Retrospective molecular investigation of Mayaro and Oropouche viruses at the human-animal interface in West-central Brazil, 2016-2018.

Mayaro virus (MAYV, Togaviridae) and Oropouche orthobunyavirus (OROV, Peribunyaviridae) are emerging enzootic arboviruses in Latin America. Outbreaks of febrile illness associated with MAYV and OROV have been reported among humans mainly in the northern region of Brazil since the 1980s, and recent data suggest these viruses have circulated also in more populated areas of western Brazil. MAYV shares mosquito vectors with yellow fever virus and it has been historically detected during yellow fever epidemics. Aiming to investigate the transmission of OROV and MAYV at the human-animal interface during a yellow fever, chikungunya and Zika outbreaks in Brazil, we conducted a retrospective molecular investigation in 810 wild and domestic animals, 106 febrile patients, and 22.931 vectors collected from 2016 to 2018 in Cuiaba and Campo Grande metropolitan regions, western Brazil. All samples tested negative for OROV and MAYV RNA by RT-qPCR. Findings presented here suggest no active circulation of MAYV and OROV in the sampled hosts. Active surveillance and retrospective investigations are instrumental approaches for the detection of cryptic and subclinical activity of enzootic arboviruses and together serve as a warning system to implement appropriate actions to prevent outbreaks.

Sialovirome of Brazilian tropical anophelines.

Anophelinae is a widely dispersed Culicidae subfamily that may carry a unique virome. Here we herein report the set of viruses found in 323 salivary glands of 16 anopheline species sampled at Upper Pantanal, Chapada dos Guimarães National Park and Coxipó river basin, South Central Mato Grosso, Brazil, pooled (n = 11) and subjected to high throughput sequencing. Metagenomics revealed the presence of nine viral sequences belonging to novel viruses from seven viral families: Purunga is a putative novel orbivirus sharing 74% and 65% aa identity, respectively, with the VP1 and VP3 segments of Changuinola serogroup, Jaracatiá flavivirus shares 60% amino-acid (aa) identity with Aedes flavivirus. Coxipó dielmovirus and Chapada dielmovirus shared 51% and 39% aa identity with Merida virus. Coloiado-orthomyxo like virus is 57.1-64.8% identical at aa level to Aedes albonnulatus orthomyxo-like virus. Mujica picorna-like virus shares 49% aa identity with Flen picorna-like virus and Chiquitos virus is 50% similar to Ista virus, both from Picornavirales order. Cerrado partiti-like-virus shares 75-86% aa identity with Atrato partiti-like virus 2. We also found the S and L segments of Anopheles triannulatus orthophasmavirus (92% identity) in Anopheles lutzi from Chapada dos Guimarães. The identification of these putative novel viruses underscore the wide dispersion of viruses in culicid hosts contributing to extensions on mosquito virome descriptions.

Effect of air pollution on the autonomic modulation of heart rate in overweight adults.

OBJECTIVE: To analyze the effect of air pollution on heart rate variability in overweight individuals. METHODS: A total of 46 adult individuals, both sexes, aged between 18 and 49 years and with body mass index >25kg/m2 were analyzed. All volunteers were students from public schools of two cities in the state of São Paulo. The clinical, demographic and anthropometric data of each individual, as well as heart rate variability through time domain, geometric and frequency indices were collected. For the air quality analysis, the following variables were investigated: concentration of carbon dioxide, particulate matter, temperature and relative humidity. The analysis was carried out with descriptive and analytical statistics, adopting a level of significance of 5%. RESULTS: There was a reduction in overall heart rate variability in overweight individuals by the following indices: mean standard deviation of all normal RR intervals, long-term standard deviation of continuous RR intervals, ratio of short-and long-term standard deviation of continuous RR intervals. In addition, the indices responsible for parasympathetic control showed a downward trend in their values, as well as the low frequency index, which represented sympathetic action, although not significant. CONCLUSION: Overweight individuals exposed to air pollution had lower heart rate variability than the Control Group.

Geometric indexes of heart rate variability in healthy individuals exposed to long-term air pollution.

