Significado do anti-HBc isolado em doadores de sangue de São Paulo

The clinical significance of isolated anti-HBc is still a challenge. To elucidate the real importance of this finding in our blood donors, an investigation algorithm was tested. One hundred and twelve isolated anti-HBc seropositive blood donors underwent clinical evaluation and retesting of HBV markers. Those who presented repeatedly reactive isolated anti-HBc, received a single dose of hepatitis B recombinant vaccine to verify anti-HBs early response. A HBV-DNA determination by PCR was done for those who did not test positive to anti-HBs after vaccine. The level of anti-HBc was recorded as a ratio of the sample-to-cut-off values (S:C ratio) in 57 candidates at donation. Comparing true and false-positive anti-HBc results, the different S:C ratios of them were statistically significant and when less than 2, implying in a false-positive result probability over 80%. A high percent of false-positive results (16.07%) was verified after anti-HBc retesting. HBV immunity was characterized in 49.11%, either by anti-HBs detection in retesting (15.18%), or after a single dose HBV vaccination (33.93%). HBV-DNA was negative in all tested donors. In conclusion, this algorithm was useful to clarify the meaning of isolated anti-HBc in most of our blood donors.O significado do anti-HBc isolado continua a ser tema relevante para aqueles envolvidos com o atendimento a doadores de sangue soropositivos. Um algoritmo de investigação foi testado com o objetivo de avaliar em nosso meio o real diagnóstico desses doadores. Cento e doze doadores com anti-HBc isolado foram submetidos a avaliação clínico-epidemiológica e testes sorológicos para o VHB. Aqueles confirmadamente anti-HBc isolado, receberam dose única da vacina recombinante contra o VHB, e após 30 dias foi pesquisada a formação do anti-HBs. Naqueles que não formaram anti-HBs após vacina, foi realizada a pesquisa do HBV-DNA por PCR. O índice do "cut-off" sobre a densidade ótica foi determinado em 57 indivíduos por ocasião da doação. Na comparação entre falsos e verdadeiros anti-HBc positivos, o índice C.O./D.O. mostrou significância estatística. Assim quando este índice foi menor que 2, a possibilidade de resultado falso-positivo foi de 83,33%. Verificamos ainda elevada porcentagem de resultados falsos-positivos (16,07%) após a simples repetição do anti-HBc. Imunidade ao VHB pôde ser caracterizada em 49,11%, tanto pela detecção do anti-HBs nos testes de repetição (15,18%) quanto pela vacinação em dose única contra a hepatite B (33,93%). O HBV-DNA foi negativo em todos os doadores testados. Concluímos que este algorítmo foi útil para esclarecer o significado do anti-HBc isolado na maioria dos doadores de sangue estudados

Competências essenciais nos serviços de informática: analise das percepções entre profissionais, gestores e professores de graduação.

O estudo analisa as competências essenciais para os profissionais de computação, verificando a existência de um gap entre a percepção de três grupos de indivíduos: profissionais, gestores e professores. Verifica, ainda, o grau de relevância e as divergências das competências, segundo a percepção de cada grupo; e o gap existente entre as competências demandadas e ofertadas. A pesquisa é exploratória e descritiva, qualitativa e quantitativa e faz uma revisão da literatura sobre o tema. O marco teórico está fundamentado no Modelo de Competências de Le Boterf (2003) e no Modelo de Análise do Gap da Qualidade de Parasuraman, Zeithaml e Berry (1985), articulado com a Qualidade em Instituições de Ensino de Sirvanci (1996). A partir dos modelos referenciais, aplicou-se o Teste T para teste das hipóteses. Os resultados revelaram a existência de gaps entre os diferentes grupos pesquisados.

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial

The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity

HCV Genotypes, Characterization of Mutations Conferring Drug Resistance to Protease Inhibitors, and Risk Factors among Blood Donors in São Paulo, Brazil

