A real-life study on the impact of direct-acting antivirals in the treatment of chronic hepatitis C in liver transplant recipients at two university centers in Northeastern Brazil

The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes

FATORES ASSOCIADOS A ÓBITO E INCAPACIDADE POR NEURO-CHIKUNGUNYA NA TRÍPLICE EPIDEMIA DE ARBOVIROES NO NORDESTE DO BRASIL: ESTUDO DE COORTE

Introdução e objetivos: O potencial do vírus chikungunya (CHIKV) causar doenças neurológicas, que podem resultar em óbito ou incapacidade, é cada vez mais reconhecido pelos médicos, particularmente em áreas endêmicas. Nós descrevemos os fatores de risco associados a óbito e incapacidade de 71 pacientes com confirmação clínica e laboratorial para CHIV. Metodologia: Realizamos uma coorte descrevendo características epidemiológicas, clínicas, neurológicas e laboratorias de pacientes com síndromes neurológicas associadas a CHIKV. A confirmação laboratorial do arbovírus incluiu qRT-PCR e IgM de líquor, soro ou vísceras. Parâmetros clínicos, liquóricos e de neuroimagem foram utilizados para diagnóstico da síndrome neurológica. Resultados e Conclusão: 43.6% (31/71) dos pacientes evoluíram a óbito. Alguns fatores de risco para agravamento da doença foram idade mais elevada (≥ 65 anos) (p = 0,010), presença de diabetes mellitus (p = 0,033), rebaixamento da consciência (p = 0,013), aumento na proteína e celularidade do líquor (p = 0,001), aumento da dosagem de uréia (p < 0,001) e alterações nos exames de neuroimagem (p = 0,021). Do grupo que evoluiu a alta hospitalar (40/71), 75% (30/40) apresentaram incapacidade. A mais frequente foi paraparesia 66.6% (20/30), seguida de quadriparesia, monoparesia de membro inferior, monoparesia de membro superior e desorientação. 73,4% apresentaram paresia em membros inferiores ou membros superiores, na admissão hospitalar. Todos tinham valores aumentados de proteína (mínimo: 83/máximo: 193). O uso do corticóide esteve associado à maior chance de sobrevida. O monitoramento das manifestações clínicas, neurológicas e laboratoriais exigem um olhar diferenciado desde o momento inicial da admissão hospitalar de um paciente com suspeita de neuro-chikungunya, auxiliando no manejo clínico e no prognóstico da doença

Candida famata-induced fulminating cholecystitis

Submitted by Kamylla Nascimento ([email protected]) on 2017-12-07T12:34:41Z No. of bitstreams: 1 art. Candida famata-induced - araujo.pdf: 647361 bytes, checksum: 277147d4bacd1921b00334c9268811ae (MD5)Approved for entry into archive by Kamylla Nascimento ([email protected]) on 2017-12-07T12:43:34Z (GMT) No. of bitstreams: 1 art. Candida famata-induced - araujo.pdf: 647361 bytes, checksum: 277147d4bacd1921b00334c9268811ae (MD5)Made available in DSpace on 2017-12-07T12:43:34Z (GMT). No. of bitstreams: 1 art. Candida famata-induced - araujo.pdf: 647361 bytes, checksum: 277147d4bacd1921b00334c9268811ae (MD5) Previous issue date: 2013Universidade Federal de Pernambuco. Hospital das Clínicas. Serviço de Doenças Infecciosas. Recife, PE, Brasil / Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Universidade Federal de Pernambuco. Hospital das Clínicas. Serviço de Doenças Infecciosas. Recife, PE, Brasil.Universidade Federal de Pernambuco. Hospital das Clínicas. Serviço de Doenças Infecciosas. Recife, PE, Brasil.Lithiasic cholecystitis is classically associated with the presence of enterobacteria, such as Escherichia coli, Enterococcus, Klebsiella, and Enterobacter, in the gallbladder. Cholecystitis associated with fungal infections is a rare event related to underlying conditions such as diabetes mellitus, steroid use, and broad-spectrum antibiotic use for prolonged periods, as well as pancreatitis and surgery of the digestive tract. Here, we present the first reported case of a gallbladder infection caused by Candida famata

Survival of AIDS patients and characteristics of those who died over eight years of highly active antiretroviral therapy, at a referral center in northeast Brazil