The aim of this study was to investigate the autonomic modulation of heart rate in healthy individuals exposed to long-term air pollution through geometric methods. We analyzed data from 109 healthy adults aged 18 to 49, divided into three groups according to the exposure time: period 0 to 15 years of exposure (n = 29), more than 15 years of exposure (n = 31), and control group (n = 49). For the analysis of heart rate variability (HRV), heart rate was recorded beat-to-beat for 20 min in the sitting position. The RR intervals were transformed into geometric indexes, and from them, we calculated the RRTri (triangular index), TINN (triangle interpolation of histogram of intervals NN), and Poincaré plot (SD1, SD2, and SD1/SD2). Significantly lower values were observed in the group of individuals exposed to air pollution for more than 15 years compared with the group of individuals exposed to air pollution for a period of 0-15 years and those not exposed for the RRTri (11.5 vs 13.8 vs 14.0), SD1 (16.4 vs 20.5 vs 20.6), SD2 (60.5 vs 68.1 vs 72.5), and SD1/SD2 (0.27 vs 0.34 vs 0.31), with the effect of this difference being considered large (RRTri), medium (SD1, SD1/SD2), and small (SD2). TINN was not significantly different among groups (198.2 vs 223.1 vs 233.6). Healthy individuals exposed to air pollution for more than 15 years present an autonomic imbalance, characterized by lower parasympathetic modulation and overall HRV.

Effect of air pollution on the autonomic modulation of heart rate in overweight adults / Efeito da poluição atmosférica na modulação autonômica da frequência cardíaca em indivíduos com excesso de peso

ABSTRACT Objective: To analyze the effect of air pollution on heart rate variability in overweight individuals. Methods: A total of 46 adult individuals, both sexes, aged between 18 and 49 years and with body mass index >25kg/m2 were analyzed. All volunteers were students from public schools of two cities in the state of São Paulo. The clinical, demographic and anthropometric data of each individual, as well as heart rate variability through time domain, geometric and frequency indices were collected. For the air quality analysis, the following variables were investigated: concentration of carbon dioxide, particulate matter, temperature and relative humidity. The analysis was carried out with descriptive and analytical statistics, adopting a level of significance of 5%. Results: There was a reduction in overall heart rate variability in overweight individuals by the following indices: mean standard deviation of all normal RR intervals, long-term standard deviation of continuous RR intervals, ratio of short-and long-term standard deviation of continuous RR intervals. In addition, the indices responsible for parasympathetic control showed a downward trend in their values, as well as the low frequency index, which represented sympathetic action, although not significant. Conclusion: Overweight individuals exposed to air pollution had lower heart rate variability than the Control Group.

RESUMO Objetivo: Analisar o efeito da poluição atmosférica na variabilidade da frequência cardíaca em indivíduos com excesso de peso. Métodos: Foram analisados 46 indivíduos adultos, de ambos os sexos, com idade entre 18 e 49 anos e índice de massa corporal >25kg/m2. Todos os voluntários eram estudantes da Educação de Jovens e Adultos em duas cidades do estado de São Paulo. Foram coletadas informações clínicas, demográficas e antropométricas de cada indivíduo, bem como a variabilidade da frequência cardíaca, por meio dos índices do domínio do tempo, geométricos e de frequência. Para a análise da qualidade do ar, foram investigadas as variáveis concentração de dióxido de carbono, material particulado, temperatura e umidade do ar. A análise se deu por estatística descritiva e analítica, adotando-se nível de significância de 5%. Resultados: Ocorreu redução na variabilidade da frequência cardíaca geral nos indivíduos com excesso de peso por meio dos índices geométricos (desvio padrão a longo prazo dos intervalos RR contínuos, e a razão entre as variações curta e longa dos intervalos RR) e o domínio do tempo (desvio padrão da média de todos os intervalos RR normais). Índices responsáveis pelo controle parassimpático mostraram-se com tendência de queda em seus valores, bem como o índice de baixa frequência que representava a ação do simpático, embora com valores não significativos. Conclusão: Indivíduos com excesso de peso expostos à poluição atmosférica apresentaram menor variabilidade da frequência cardíaca em comparação ao Grupo Controle.

Novel Viruses in Mosquitoes from Brazilian Pantanal.

