ENDOMETRIOSIS OF THE CECUM AND APPENDIX: REVIEW OF LITERATURE.

Endometriosis is a benign, chronic, inflammatory and estrogen dependent pathology in which there is the implantation of functional extrauterine endometrial tissue. Pelvic and abdominal endometriosis are the most frequent presentations and, in these forms, ectopic endometrial implantation affects the lesser pelvis, uterosacral ligaments, ovaries, uterine tubes, urinary and gastrointestinal tracts. Some symptoms such as altered bowel habits, pelvic pain, infertility and bleeding during bowel movements are present. In this work the focus is on the manifestations of endometriosis in the appendix and cecum. The use of imaging tests, such as transrectal and transvaginal ultrasonography, magnetic resonance imaging and colonoscopy are important tools used, however, the gold standard is videolaparoscopy with biopsy to confirm the anatomopathological findings. The surgical strategy is related to the degree of impairment and must take into account the eradication of the disease together with the preservation of fertility. Therefore, the importance of evaluating and treating all areas that endometriosis affects is clear, with a multidisciplinary approach by general surgeons and gynecologists, in order to investigate, diagnose and correctly address the disease in an organized and correct way. &nbsp

Helicobacter pylori como principal fator de risco para adenocarcinoma gástrico / Helicobacter pylori as a main risk factor for gastric adenocarcinoma

Introdução: O tipo adenocarcinoma é responsável por cerca de 95% dos casos de câncer gástrico e pode ser diferenciado em intestinal e difuso, tendo como maior fator de risco a infecção por Helicobacter Pylori. Objetivos: Realizar uma revisão bibliográfica sobre o adenocarcinoma gástrico (ACG) enfatizando sintomas, diagnóstico e a sua relação com o H. Pylori. Métodos e materiais: Trata-se de uma revisão bibliográfica com artigos retirados do banco de dados do PubMed, UpToDate e Scientific Eletronic Library Online (SCIELO). Resultados: O H. Pylori, considerado cancerígeno do Grupo I pela Organização Nacional de Saúde, é um dos principais fatores de risco pro ACG, tendo estudos que apontam sua relação à infecção pelas cepas CagA da bactéria. Sendo o público masculino em torno dos 40 anos na qual a infecção é mais prevalente, os portadores dessa bactéria apresentam risco de três a seis vezes maior de adquirir o adenocarcinoma. Os principais sintomas relatados são dor abdominal e perda de peso. O diagnóstico é baseado na história clínica do paciente, exames físicos, laboratoriais e de imagem, sendo confirmado apenas por biópsia histológica. Conclusão: Sendo o câncer gástrico o terceiro mais comum em homens e o quinto entre as mulheres, ele possui grande agravo na saúde pública, sendo considerado de grande importância estudos detalhados da relação de infecção pelo H. Pylori e da manifestação do ACG para que as mesmas sejam previamente tratadas e apresentem um melhor prognóstico

ENDOMETRIOSE INFILTRATIVA DO CANAL DE NUCK NA PARAÍBA: DESCRIÇÃO TÉCNICA DO MANEJO CIRÚRGICO.

Introduction: Patient, female, 41 years old, nulliparous, reports chronic pelvic pain,dyspareunia and severe dysmenorrhea, progressive swelling and pain in the right inguinalregion, with a strong impact on her quality of life. Objectives: To describe the surgicaltechnique used in the treatment of a case of infiltrative endometriosis of the Nuck's canal,exploring the technique used, therefore, the knowledge of this condition by the academiccommunity is relevant. Methodology: Information will be obtained by reviewing the medicalrecords, interviewing the patient, photographing the diagnostic methods to which the patientwas submitted and reviewing the literature. Results: The patient reports chronic pelvic pain,dyspareunia and severe dysmenorrhea, swelling and pain in the right inguinal region, whichradiates to the lower portion of the abdomen, which worsens during menstruation. Associatedwith these symptoms, the patient reports pain in the right lower limb. She also reports that shehas painful evacuation effort and constipation, and she denied a history of lower urinary tractsymptoms. Conclusion: Imaging tests and anatomopathological study were requested, whichshowed solid formation centered on the distal portion of the right inguinal canal. After theremoval of the nodular tissue fragment by means of videolaparoscopic surgery, the patient hasan excellent prognosis. Pathology confirmed the diagnosis of endometriosis of Nuck's canal.Introdução: Paciente, feminino, 41 anos, nulípara, refere dor pélvica crônica, dispareunia e dismenorréia intensa, edema de aumento progressivo e dor na região inguinal direita, acarretando em forte impacto da sua qualidade de vida. Objetivos: Descrever a técnica cirúrgica utilizada no tratamento de de um caso de endometriose infiltrativa do canal de Nuck, explorando a técnica utilizada, sendo, portanto, relevante o conhecimento dessa condição pela comunidade acadêmica. Metodologia: As informações serão obtidas por meio de revisão do prontuário, entrevista com a paciente, registro fotográfico dos métodos diagnósticos aos quais a paciente foi submetida e revisão da literatura. Resultados: A paciente refere dor pélvica crônica, dispareunia e dismenorréia intensa, edema e dor na região inguinal direita a qual irradia para a porção inferior do abdome que piora durante a menstruação. Associada a esses sintomas, a paciente relata dor em membro inferior direito. Relata ainda que possui esforço evacuatório doloroso e constipação, e negou história de sintomas do trato urinário inferior. Conclusão: Foram solicitados exames de imagem e estudo anatomopatológico, os quais evidenciaram formação sólida centrada na porção distal do canal inguinal direito. Realizada a retirada do fragmento tecidual nodular por meio de cirurgia videolaparoscópica, a paciente segue com ótimo prognóstico. Anatomopatológico confirmou o diagnóstico de endometriose do canal de Nuck