Introduction of highly active antiretroviral therapy has resulted in a significant reduction in morbimortality and significant changes in the causes of death among HIV/AIDS patients. For this reason, it has become essential to monitor survival and causes of death. We constructed a survival curve based on 597 adult patients notified as AIDS cases between 1997 and 2004, at the Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil. Among those patients, 150 (25%) progressed to death by December, 2005. Of these, 119 were studied in detail. The data were collected from notification files of the State Health Department and the State Mortality Information System, and were complemented by analysis of medical records. These 597 patients had a survival rate of 88%, 86% and 82% after one, two and five years, respectively, and a 75% likelihood of surviving to 1,984 days (66 months). Most of the deaths occurred during the first months after the diagnosis (median, 129 days). Patients who died were predominantly young men who had sexual exposure and came from Recife (the state capital) or its metropolitan region. When the patients were first seen, a large proportion had already presented severe signs of immunodeficiency. Comparing the patients within this group, the characteristics that were associated with lower survival were: male sex, hemoglobin < 10 mg/dL, lymphocytes < 1,000/mm³, use of fewer therapeutic drugs and antiretroviral regimens and non-introduction of protease inhibitors. Most of them died from AIDS-related diseases, particularly undefined respiratory infections

Prevalence and risk factors of syphilis and human immunodeficiency virus co-infection at a university hospital in Brazil

Submitted by Ana Beatriz Oliveira ([email protected]) on 2019-03-28T13:32:15Z No. of bitstreams: 1 Prevalence and risk factors of syphilis and human.pdf: 957483 bytes, checksum: 8acc9f2ff4149717d5f899350b1dce35 (MD5)Approved for entry into archive by Ana Beatriz Oliveira ([email protected]) on 2019-03-28T13:41:43Z (GMT) No. of bitstreams: 1 Prevalence and risk factors of syphilis and human.pdf: 957483 bytes, checksum: 8acc9f2ff4149717d5f899350b1dce35 (MD5)Made available in DSpace on 2019-03-28T13:41:43Z (GMT). No. of bitstreams: 1 Prevalence and risk factors of syphilis and human.pdf: 957483 bytes, checksum: 8acc9f2ff4149717d5f899350b1dce35 (MD5) Previous issue date: 2018Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Laboratório de Imunopatologia Keizo Asami. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Laboratório de Imunopatologia Keizo Asami. Recife, PE, Brasil.Departamento de Saúde do Estado de Pernambuco. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil.Universidade Federal de Pernambuco. Departamento de Medicina Tropical. Recife, PE, Brasil / Fundação Oswaldo Cruz. Instituto Aggeu Magalhaes. Recife, PE, Brasil.Introduction: The incidence of syphilis has increased since the 1970s. Methods: This was a descriptive and analytical crosssectional study with a non-probabilistic sample. Results: Of 973 patients with human immunodeficiency virus, 179 (18.4%) tested positive for both human immunodeficiency virus and syphilis, 84.8% were men, 50.9% were aged between 36 and 50 years, 47.8% with syphilis were diagnosed with human immunodeficiency virus for 10–20 years, and 40.3% received antiretroviral therapy for 10–20 years. Conclusions: The prevalence of syphilis in patients with human immunodeficiency virus is higher than expected, making it urgent to adopt efficient public health measures

Prevalence and risk factors of syphilis and human immunodeficiency virus co-infection at a university hospital in Brazil

Abstract INTRODUCTION The incidence of syphilis has increased since the 1970s. METHODS This was a descriptive and analytical cross-sectional study with a non-probabilistic sample. RESULTS: Of 973 patients with human immunodeficiency virus, 179 (18.4%) tested positive for both human immunodeficiency virus and syphilis, 84.8% were men, 50.9% were aged between 36 and 50 years, 47.8% with syphilis were diagnosed with human immunodeficiency virus for 10-20 years, and 40.3% received antiretroviral therapy for 10-20 years. CONCLUSIONS The prevalence of syphilis in patients with human immunodeficiency virus is higher than expected, making it urgent to adopt efficient public health measures

Prevalence and socioeconomic factors associated with smoking in people living with HIV by sex, in Recife, Brazil.

INTRODUCTION: Smoking is the leading cause of preventable death in the world. The prevalence of smoking is higher in people infected with HIV than in the general population. Although it is biologically plausible that smoking increases the morbidity and mortality of people living with HIV/AIDS, few studies in developing countries have analyzed the determinants and consequences of smoking in HIV infected people. OBJECTIVE: To estimate the prevalence of smoking and identify the socioeconomic factors associated with smoking and smoking cessation in patients with HIV by sex. METHODS: A cross-sectional study was conducted with baseline data, obtained from an ongoing prospective cohort study of patients with HIV attending two referral centers in Recife, Northeast Region of Brazil, between July 2007 and October 2009. RESULTS: The prevalence of current smoking was 28.9%. For both sexes, smoking was independently associated with heavy alcohol drinking and marijuana use. Among women, smoking was associated with living alone, not being married and illiteracy; and among men, being 40 years or older, low income and using crack. Compared with ex-smokers, current smokers were younger and more likely to be unmarried, heavy drinkers and marijuana users. CONCLUSIONS: It is important to incorporate smoking cessation interventions for the treatment of heavy alcohol drinkers and marijuana users with HIV/AIDS, which may increase life expectancy and quality of life, as smoking is related to risk of death, relapse of tuberculosis, and non communicable diseases