Viruses are ubiquitous and diverse microorganisms arising as a result of interactions within their vertebrate and invertebrate hosts. Here we report the presence of different viruses in the salivary glands of 1657 mosquitoes classified over 28 culicinae species from the North region of the Brazilian Pantanal wetland through metagenomics, viral isolation, and RT-PCR. In total, 12 viruses were found, eight putative novel viruses with relatively low similarity with pre-existing species of viruses within their families, named Pirizal iflavirus, Furrundu phlebovirus, Pixé phlebovirus, Guampa vesiculovirus, Chacororé flavivirus, Rasqueado orbivirus, Uru chuvirus, and Bororo circovirus. We also found the already described Lobeira dielmorhabdovirus, Sabethes flavivirus, Araticum partitivirus, and Murici totivirus. Therefore, these findings underscore the vast diversity of culicinae and novel viruses yet to be explored in Pantanal, the largest wetland on the planet.

Zika Virus Surveillance at the Human-Animal Interface in West-Central Brazil, 2017-2018.

Zika virus (ZIKV) was first discovered in 1947 in Uganda but was not considered a public health threat until 2007 when it found to be the source of epidemic activity in Asia. Epidemic activity spread to Brazil in 2014 and continued to spread throughout the tropical and subtropical regions of the Americas. Despite ZIKV being zoonotic in origin, information about transmission, or even exposure of non-human vertebrates and mosquitoes to ZIKV in the Americas, is lacking. Accordingly, from February 2017 to March 2018, we sought evidence of sylvatic ZIKV transmission by sampling whole blood from approximately 2000 domestic and wild vertebrates of over 100 species in West-Central Brazil within the active human ZIKV transmission area. In addition, we collected over 24,300 mosquitoes of at least 17 genera and 62 species. We screened whole blood samples and mosquito pools for ZIKV RNA using pan-flavivirus primers in a real-time reverse-transcription polymerase chain reaction (RT-PCR) in a SYBR Green platform. Positives were confirmed using ZIKV-specific envelope gene real-time RT-PCR and nucleotide sequencing. Of the 2068 vertebrates tested, none were ZIKV positive. Of the 23,315 non-engorged mosquitoes consolidated into 1503 pools tested, 22 (1.5%) with full data available showed some degree of homology to insect-specific flaviviruses. To identify previous exposure to ZIKV, 1498 plasma samples representing 62 species of domestic and sylvatic vertebrates were tested for ZIKV-neutralizing antibodies by plaque reduction neutralization test (PRNT90). From these, 23 (1.5%) of seven species were seropositive for ZIKV and negative for dengue virus serotype 2, yellow fever virus, and West Nile virus, suggesting potential monotypic reaction for ZIKV. Results presented here suggest no active transmission of ZIKV in non-human vertebrate populations or in alternative vector candidates, but suggest that vertebrates around human populations have indeed been exposed to ZIKV in West-Central Brazil.

Plasma urocortin-1 as a preoperative marker of endometriosis in symptomatic women.

Accurate noninvasive diagnostic tests for endometriosis are still missing. This study evaluated the predictive value of the neuropeptide urocortin 1 (Ucn1) to detect pelvic endometriosis in symptomatic women. We enrolled prospectively 97 consecutive women submitted to gynecologic laparoscopy for chronic or acute pelvic pain, infertility or adnexal mass. Preoperative blood samples were assayed for Ucn1 using enzyme immunoassay. Patients with endometriosis had higher plasma Ucn1 levels compared to patients with no lesions (median 59 vs. 34 pg/ml, p < .01, Dunn's test). Elevated plasma Ucn1 levels were found among all endometriosis phenotypes (superficial peritoneal lesions, ovarian endometrioma, and deep infiltrating endometriosis, p < .05 vs. no lesions). Receiver operating characteristics curve analysis identified plasma Ucn1 > 46 pg/mL as the best cutoff point to detect endometriosis vs. no lesions, with 76% sensitivity and 88% specificity (area under the curve [AUC] 0.827, 95% confidence interval [CI] 0.695 - 0.959), but no cutoff could accurately distinguish endometriosis from other pathological conditions (AUC 0.593 [95% CI 0.474 - 0.711]). In women with chronic pelvic pain, infertility, or both symptoms, the probability of endometriosis (positive predictive value) increased consistently with the increase of plasma Ucn1 levels. The present findings suggest that high plasma Ucn1 levels increase the likelihood of endometriosis in symptomatic women.

