Clinical and histological impact of occult hepatitis B infection in hepatitis C virus chronic carriers

Introdução: Define-se como infecção oculta pelo vírus da hepatite B (HBV) a detecção de HBV-DNA no soro ou tecido hepático de pacientes com HBsAg negativo. Estudos sugerem que portadores do vírus da hepatite C (HCV) com esta infecção exibem fibrose hepática mais extensa, pior resposta ao tratamento com interferon alfa e maior risco de desenvolvimento de hepatocarcinoma. Achados similares foram descritos em portadores de HCV com marcadores de infecção prévia pelo HBV (anti-HBc positivo, com ou sem anti-HBs), independentemente da detecção de HBV-DNA. Entretanto, tais estudos não exerceram controle adequado para variáveis associadas à progressão da fibrose na hepatite C, como tempo de infecção, etilismo e idade no momento da infecção. Objetivos: Determinar a prevalência e o impacto da infecção oculta e da infecção prévia pelo HBV nas características clínicas, bioquímicas, virológicas e histológicas de portadores de infecção crônica pelo HCV. Material e Métodos: Estudo caso-controle que avaliou pacientes não-etilistas com HBsAg e anti-HIV negativos e HCV-RNA positivo. Todos os casos possuíam exposição parenteral como provável modo de contaminação pelo HCV (antecedentes transfusionais ou drogadição). Amostras séricas coletadas em intervalo de até 6 meses da biópsia hepática foram submetidas à pesquisa de HBV-DNA por ensaio comercial baseado em PCR, com limite de detecção de 103 cópias/mL (Amplicor HBV MONITOR® Test, Roche). A classificação de METAVIR foi usada para análise histológica. Resultados: Cento e onze pacientes foram incluídos, sendo 46% do gênero masculino e 82% com transfusão prévia. As médias da idade na infecção e do tempo de infecção pelo HCV foram de 25,5+12,4 e 21,9+6,5 anos, respectivamente. O anti-HBc foi positivo em 31 indivíduos (28%) e nenhuma amostra foi positiva para o HBV-DNA. Pacientes com antiHBc positivo foram comparáveis aos com anti-HBc negativo com relação ao gênero, idade na infecção pelo HCV, tempo de infecção, raça, modo de aquisição do HCV e prevalência de descompensação hepática. A distribuição de genótipos do HCV foi semelhante entre os dois grupos. Entretanto, indivíduos com anti-HBc positivo mostraram níveis mais baixos de albumina (P = 0,001) e menor atividade de protrombina (P = 0,046) e maiores níveis de ALT (P = 0,052), AST (P = 0,004) e GGT (P = 0,010). Estes pacientes também demonstraram maior atividade histológica (P < 0,001), maior escore de fibrose hepática (P = 0,001) e taxa de progressão de fibrose (TPF) mais rápida (P = 0.002) do que aqueles com anti-HBc negativo. Na análise multivariada, ALT > 2 vezes o limite superior do normal (xLSN) (OR = 4,460; P = 0,002), GGT > 1,5 xLSN (OR = 7,582; P < 0,001) e anti-HBc positivo (OR = 4,009; P = 0,019) foram preditivos de atividade necroinflamatória moderada ou acentuada (A2/A3). A positividade do anti-HBc (OR = 3,364; P = 0,017) e a aquisição do HCV após 30 anos de idade (OR = 4,252; P = 0,002) foram independentemente associados à fibrose significativa (F2/F3/F4). Os fatores associados à rápida progressão da fibrose, definida como TPF > 0,133 unidade de fibrose/ano, foram idade na infecção > 30 anos (OR = 2,913; P = 0,033) e anti-HBc positivo (OR = 3,241; P = 0,015). O tempo esperado até o surgimento de cirrose hepática foi de 26 anos (20 a 44 anos) para indivíduos anti-HBcpositivo que se infectaram com o HCV com idade > 30 anos. Aqueles com anti-HBc negativo contaminados com menos de 30 anos de idade desenvolveriam cirrose após 80 anos de infecção (60 a 93 anos) (P < 0,001). Conclusões: A infecção prévia pelo HBV é encontrada em cerca de um terço dos portadores do HCV e pode exercer impacto negativo sobre a história natural da infecção crônica pelo HCV. Este efeito parece independer da presença da infecção oculta pelo HBV.Background: Occult hepatitis B virus (HBV) infection is defined by the presence of HBV-DNA by PCR in serum or liver tissue samples from HBsAg-negative individuals. Recent reports suggest that hepatitis C virus (HCV) carriers who also harbor this silent infection have more advanced liver fibrosis, reduced response to interferon, and increased risk of developing hepatocellular carcinoma. Similar findings have been described among chronic hepatitis C patients with serological markers of prior HBV infection (anti-HBc positive, with or without anti-HBs), irrespective of HBV-DNA detection. However, these studies have failed to appropriately control for factors known to impact HCV-related fibrogenesis including duration of infection, alcohol abuse, and age at infection. Aims: To assess the prevalence and impact of occult and previous HBV infection on clinical, biochemical, virological and histological features in patients with chronic hepatitis C from a liver clinic cohort. Methods: This case-control study included non-alcoholic subjects whose sera tested negative for HBsAg and anti-HIV, and positive for HCV-RNA. All patients had prior parenteral exposure as the probable source of HCV infection (blood transfusions or IV drug use). Serum samples were collected within 6 months of liver biopsy and were tested for HBV-DNA using a commercial PCR assay with sensitivity of 103 copies/mL (Amplicor HBV MONITOR® Test, Roche). METAVIR scoring system was applied for grading necroinflammatory activity and staging fibrosis. Results: One hundred and eleven patients were evaluated. Forty six percent were male and 82% reported past transfusion of blood derivates. The mean age at infection and the estimated duration of infection were 25.5 + 12.4 and 21.9 + 6.5 years, respectively. Thirty-one out of 111 patients (28%) tested positive for antiHBc. HBV-DNA was not detected in any sample. There were no differences between anti-HBc-positive and -negative patients concerning gender, age at infection, estimated duration of infection, ethnicity, source of HCV infection, and prevalence of hepatic decompensation. In addition, HCV genotyping distribution were not influenced by antiHBc status. However, anti-HBc-positive patients showed lower albumin levels (P = 0.001), lower prothrombin activity (P = 0.046) and higher levels of ALT (P = 0.052), AST (P = 0.004), and GGT (P = 0.010). These patients also showed higher histological grading (P < 0.001) and staging scores (P = 0.001), and higher rate of fibrosis progression (RFP) (P = 0.002) as compared to those who tested negative for anti-HBc. By multivariate analysis, ALT > 2x upper limit of normal (ULN) (OR = 4.460; P = 0.002), GGT > 1.5x ULN (OR = 7.582; P < 0.001) and anti-HBc-positivity (OR = 4.009; P = 0.019) were predictive of moderate to severe necroinflammatory activity (A2/A3). AntiHBc-positivity (OR = 3.364; P = 0.017) and age at infection > 30 years (OR = 4.252; P = 0.002) were independently associated with significantly hepatic fibrosis (F2/F3/F4). Likewise, independent predictors of rapid fibrosis progression, defined as a RFP > 0,133 fibrosis unit/year, were age at infection > 30 years (OR = 2.913; P = 0.033) and anti-HBc-positivity (OR = 3.241; P = 0.015). The median duration from HCV infection to cirrhosis was 26 years (20 to 44) in anti-HBc-positive patients who were infected with HCV when older than 30 years. On the other hand, among anti-HBc-negative subjects who acquired HCV before the age of 30, the expected time to cirrhosis was 80 years (60 to 93) (P < 0,001). Conclusions: Previous HBV infection is common among HCVinfected individuals and may exert a negative impact on the natural history of hepatitis C virus infection. This effect seems to be independent of the presence of occult HBV infection.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESP: 2002/05260-6BV UNIFESP: Teses e dissertaçõe

