Background
information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce.
Aims
To analyze clinical and laboratory evolution and histological progression of ...hepatitis C in patients evaluated before and after RTx.
Methods
Twenty‐two HCV‐infected patients submitted to liver biopsy pre‐ and post‐RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared.
Results
Patients were mostly men (73%) with mean age of 36 ± 9 yr. Time post‐transplant was 4 ± 2 yr and time between biopsies was 5 ± 2 yr. An elevation of alanine aminotransferase (p = 0.041) and aspartate aminotransferase (p = 0.004) levels was observed in the post‐transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. The histological progression occurred even among those without significant histological lesions in pre‐transplant biopsy.
Conclusion
The findings of this study suggest that the practice of indicating treatment in the pre‐transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
There is scarce information regarding clinical evolution of HBV infection in renal transplant patients.
To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and ...its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis.
HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5× ULN and/or >3× baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis.
140 HBV-infected renal transplant patients were included (71% males; age 46±10 years; post-renal transplant time 8±5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4±3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect.
Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Mixed cryoglobulinemia is one of the most closely related extrahepatic manifestations of hepatitis C virus and requires a challenging therapeutic approach depending on the severity of the symptoms. ...Here, we describe the long-term follow-up of a patient with important cutaneous, articular and neural manifestations of cryoglobulinemia associated with chronic hepatitis C treated with rituximab. A 42-year-old woman who did not respond to previous interferon-based treatments (standard and pegylated interferon plus ribavirin) and corticosteroids was subjected to treatment with rituximab at a dose of 375 mg/m² per week for 4 consecutive weeks. The drug was well tolerated and complete improvement of arthralgia was immediately evident. There was gradual improvement of lower limbs paresthesia and healing of a leg ulcer that had been active for 5 years. The clinical and immunological responses induced by rituximab are sustained over long-term follow-up, and this case illustrates the drug efficacy for non-responder patients to antiviral therapy.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of ...hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia and parenteral iron therapy were excluded. The iron related markers and HIC were compared between those who achieved an SVR and non-responders (NR) patients. The mean age was 45.7 years and the proportion of patients' gender was not different between SVR and NR patients. The median serum iron was 138 and 134 microg/dL (p = 0.9), the median serum ferritin was 152.5 and 179.5 ng/mL (p = 0.87) and the median HIC was 9.9 and 8.2 micromol/g dry tissue (p = 0.51), for SVR and NR patients, respectively. Thus, hepatic iron concentration, determined by a reliable quantitative method, was not a negative predictive factor of SVR in patients with chronic hepatitis C presenting mild to moderate hepatic iron accumulation.
Summary Objective The aim of the present study was to determine whether hepatitis C virus (HCV) RNA present at week 12 is a good predictor of the response to interferon (IFN) monotherapy in ...hemodialysis patients with hepatitis C. Methods Hemodialysis patients with hepatitis C who were treated between 1997 and 2008 with IFN monotherapy for 48 weeks without dose reduction were included. The predictive value of HCV RNA at week 12 for achieving a sustained virological response (SVR) was determined. Results Forty patients (mean age 47 ± 9 years; 75% males and 80% with genotype 1) were included. Septal fibrosis or cirrhosis was observed in 38% of these patients. Twelve (30%) of the 40 patients achieved SVR. HCV RNA was undetectable at week 12 in 68%. The positive predictive value of HCV RNA at week 12 was 45% and the negative predictive value was 100%. Conclusions The presence of HCV RNA at week 12 had a high negative predictive value for SVR in hemodialysis patients with chronic hepatitis C treated with IFN for 48 weeks. Therefore, if HCV RNA is detected at week 12, treatment should be discontinued due to the low probability of a sustained response.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of ...hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia and parenteral iron therapy were excluded. The iron related markers and HIC were compared between those who achieved an SVR and non-responders (NR) patients. The mean age was 45.7 years and the proportion of patients' gender was not different between SVR and NR patients. The median serum iron was 138 and 134 µg/dL (p = 0.9), the median serum ferritin was 152.5 and 179.5 ng/mL (p = 0.87) and the median HIC was 9.9 and 8.2 µmol/g dry tissue (p = 0.51), for SVR and NR patients, respectively. Thus, hepatic iron concentration, determined by a reliable quantitative method, was not a negative predictive factor of SVR in patients with chronic hepatitis C presenting mild to moderate hepatic iron accumulation.A complexa interação entre infecção pelo vírus da hepatite C, homeostase do ferro e resposta ao tratamento antiviral permanece controversa. O objetivo deste estudo foi avaliar a influência da concentração hepática de ferro (CHF) na resposta virológica sustentada (RVS) à terapia antiviral na hepatite C crônica. Foram incluídos 50 pacientes que foram submetidos à biopsia hepática pré-tratamento com determinação da CHF por espectrofotometria de absorção atômica com forno de grafite e tratados posteriormente com interferon/peginterferon e ribavirina. Pacientes com alcoolismo, história de múltiplas transfusões sanguíneas, doença renal crônica, anemia hemolítica e terapia com ferro parenteral foram excluídos. O perfil de ferro sérico e a CHF foram comparados entre aqueles que atingiram RVS e os não-respondedores (NR). A média de idade dos pacientes foi 45,7 anos e não houve diferença na proporção de homens e mulheres entre os grupos RVS e NR. A mediana do ferro sérico foi 138 and 134 µg/dL (p = 0.9), a mediana da ferritina sérica foi 152,5 e 179,5 ng/mL (p = 0,87) e a CHF mediana foi 9,9 e 8,2 µmol/g de tecido seco (p = 0,51), para pacientes com RVS e NR, respectivamente. Concluindo, a concentração hepática de ferro, determinada por um método quantitativo confiável, não foi um fator preditivo negativo de RVS em pacientes com hepatite C crônica e acúmulo de ferro hepático leve a moderado.