Associação entre endometriose e o aumento do risco coronariano em mulheres/ Association between endometriosis and increased coronary risk in women

Introdução: A endometriose é uma condição crônica que representa uma das doenças ginecológicas benignas mais comuns, caracterizada pela existência de tecido endometrial em localizações ectópicas. As localizações mais frequentes são no peritoneu pélvico, nos ovários e no septo reto vaginal. Quando sintomática associa-se a dor pélvica, dismenorreia e infertilidade. Em mulheres com endometriose células imunes anômalas, quimiocinas, prostaglandinas e metaloproteinases estão aumentados no soro e no líquido peritoneal o que pode promover o desenvolvimento e progressão da doença coronariana aterosclerótica. Objetivo: Este estudo tem por objetivo verificar a associação entre endometriose e aumento do risco coronário na mulher, descritos na literatura brasileira. Metodologia: Trata-se de uma revisão sistemática da literatura indexada entre 2016 e 2020, publicados nas bases de dados Scientific Eletronic Library e PubMed. Foram incluídos artigos publicados em língua portuguesa e inglesa. Discussão: Os resultados do estudo permitiram concluir que as mulheres com endometriose têm risco de doença coronária significativamente mais elevada. A lesão aterosclerótica mais precoce – a estria lipídica – é uma lesão puramente inflamatória. Existem evidências de que a endometriose cursa com um estado de inflamação crônica sistêmica, o que pode contribuir para o aumento do risco coronário. As mulheres com endometriose apresentaram valores significativamente mais elevados de marcadores de inflamação e ativação endotelial (ICAM-I, VCAM-I, E-selectina, fator de von Willebrand e cofator ristocetina), que constituem etapas precoces do processo aterosclerótico. Conclusão: Os resultados apontam que mulheres com endometriose apresentam o risco coronário aumentado entre os 25 e os 60 anos de idade. Esse aumento deve-se principalmente ao estado de inflamação crónica e à eventual intervenção médica, como a histerectomia e/ou ooforectomia, e ainda a potenciais fatores como: o recurso a anti-inflamatórios não esteroides e aos análogos das gonadotrofinas hipotalâmicas; e a suscetibilidade geneticamente determinada. É importante avaliar precocemente os marcadores de risco e de doença cardiovascular nestas mulheres, de forma a prevenir e fazer o diagnóstico precoce de eventos coronários. Além disso, é importante sensibilizar as doentes com endometriose para o risco acrescido de eventos cardiovasculares a fim de promover e enaltecer os estilos de vida saudáveis

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016.

BACKGROUND: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará, Northern Brazil Possível transmissão do vírus da hepatite C por compartilhamento de materiais cortantes e perfurantes em doadores de sangue no Estado do Pará, Norte do Brasil

We determined the risk factors for HCV infection in blood donors in the State of Pará, Northern Brazil. We examined 256 blood donors seen at the Blood Bank of Pará State between 2004 and 2006. They were divided into two groups, depending on whether they were infected with HCV or not; 116 donors were infected with HCV, while the other 140 were free of infection. The HCV-RNA was detected by real-time PCR. All of the participants filled out a questionnaire about possible risk factors. The data were evaluated using simple and multiple logistic regressions. The main risk factors for HCV were found to be use of needles and syringes sterilized at home (OR = 4.55), invasive dental treatment (OR = 3.08), shared use of razors at home (OR = 1.99), sharing of disposable razors in barbershops, beauty salons, etc. (OR = 2.34), and sharing manicure and pedicure material (OR = 3.45). Local and regional health authorities should educate the public about sharing perforating and cutting materials at home, in barber/beauty shops, and in dental clinics as risk factors for HCV infection.<br>Nós determinamos os fatores de risco à infecção pelo HCV em doadores de sangue no Estado do Pará, Brasil. Foram analisados 256 doadores de sangue atendidos na Fundação HEMOPA de 2004 a 2006, sendo divididos em dois grupos: infectados e não-infectados. O diagnóstico foi realizado por PCR em tempo real. Todos os participantes responderam a questionário sobre possíveis fatores de risco, sendo a modelagem estatística feita por regressão logística simples e múltipla. Os fatores de risco à infecção foram: uso de agulhas e seringas de vidros esterilizadas em casa (OR = 4,55), realização de tratamento dentário invasivo (OR = 3,08), compartilhamento de lâminas em domicílio (OR = 1,99), compartilhamento de lâminas descartáveis em barbearias, salões de beleza (OR = 2,34), e compartilhamento de material de manicure e pedicure (OR = 3,45). As autoridades de saúde devem conscientizar a população sobre o compartilhamento de materiais perfuro-cortantes em domicílio, salões de beleza e consultórios dentários como fatores de risco à infecção