Plasma brain-derived neurotrophic factor in women with pelvic pain: a potential biomarker for endometriosis?

AIM: To test whether plasma BDNF levels are useful to predict the presence of endometriosis in women with pelvic pain. PATIENTS & METHODS: Prospective cross-sectional study including 67 consecutive women aged 24-49 years, scheduled for laparoscopy due to chronic pelvic pain. Preoperative plasma samples were assayed for BDNF using a commercial enzyme immunoassay. RESULTS: Women with ovarian endometrioma had higher preoperative plasma BDNF (1063 ± 157 pg/ml) compared with women with other benign ovarian tumors (537 ± 131 pg/ml, F = 2.53; p = 0.02). However, plasma BDNF levels were not helpful to indicate the presence of peritoneal or deep infiltrating endometriosis. Plasma BDNF levels were positively correlated with the severity of pelvic pain (r = 0.489; p < 0.0001). CONCLUSION: Plasma BDNF might be a biomarker of ovarian endometrioma but not a useful diagnostic marker to detect other forms of endometriosis in women with painful symptoms.

Magnetic iron species highly dispersed over silica: use as catalysts for removal of pollutants in water.

Fe2O3-SiO2 composites were prepared by impregnation (sample FeIMP) or doping (sample FeDOP) in the structure of porous silica. The dye removal capacity of the materials was investigated through adsorption and oxidation studies of methylene blue and rhodamine B. N2 adsorption/desorption measurements on FeIMP and FeDOP resulted in specific areas of 27 and 235 m2 g-1, respectively. Mössbauer spectroscopy and XRD data detected hematite and maghemite as the iron phases in the samples FeIMP and FeDOP, respectively. Adsorption isotherms and kinetic studies of the dyes were better fitted in DKR model for FeDOP, where the process follows a pseudo-second order with the interparticle diffusion step being the rate-limiting step. On the other hand, FeIMP has better fit in the Langmuir model. Photocatalytic activity was observed in FeDOP under UV irradiation by the presence of reaction-hydroxylated intermediates for MB (m/z = 301) and RhB (m/z = 459). However, the photocatalytic activity was strongly influenced by the adsorption affinity between dye/catalyst. Photogenerated holes are the species responsible for the dye degradation when the adsorption is too strong, while hydroxyl radical action will be favored when the adsorption is not vigorous as detected by ESI-MS. Graphical Abstract Action of photogenerated holes and free electrons into the photocatalytically mechanism of methylene blue degradation over a semiconductor.

Prospective Evaluation of a Panel of Plasma Cytokines and Chemokines as Potential Markers of Pelvic Endometriosis in Symptomatic Women.

BACKGROUND: Endometriosis is a chronic inflammatory disease for which no accurate peripheral diagnostic marker is available. Many cytokines and chemokines have been found altered in the plasma and peritoneal fluid of women with endometriosis compared to healthy controls, but little is known about their diagnostic utility to confirm or discard endometriosis among symptomatic women. OBJECTIVE: The study aims to assess the diagnostic value of a panel of plasma cytokines and chemokines to detect endometriosis in women undergoing laparoscopy for gynecological complains. METHODS: We performed a prospective cohort study evaluating simultaneously plasma concentrations of interleukin (IL)-2, IL-4, IL-6, IL-10, MCP-1/CCL2, IP-10/CXCL10 and eotaxin/CCL11 in 75 symptomatic women (chronic pelvic pain, infertility or ovarian cyst) submitted to laparoscopy. Assays were performed by Cytometric Bead Array System. Endometriosis was confirmed by histopathological examination of surgical specimens. RESULTS: Plasma IL-2, IL-4, IL-6, IL-10, MCP-1/CCL2, IP-10/CXCL10 and eotaxin/CCL11 concentrations were not able to distinguish the women who eventually were diagnosed with endometriosis. CONCLUSION: Although previously shown to be altered in women with endometriosis compared to healthy women, the tested cytokines and chemokines were not useful to predict the presence of endometriosis among symptomatic women. This finding suggests that inflammatory markers modified by endometriosis may also be altered by other conditions associated with similar symptoms, which limits their use in clinical practice.