The Brazilian National Student Performance Examination - ENADE is an instrument used to measure the quality of undergraduate courses. The identification of factors that influence the result of this ...examination can contribute to providing support necessary to improve the quality of medical courses. The purpose of this work was to evaluate the factors that affect the National Student Performance Examination grades of Brazilian undergraduate medical programs.
Factors that influenced the 2010 ENADE grades of 100 undergraduate medical programs were studied. Data collection was performed using public databases. Academic and healthcare infrastructure variables were investigated. The data analysis was based on the performance of the medical programs on the 2010 ENADE, whereby the programs were divided into two groups: ENADE 1-2 (unsatisfactory grade) versus ENADE 4-5 (satisfactory grade).
One hundred schools were included in this analysis. In the univariate analysis the university variables (p=0.037), public institution (p<0.001), lower number of openings per course (p=0.036), lower number of specialist professors (p=0.003) and higher number of doctors (p=0.010),
post-graduation program (p<0.001), higher course lifetime (p<0.001) were associated to best results in ENADE. In the multivariate analysis of logistic binary regression four variables remained independently associated to a better performance in ENADE: public institution (OR 9.9; 95%CI 1.03 to 95.5), lower number of openings per course (OR 0.984; 95% CI 0.969 to 0.999),
post-graduation program (OR 8.189; 95% CI 1.459 to 45.971) and longer course lifetime (OR 1.058; 95% CI 1.013 to 1.105).
The satisfactory score of this evaluation (ENADE 4-5) was associated to the public administration category of higher degree institutions, lower number of openings offered per course, the presence of a
and longer course lifetime.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
A Doença de Parkinson (DP) é uma doença degenarativa e crônica cuja prevalência tem aumentado em consequência do envelhecimento populacional. A ocorrência de depressão nesta população muitas vezes é ...subdiagnosticada. O objetivo do presente estudo foi verificar as características clínicas, suporte social, prática religiosa na associação entre as morbidades de DP e Depressão. Pretende-se ainda avaliar o impacto da DP na qualidade de vida e analisar as estratégias de enfrentamento utilizadas por esse grupo de pacientes. Foi realizado um estudo transversal por meio de uma amostragem de 15 pacientes com diagnóstico de DP. Foi aplicado um questionário sócio-demográfico, a escala de Depressão Geriátrica (GDS 15), a PDQ-39 (escala específica para avaliação da qualidade de vida na DP) e o inventário de Estratégias de Enfrentamento de Lazarus e Folkman. Participaram do estudo nove homens (60%) e 6 mulheres(40%) com diagnóstico de DP com idade média de 72,6 anos(Desvio padrão:11,26). A idade média do diasgnóstico da DP foi de 69,67 anos, e o tempo médio da doença na amostra foi de 6,89 anos. Da amostra total, 10 pacientes (66,7%) apresentaram índices de alta suspeição de depressão. Na análise comparativa entre depressão e estratégias de enfrentamento, observou-se associação com a estratégia resolução de problemas. A dificuldade em resolver problemas pode ter papel determinante para o desenvolvimento de depressão. A abordagem de ampliação das estratégias de enfrentamento pode contribuir para a modificação da percepção da qualidade de vida e, consequentemente, prevenção de transtornos mentais.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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