High prevalence of hepatitis C infection in a Brazilian prison: identification of risk factors for infection.

Hepatitis C virus (HCV) causes infectious hepatitis worldwide. It is transmitted mainly by blood products and sharing of intravenous paraphernalia during illicit drug use. High prevalence rates have been described among specific groups considered to be at higher risk for HCV infection, including prison inmates. The objectives of this study were: to determine the HCV seroprevalence among inmates of Casa de Detenção de São Paulo; to identify risk factors for HCV infection; and to compare the seroprevalence of HCV to other blood borne or sexually transmitted diseases. From December, 1993, to January, 1994, a total of 779 inmates were interviewed to collect information on sociodemographic status, sexual behavior, and past experience with illicit drugs. Blood samples were obtained from 756 inmates for serological tests. 310 (41%) blood samples were positive for anti-HCV, 425 (56.2%) were negative, and 21 (2.8%) showed indeterminate results. In this population, we found a seroprevalence of 13.7% for HIV, 3.3% for syphilis (VDRL), and 68.1% for hepatitis B virus previous infection. Four variables were each identified as associated with a positive anti-HCV serologic test: a positive VDRL (OR = 2.63 IC 95% 1.08 to 6.36); a time of current imprisonment longer than 130 months (OR = 2.44 IC 95% 1.04 to 5.71); previous incarceration at Casa de Detenção de São Paulo (OR = 1.73 IC 95% 1.19 to 2.52) and; illicit drug use before admission to the Casa de Detenção de São Paulo (OR = 1.64 IC 95% 1.15 to 2.33). The seroprevalence of HCV antibodies among the study population was high (41%), indeed, one of the highest clusters of HCV infection recorded until now. Four variables were each shown to be associated with HCV infection. The simultaneous presence of these 4 variables is associated with an 82% probability of being anti-HCV positive. Although risk factor analysis indicates most HCV infections occur prior to inprisonment, initiation of control measures to prevent continued transmission after incarceration should be done.

[Carcinoid tumors of the common bile duct: report of a case]. / Tumor carcinóide de ducto biliar comum: relato de um caso.

The authors discuss an uncommon case in the literature of a carcinoid tumor of in the bifurcation of common hepatic duct. The tumor was surgically resected and the duct was reconstructed by Y of Roux's technic. The patient had a good evolution and no tumoral lesion was found in post operative exams during the last six months. The authors present a literature review and discuss diagnosis, treatment and prognosis.

HIV Seroprevalence and Risk Factors in a Brazilian Prison.

The burden of the AIDS epidemic in Brazil is characterized by high prevalence rates in specific groups, including prison populations. Reports o HIV seroprevalence rates from several, prisons in different countries have varied widely. Those rates have usually reflected the HIV seroprevalence in the community served by the correctional facility studied and the risk factors of inmates for HIV infection. The present study was designed: 1) to determine the HIV seroprevalence among inmates of Casa de Detenção de São Paulo; 2) to identify independent risk factors for HIV acquisition; and 3) to determine the relevance of transmission of HIV infection within the prison. From December 20, 1993, through January 5, 1994, 780 inmates were interviewed using a standardized questionnaire and had their blood drawn for HIV testing by ELISA with confirmatory Western Blot. Out of 766 inmates tested, 637 (83.1%) were negative for HIV, 105 (13.7%) were positive, and 24 (3.1%) had indeterminate test results. Multivariate logistic regression analysis identified the following variables as independent risk factors for HIV seropositivity: 1) age less than 29 years-old; 2) previous incarceration in Casa de Detençã; 3) more than one sexual partner in the last year in Casa de Detençã; and 4) intravenous drug use before admission to Casa de Detençã. We conclude from this study that HIV infection among prisoners is high (13.7%) and that several risk factors are responsible. Of these, intravenous drug use before imprisonment is the most likely factor, but HIV transmission can also occur during incarceration.

HIV infection among Brazilian transvestites in a prison population.

Eighty-two male transvestites imprisoned in Casa de Detenção (São Paulo, Brazil) were tested for HIV antibodies, and completed a questionnaire investigating their demographics, arrest and imprisonment records, sexual practices, and drug use. Data were then analyzed to evaluate the incidence of HIV infection and its association with various behavioral and other factors. Sixty-four of 82 (78%, 95% confidence interval [CI], 67-87%) transvestites were positive for HIV infection. The factors associated with significant differences in positivity among these individuals were the time spent in prison and the number of sexual partners during the previous year. It appears that the high rate of infection in this group obscured the importance of other risk factors and behavioral patterns potentially associated with infection. Given the social environment and the high rate of HIV infection among imprisoned transvestites, their role as "vectors" for dissemination of HIV in urban areas of Brazil may be significant.

Sarcoma de Kaposi em homossexuais jovens do sexo masculino. Relato de dois casos. / Kaposi's sarcoma in young male homosexuals. Report of 2 cases

Sao apresentados dois casos de sarcoma de Kaposi (SK) em homossexuais jovens do sexo masculino previamente sadios. Os dados epidemiologicos e o deficit de resposta linfocitaria a estimulacao com fito-hemaglutinina sugerem, em ambos os casos, a possibilidade da ocorrencia do SK como forma de expressao da sindrome da imunodeficiencia adquirida (AIDS)

Poliquimioterapia associada ao BCG oral no tratamento do carcinoma avancado da mama. Observacoes preliminares de um ensaio terapeutico controlado. / Polychemotherapy associated with oral BCG in the treatment of advanced breast carcinoma.Preliminary observations of a controlled therapeutic trial

Quarenta e uma pacientes portadoras de carcinoma disseminado da mama foram incluidas em um ensaio terapeutico randomizando. Vinte e uma receberam poliquimioterapia (CMF+BCG) oral e 20 apenas CMF. O grupo CMF apresentou maior percentagem de remissao que o grupo CMF+BCG. A duracao da remissao e o tempo de sobrevida foram um pouco maior nas pacientes que receberam BCG; as diferencas nao foram, entretanto, estatisticamente significativas.Nao verificamos influencia favoravel do BCG na modificacao do estado imunologico, avaliado pelo teste do DNCB. As pacientes com DNCB negativos e que permaneceram negativos com o tratamento apresentaram piores resultados do que aquelas com testes negativos e que posteriormente se positivaram, bem como do que aquelas que apresentavam testes positivos e permaneceram positivos