Educação permanente em saúde em movimento: o ambiente virtual de aprendizagem como recurso pedagógico / Permanent education in moving health: the virtual learning environment as a pedagogical resource

O objetivo deste estudo foi identificar e analisar potencialidades e desafios da utilização do Ambiente Virtual de Aprendizagem (AVA) como recurso pedagógico para multiplicar a proposta de Educação Permanente em Saúde (EPS) no Brasil por meio de um curso chamado de EPS em Movimento. Através da atuação da pesquisadora nas atividades de secretaria e organização do curso EPS em Movimento foram verificados nas reuniões de curso desafios e impasses os quais motivaram aprofundar o estudo acerca da EPS. O objetivo central foi identificar potencialidades e desafios da utilização do AVA como recurso pedagógico para o curso EPS em Movimento, na perspectiva dos tutores. Para isso, foram escolhidos cinco Estados que comtemplassem as cinco regiões do Brasil (Sul, Sudeste, Centro-Oeste, Nordeste, Norte) assim participaram, respectivamente, os Estados de Santa Catarina, Minas Gerais, Goiás, Paraíba e Pará. Foram convidados a participar da pesquisa cinco tutores de cada Estado. Para as respostas das perspectivas dos tutores aplicou-se o método análise de conteúdo, e além dos questionários, a pesquisa contou com diário de campo recolhidos das reuniões de curso com intuito de colaborar nas inferências e formulações de hipóteses. Ficou evidente que há movimentos de reflexão sobre o cotidiano do trabalho através de algumas percepções de tutores. Entretanto, há dificuldades dos tutores em trabalhar o conceito EPS no AVA do Otics. Através de referências constatou-se que a educação a distância (EAD) está cada vez mais comum, sendo uma maneira potente de disseminar o conhecimento. Entende-se que o movimento de EPS pode se dar em vários tipos de encontro. A aposta está em novas ideias de encontros que incentivem o diálogo seja esse virtual ou presencial, assim como na potência de formar tutores aptos a conduzir a proposta da EPS esteja onde estiver.

The purpose of this study was to identify and to analyse the potentialities and challenges of theuse of the Virtual Learning Environment (VLE) as an educational resource to multiply the motion of the Permanent Health Education (PHE) in Brazil in the course called EPS em Movimento. By the work of the researcher in the secretariat and organization activities of the EPS em Movimento course were verified in the meetings the challenges andimpasses that motivated people to deepen the knowledge about PHE. The main purpose of the research was to identify the potentialities and challenges of using the VLE as an educational resource for the EPS em Movimento course from the perspective of tutors. Five states that behold the five regions of Brazil (South, Southeast, Midwest, Northeast and North) were chosen. Participated of the study the following states respectively: Santa Catarina, Minas Gerais, Goiás, Paraíba and Pará. Five tutors of each chosen state were invited to participate. To collect the answers of the tutors’ narratives was applied theContent Analysis Method and in addition to the questionnaires the field journals, collected in the course’s meetings, in order to collaborate on inferences and hypotheses formulations. It is clear that there is reflection about the daily work through some tutors’ narratives. However there are also some difficulties to the tutor to work the concept of PHE in the VLE. Through some referrals it was found that Distance Education is becoming more common and is an efficient tool to disseminate knowledge. It is meant that the PHE movement can occur in different types of encounters. The bet is on new ideas for meetings that encourage dialogue, whether it be virtual or face, as well as in the power to form tutors able to drive the proposal of PHE wherever you are.

[Characterization of hepatitis C virus in chronic hepatitis patients: genotypes in the State of Amazonas, Brazil]. / Caracterização do vírus da hepatite C em pacientes com hepatite crônica: genótipos no Estado do Amazonas, Brasil.

INTRODUCTION: In the State of Amazonas, data regarding the prevalence of different genotypes of hepatitis C virus remains scarce. METHODS: The genotype of 69 HCV positive patients was determined. An in-house standardized nested-PCR was used to detect HCV RNA. Genotype assignment was based on type-specific motifs on the sequenced amplicons delimited by primers HC11/HC18 from the 5' untranslated region. RESULTS: Of the 69 patients studied, 65.2% were male and 34.8% were female. Genotype 1 showed the greatest prevalence, followed by 3 and 2. CONCLUSIONS: These data suggesting that Manaus is the point of arrival of HCV in the State of Amazonas.

