. 2. To assess the incidence of hypocomplementaemia and its components in children with chronic viral hepatitis, studies on a larger group of patients are needed. 3. In children with chronic viral hepatitis it is indicated to determine complement components concentration. 4. Vaccination against encapsulated bacteria infections should be recommended for patients with chronic viral hepatitis, in particular in cases with lowered complement components concentration.