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

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.

Evaluation of drug-induced liver injury as etiology for acute liver failure in Brazil.

INTRODUCTION AND OBJECTIVES: Little is known about the etiology of acute liver failure (ALF) in Latin America. The objective of this paper is to investigate the main etiologies of ALF in Brazil, including Drug Induced Liver Injury (DILI) using stringent causality criteria. PATIENTS OR MATERIAL AND METHODS: All the cases of individuals who underwent liver transplantation (LT) in 12 centers in Brazil for ALF were reviewed. When DILI was stated as the cause of ALF, causality criteria were applied on site by the main investigator in order to rule out other etiologies. RESULTS: 325 individuals had ALF mainly for unknown reasons (34%), DILI (27%) and AIH (18%). Reassessment of the 89 cases of DILI, using stringent causality criteria, revealed that in only 42 subjects could DILI be confirmed as the cause of ALF. Acetaminophen (APAP) toxicity (n = 3) or DILI due to herbal and dietary supplements (HDS) (n = 2) were not commonly observed. CONCLUSIONS: Undetermined etiology and DILI are the main causes of ALF in Brazil. However, APAP toxicity and DILI due to HDS are mostly uncommon.

500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil.

INTRODUCTION: Liver transplantation is the standard treatment for end-stage liver disease. Brazil holds the third highest number of liver transplants performed per year, but center maldistribution results in high discrepancies in accessing this treatment. In 2012, an interstate partnership successfully implemented a new liver transplantation program in the middle west of Brazil. Here, we report the results of the first 500 liver transplants performed in this new program and discuss the impacts of a new transplant center in regional transplantation dynamics. METHODS: We reviewed data from the first 500 consecutive deceased donor liver transplants performed in the new program during an 8-year period. We analyzed data on patients' clinical and demographic profiles, postoperative outcomes, and graft and recipient survival rates. Univariate survival analysis was conducted using log-rank tests to compare the groups. RESULTS: Almost half (48%) of the procured organs and 40% of the recipients transplanted in our center were from outside our state. Recipient 30-day mortality was 9%. Overall recipient survival at 1 year and 5 years was 85% and 80%, respectively. Mortality was significantly associated with higher Model for End-Stage Liver Disease (P < .001) but not with the presence of hepatocellular carcinoma (P = .795). DISCUSSION: The new transplantation program treated patients from different regions of Brazil and became the reference center in liver transplantation for the middle west region. Despite the recent implementation, our outcomes are comparable to experienced centers around the world. This model can inspire the creation of new transplantation programs aiming to democratize access to liver transplantation nationwide.

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)

Plasma myeloperoxidase levels correlate with hepatocellular carcinoma in chronic hepatitis C.

Myeloperoxidase (MPO) is an enzyme responsible for generating hypochlorous acid and reactive oxidants that may lead to liver injury and cancer in hepatitis C (HCV) infection. MPO expression level is regulated by a polymorphism in the promoter region -463 of MPO gene. In the current study, MPO plasma levels and the G-463A MPO polymorphism were determined in 158 chronically HCV infected patients with and without hepatocellular carcinoma (HCC). MPO plasma levels were determined using a commercially ELISA kit. The G-463A MPO polymorphism was accessed by real time PCR using TaqMan probes. The MPO plasma levels of patients with HCV-HCC were higher in comparison to patients with chronic hepatitis or with those patients with severe fibrosis (p=0.01 and p=0.04, respectively). The MPO G-463A polymorphism was not associated with HCV outcome. These findings suggest MPO levels monitoring may be a potential biological marker to HCC screening in patients with HCV.

Structural and magnetic properties of Fe and Co nanoparticles embedded in powdered Al2O3.

The structural and magnetic properties of powdered composites consisting of nanosized Fe and Co particles embedded in alumina grains have been investigated. The composites were synthesized by a novel and simple method using co-precipitation from a hybrid gel solution containing layered double hydroxide and aluminium hydroxide. After a vacuum annealing procedure, the Fe composites have a negligible number of Fe(+3) ions and a high concentration of crystalline alpha-Fe nanoparticles having truncated polyhedron shapes with an average diameter of 20 nm that are physically well separated from each other. Magnetization measurements as a function of temperature revealed a superparamagnetic-like behavior characteristic of an assembly of fine particles. A spurious ferromagnetism related to surface interaction between magnetic particles from different powder grains and the formation mechanism of the composites are also discussed.