Caracterização do vírus da hepatite C em pacientes com hepatite crônica: genótipos no Estado do Amazonas, Brasil / Characterization of hepatitis C virus in chronic hepatitis patients: genotypes in the State of Amazonas, Brazil

INTRODUÇÃO: No Estado do Amazonas, os dados sobre a prevalência dos genótipos do vírus da hepatite C ainda são escassos. MÉTODOS: Os genótipos do VHC foram determinados em 69 pacientes da Fundação de Medicina Tropical do Amazonas - FMT-AM. O RNA do VHC foi detectado pela técnica de RT-PCR, utilizando-se iniciadores HC11/HC18 para a região 5'não traduzida. RESULTADOS: Dos 69 pacientes, 65,2 por cento era do sexo masculino e 34,8 por cento do feminino. O genótipo 1 foi o mais prevalente, seguidos dos 3 e 2. CONCLUSÕES: Estes dados sugerem que Manaus é uma porta de entrada do vírus VHC no Estado do Amazonas.

INTRODUCTION: In the State of Amazonas, data regarding the prevalence of different genotypes of hepatitis C virus remains scarce. METHODS: The genotype of 69 HCV positive patients was determined. An in-house standardized nested-PCR was used to detect HCV RNA. Genotype assignment was based on type-specific motifs on the sequenced amplicons delimited by primers HC11/HC18 from the 5' untranslated region. RESULTS: Of the 69 patients studied, 65.2 percent were male and 34.8 percent were female. Genotype 1 showed the greatest prevalence, followed by 3 and 2. CONCLUSIONS: These data suggesting that Manaus is the point of arrival of HCV in the State of Amazonas.

Uso dos antirretrovirais na gestação e seus possíveis efeitos adversos / Use of antiretroviral agents during pregnancy and their possible adverse effects

A transmissão vertical do HIV tem sido a forma de transmissão que mais sofreu redução nos últimos anos. O principal fator determinante para tal diminuição foi o uso da terapia antirretroviral de alta potência (HAART) nas gestantes infectadas. Atualmente, a taxa de transmissão vertical do HIV em países desenvolvidos está em torno de 2%. Apesar de seu efeito benéfico indiscutível, alguns estudos mostram possíveis efeitos colaterais causados pelo uso dos antirretrovirais nas gestantes e nos recém-nascidos. Entre os efeitos adversos mais frequentes, estão aqueles que podem estar presentes em qualquer paciente que use a medicação, como hipersensibilidade, toxicidade mitocondrial e lipodistrofia. No entanto, existem também os efeitos colaterais específicos do uso destas medicações durante a gestação. Vários estudos têm sido realizados para determinar a segurança dos antirretrovirais no binômio mãe e feto. Os possíveis efeitos adversos descritos pelo uso dos antirretrovirais na gestação são: resistência à insulina e o desenvolvimento de diabetes gestacional; pré-eclâmpsia; aumento de incidência de malformações congênitas; maior índice de parto pré-termo e/ou de baixo peso ao nascer. Esta revisão discute os possíveis efeitos adversos e suas consequências

HIV vertical transmission has been the route of transmission that most declined in the last years. The main factor implied in this mother-to-child-transmission reduction was the routine use of highly active antiretroviral therapy (HAART) by infected pregnant women. Currently, the HIV vertical transmission rate in developed countries is about 2%. Although there is an incontestable benefic effect of antiretroviral therapy, some studies show possible adverse effects in pregnant women and newborns after using the antiretroviral therapy. There are collateral effects that can occur in any patient using these drugs, such as hypersensitivity, mitochondrial toxicity, and lipodystrophy. However, there are other collateral effects, which are specific to the use of these drugs during pregnancy. Several authors have studied antiretroviral treatment in pregnancy to determine the safety of HAART to the mother-child binomial. The possible adverse effects caused by antiretroviral therapy use during pregnancy are: insulin resistance and the development of gestational diabetes; preeclampsia; higher incidence of congenital abnormalities; higher rates of preterm birth, and/or low-birth weight. This review discusses the possible adverse effects and their consequences

[Sustained virological response in patients with coinfection by hepatitis C virus genotypes 1 and 2, after just nine weeks of antiviral therapy: case report]. / Resposta virológica sustentada em pacientes com co-infecção pelos genótipos 1 e 2 do vírus da hepatite C, com apenas nove semanas de terapêutica antiviral: relato de caso.