Cinzas de Pinus spp. e o mecanismo de desenvolvimento limpo: reduções certificadas de emissões e créditos de carbono

The use of Pinus spp. as mineral addition or partial replacement of Portland cement, can provide the mitigation of CO2 emissions and the obtaining of carbon credits, through the clean development mechanism. This work assessed the potential for reducing CO2 emissions, through two approaches. The first approach used the ACM 0005 UNFCCC methodology, in a scenario to assess the feasibility of implementing a clean development mechanism project - CDM, covering the State of Paraná, using the ashes of Pinus spp. in partial replacement of clinker, in the production of Portland cement. The second approach analyzed the potential for reducing CO2 emissions, covering the Brazilian territory, using the ashes of Pinus spp. in partial replacement of Portland cement in the mixing of concrete, mortar and pastes. Elevations in CO2 emissions were observed due to the increase in the average distances in the transport of ash, in both approaches (128 km and 100 km, respectively). Even so, in the overall emission balances, reduction potentials were observed (10,800 t and 20,546 t of CO2, respectively). The results obtained allowed inferring the feasibility of implementing CDM projects and obtaining carbon credits through certified emission reductions - CERs.A utilização das cinzas de Pinus spp. como adição mineral ou substituição parcial ao cimento Portland pode proporcionar a mitigação de emissões de CO2 e a obtenção de créditos de carbono, através do mecanismo de desenvolvimento limpo. Este trabalho pretendeu avaliar o potencial de redução de emissões de CO2, através de duas abordagens. A primeira abordagem utilizou a metodologia ACM 0005 UNFCCC, em um cenário para avaliar a viabilidade de implementação de um projeto do mecanismo de desenvolvimento limpo – MDL, com abrangência para o Estado do Paraná, utilizando as cinzas de Pinus spp. em substituição parcial ao clínquer, na produção do cimento Portland. A segunda abordagem analisou o potencial de redução de emissões de CO2, com abrangência para o território brasileiro, utilizando as cinzas de Pinus spp. em substituição parcial ao cimento Portland na mixagem de concretos, argamassa e pastas. Foram observadas elevações nas emissões de CO2, pelo aumento nas distâncias médias no transporte das cinzas, nas duas abordagens (128 km e 100 km, respectivamente). Mesmo assim, nos balanços gerais das emissões, foram observados potenciais de redução (10.800 t e 20.546 t de CO2, respectivamente). Os resultados obtidos permitiram inferir pela viabilidade da implementação de projetos de MDL e da obtenção de créditos de carbono através da redução certificada de emissões - RCEs

A voltage-based approach for series high impedance fault detection and location in distribution systems using smart meters

High impedance faults (HIFs) have been a major concern for protecting distribution systems and public safety hazards when involving downed conductors. The deployment of smarter grids brings new technologies for smart monitoring, automation, and protection of distribution networks. This paper presents a new method for a series of HIF detection and location in primary distribution feeders, using voltage unbalance measurements collected from smart meters (SMs) installed at low-voltage end-users. The methodology was tested in MATLAB and Simulink through steady-state simulations of a typical 13.8 kV distribution system, under load unbalance and di erent fault scenarios. Results show that the proposed method is robust and accurate for the detection of blown fuses and broken conductors, with or without ground faults, located either at the source or the load-side. The ease of implementation in SM design, formulation of parameters, and reliable simulation results show potential real-life applications

Trombose venosa cerebral e hepatite: relato de caso

Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis is been regarded as a rare associated condition. We report on a 56-years-old man presenting CVT associated with hepatitis B and C coinfections outlining probable pathogenic mechanisms. We suggest that virus B and C serology should be performed in the cases of cerebral venous thrombosis with unknown etiology.Dentre as várias causas infecciosas de trombose venosa cerebral (TVC), a hepatite viral tem sido reconhecida como causa rara de TVC. Relatamos sobre um homem de 56 anos com TVC associada a coinfecção pelos vírus B e C da hepatite, ressaltando possíveis mecanismos patogênicos. Sugerimos que sorologia para vírus da hepatite B e C deveria ser solicitado em todos os casos de TVC de origem indeterminada.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departments of NeurologyUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPM, Departments of NeurologyUNIFESP, EPMSciEL

Impacto da satisfação corporal sobre a motivação à prática de atividade física na comunidade acadêmica da UNIVASF-PE

Este estudo investigou o impacto da satisfação corporal na motivação à prática de atividade física da comunidade acadêmica da Universidade Federal do Vale do São Francisco (UNIVASF). Participaram da pesquisa 659 alunos, docentes e técnicos do sexo masculino e feminino praticantes de musculação no projeto de extensão “Academia Universitária” da Univasf, Petrolina-PE. Como instrumentos foram utilizados a Escala Situacional de Satisfação Corporal (ESSC) e a Escala de Motivação à Práticade Atividades Físicas (MPAM-R26). Na análise dos dados, utilizou-se o teste de Kruskall-Wallis, Mann-Whitney, a correlação de Spearman e a Análise de Equações Estruturais/Regressão (p&lt;0,05). Os resultados evidenciaram que os alunos são mais motivados a praticar atividades físicas por diversão, pela aparência física e para se sentirem competentes em comparação aos docentes e técnicos (p &lt; 0,05). Verificou-se que os alunos se engajam mais em atividades físicas para fazer novas amizades em comparação aos docentes (p &lt; 0,05). Os técnicos são mais insatisfeitos quanto à gordura corporal em comparação aos alunos, enquanto os docentes são mais satisfeitos em relação às partes externas e aos músculos (p &lt; 0,05). A insatisfação com a gordura e as partes externas apresentaram efeito significativo (p &lt; 0,05) sobre os fatores motivacionais nos três grupos, entretanto, o maior impacto foi encontrado para os docentes. Concluiu-se que para o contexto universitário, a insatisfação com a gordura e a satisfação com as partes externas são elementos intervenientes na motivação à prática de atividade física, com maior destaque para os docentes

Fatal evolution of systemic Lupus erythematosus associated with Crohn's disease

The authors describe the case of a young Brazilian woman who was treated of ileocolonic Crohn's disease sparing rectum, as confirmed by colonoscopy and histopathological examination. After a 4-year course of sulfasalazine treatment, she presented with skin facial lesions in vespertilio, fever, arthralgias and high titers of anti-ANA and LE cells. A sulfasalazine-induced lupus syndrome was diagnosed, because after sulfasalazine withdrawal and a short course of prednisone, the clinical symptoms disappeared and the laboratory tests returned to normal. Mesalazine 3 g/day was started and the patient remained well for the next 3 years, when she was again admitted with fever, weakness, arthralgias, diplopy, strabismus and hypoaesthesia in both hands and feet, microhematuria, haematic casts, hypocomplementemia and high titers of autoimmune antibodies. A diagnosis of associated systemic lupus erythematosus was made. Although a pulsotherapy with methylprednisolone was started, no improvement was noticed. A cyclophosphamide trial was tried and again no positive results occurred. The patient evolved to severe clinical manifestations of general vasculitis affecting the central and peripheral nervous system and lungs, having a fatal evolution after 2 weeks. Although uncommon, the association of both disease may occur, and the authors call attention to this possibility, making a brief review of literature.

Fatigue design in reinforced concrete bridges according to Brazilian code

There has been an increase in the flow of freight vehicles commuting on Brazilian highways. Then, special attention to the structural performance of bridges regarding the fatigue in beams is needed. Brazil has neither normative metrology to study real data flow of vehicles, nor specific fatigue load train models and coefficients to the analysis and design of road bridges. The same load train that is used for general dimensioning, TB 450, is used for the fatigue verification. Hence, this work aims to verify if the current TB 450 is representative of the freight heavy vehicles with 2 to 9 axles concerning the effects of fatigue in the longitudinal reinforcement of beams of theoretical reinforced concrete bridges with two, three, and five beams. This verification is performed analyzing the stress variations found in the longitudinal reinforcement of vehicles with 2 to 9 axles and the TB 450. Based on the results, the longitudinal steel reinforcement was more susceptible to fatigue\u27s effects. Freight vehicles with 5, 6, 8 and 9 axles presented the most significant stress, therefore, they tend to cause more deleterious effects. Hence, the adoption of a Brazilian normative fatigue specific load train and coefficients is necessary to analyze pre-existing road bridges and design new ones most accurately

Is lifestyle a determining factor for body satisfaction in high education?

People's lives are increasingly hurrying because of several factors that interfere with lifestyle. However, little is known how much this style interferes in people body satisfaction. This study investigated the impact of lifestyle on body satisfaction of the university community. A total of 659 students (n=460), professors (n=49) and administrative staff (n=150) of a federal northeastern Brazilian university, answered the Body Satisfaction Situational Scale and Fantastic Lifestyle Questionnaire. Linear regression indicated that the work has a positive impact on the satisfaction of external parties for students, while for the administrative staff was the lowest alcohol consumption and being with family/friends that the impact, as professors, body satisfaction suffered impact of higher alcohol consumption, aggressive behavior, sleep deprivation, lower stress management and unsafe attitudes (p &lt; .05). It is concluded that the lifestyle profile can be considered a determining factor for body satisfaction in higher education, contributing or not for higher body satisfaction