A report of a 67 year-old male patient with positive serology for HCV. PCR revealed the presence of HCV RNA, viral load of 2,000 copies/mL and genotypes 1 and 2. The patient was treated with peginterferon alfa-2a at 180 mcg/week and ribavirin at 1,000 mg/day. In week four of treatment, HCV viral load was undetectable. In week nine, the patient developed hematemesis, worsening of asthenia, anorexia and impaired general condition, so the treatment was discontinued. The PCR was negative six months and one year after the cessation of treatment. The patient remains asymptomatic.

Resposta virológica sustentada em pacientes com co-infecção pelos genótipos 1 e 2 do vírus da hepatite C, com apenas nove semanas de terapêutica antiviral: relato de caso / Sustained virological response in patients with coinfection by hepatitis C virus genotypes 1 and 2, after just nine weeks of antiviral therapy: case report

Relata-se um paciente do sexo masculino com 67 anos e sorologia positiva para o vírus da hepatite C (HCV). Exames moleculares revelaram a presença do RNA do HCV, com carga viral de 2.000 cópias/mL e genótipos 1 e 2. O tratamento foi com alfapeginterferon-2a, 180mcg/semana e ribavirina, 1.000mg/dia. Na quarta semana de tratamento, a carga viral para o HCV era indetectável. Na nona semana, o paciente apresentou hematêmese, piora do quadro de astenia, inapetência e comprometimento do estado geral, quando o tratamento foi descontinuado. O PCR foi negativo após 6 meses e permaneceu assim após um ano. O paciente encontra-se assintomático.

A report of a 67 year-old male patient with positive serology for HCV. PCR revealed the presence of HCV RNA, viral load of 2,000 copies/mL and genotypes 1 and 2. The pacient was treated with peginterferon alfa-2a at 180mcg/week and ribavirin at 1,000mg/day. In week four of treatment, HCV viral load was undetectable. In week nine, the patient developed hematemesis, worsening of asthenia, anorexia and impaired general condition, so the treatment was discontinued. The PCR was negative six months and one year after the cessation of treatment. The patient remains asymptomatic.

Caesarean section greatly increases risk of scar endometriosis.

OBJECTIVE: To estimate the incidence of scar endometriosis after different surgical procedures. STUDY DESIGN: A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated. RESULTS: Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years. CONCLUSION: Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis.

Hepatitis C virus screening and clinical monitoring of biomarkers in patients undergoing hemodialysis.

In this study, 395 volunteers were enrolled to investigate the seroprevalence of hepatitis C virus, the immunological and the alanine aminotransferase (ALT) biomarkers amongst hemodialysis patients, living in Manaus, Brazil. An overall seroprevalence of 13.9% was found in the hemodialysis patients. Analysis of seroconversion patterns demonstrated that most patients with HCV seroconverted up to 10 years following the first hemodialysis session. Anti-NS5 antibody was detectable in 60.4% of patients with HCV. A lower percentage of circulating CD3(+) and CD4(+) T-cells was found in patients seronegative for HCV, whereas a higher frequency of CD8(+) T-cells was the hallmark of patients with HCV. An overall low activation state of monocytes and eosinophils were observed in hemodialysis patients. In contrast, a higher frequency of activated neutrophils was observed in patients with HCV, selectively in the NS5+ subgroup. All hemodialysis patients had a higher percentage of activated lymphocytes, with the higher activation state in patients with NS5- reactivity. Higher ALT levels were observed in patients with HCV, especially in the NS5+ subgroup. Interestingly, the ALT levels were correlated negatively with the lymphocyte activation state, selectively in the NS5- subgroup, suggesting a protective role of these activated lymphocytes in patients with HCV. These findings reinforce the importance of the transmission of HCV among hemodialysis patients, suggesting that apart from the HCV screening, the serological and ALT biomarkers may represent important predictors of morbidity and/or mortality among patients undergoing hemodialysis.