Background: Hepatitis C virus (HCV) infection is a global health problem estimated to affect almost 200 million people worldwide. the aim of this study is to analyze the subtypes and existence of variants resistant to protease inhibitors and their association with potential HCV risk factors among blood donors in Brazil.Methods: Repeat anti-HCV reactive blood donors are systematically asked to return for retest, notification, and counseling in which they are interviewed for risk factors for transfusion-transmitted diseases. We analyzed 202 donors who returned for counseling from 2007 to 2010 and presented enzyme immunoassay-and immunoblot-reactive results. the HCV genotypes and resistance mutation analyses were determined by the direct sequencing of the NS5b and NS3 regions, respectively. the HCV viral load was determined using an in-house real-time PCR assay targeting the 5'-NCR.Results: HCV subtypes 1b, 1a, and 3a were found in 45.5%, 32.0%, and 18.0% of the donors, respectively. the mean viral load of genotype 1 was significantly higher than that of the genotype 3 isolates. Subtype 1a was more frequent among young donors and 3a was more frequent among older donors. Protease inhibitor-resistant variants were detected in 12.8% of the sequenced samples belonging to genotype 1, and a higher frequency was observed among subtype 1a (20%) in comparison to 1b (8%). There was no difference in the prevalence of HCV risk factors among the genotypes or drug-resistant variants.Conclusions: We found a predominance of subtype 1b, with an increase in the frequency of subtype 1a, in young subjects. Mutations conferring resistance to NS3 inhibitors were frequent in treatment-naive blood donors, particularly those infected with subtype 1a. These variants were detected in the major viral population of HCV quasispecies, have replicative capacities comparable to nonresistant strains, and could be important for predicting the response to antiviral triple therapy.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundacao Pro-Sangue/Hemocentro de São PauloFundacao Prosangue Hemoctr São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, Infect Dis Div DIPA, São Paulo, BrazilUniv São Paulo, Fac Med, Discipline Med Sci, São Paulo, BrazilHCFMUSP, Dept Pathol, LIM Lab Medice Lab 03, São Paulo, BrazilUniv Sao Joao del Rei, Divinopolis, MG, BrazilUniv São Paulo, Fac Med, Dept Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Infect Dis Div DIPA, São Paulo, BrazilWeb of Scienc

COVID-19 e isolamento social: as implicações na saúde mental de estudantes de enfermagem

Objetivo: avaliar as repercussões da COVID-19 e do isolamento social durante a pandemia na saúde mental de estudantes de graduação em enfermagem. Métodos: estudo descritivo transversal, realizado no Ceará, Brasil, com 347 estudantes. Os dados foram coletados por meio de questionário para obtenção de dados sociodemográficas e informações sobre aspectos relacionados à pandemia, além do Inventário de Saúde Mental-38 (MHI-38). Resultados: percentual de 51,9% dos estudantes continuaram a graduação por meio de atividades de ensino remoto e avaliações on-line e 62,3% acessavam a internet essencialmente pelo celular. Para 76,9% dos estudantes, a maior preocupação era com a morte de um membro da família/amigo. Quanto à saúde mental dos estudantes, os escores na dimensão de Bem-estar Psicológico do MHI-38 foram em média 47,9 (± 16,8) e na dimensão de Sofrimento Psicológico a média foi 52,8 (± 18,5). A média de pontuação global no MHI-38 foi 51,0 (± 16,9), com diferenças entre os sexos (p = 0,039). Conclusão: os estudantes tiveram a saúde mental afetada pela pandemia de COVID-19 e o isolamento social, com maior impacto para as mulheres. Assim, instituições de ensino precisam desenvolver estratégias para monitorar e promover a saúde mental desta população no retorno às aulas no período pós-pandemia

Influência do ambiente na estrutura de tamanho e biomassa da Emerita brasiliensis (Schimitt, 1935) na praia Brava e Guarda do Embaú

Emerita brasiliensis is an important species of Brazilian macrofauna, they are inhabitants of the intertidal areas, and have important components that enable their use as biological indicators environmental. Therefore, the objective was to analyze the relationship between population and size of individuals of Eremita brasiliensis, comparing two beaches on the coast of Santa Catarina, being Praia brava in Itajaí, with an increasing level of urbanization and Guarda do Embaú Beach in Paulo Lopes, which has a stationary degree. The collections took place in March and September 2016, with the sample area parallel to the sand and intertidal strips for a systematic sampling observing the estimated time for low tide. For collection, a 20cm diameter PVC cylinder was used and buried at a depth of 20cm. The samples were arranged in a 0.5mm opening mesh and sent to the laboratory, where the organisms of the genus Emerita brasiliensis were separated and identified for the measurement of biomorphometric data, observing the lateral diameter and rostro-caudal length of the carapace. The biomass weighing was performed before and after the drying procedure, performed in a controlled temperature oven at 37ºC for 48 hours. For statistical analysis, the ANOVA test was used. Based on the individuals collected, it is observed Guarda do Embaú beach with more individuals when compared to Brava Beach. Statistical data show a significant difference between the months and the beaches, which is justified by the state of conservation of Guarda do Embaú beach, which remains static due to its low urbanization. Therefore, it is concluded that the difference between Emerita Brasiliensis communities is due to changes in local dynamics, such as anthropic trampling and sediment change. The results were not accurate due to the low number of samples, but are significant and relevant for further research

Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up

OBJECTIVE To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS Blood donors from 1994 to 2012, identified with positive anti- HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95%CI 1.15–1.71), age under or equal to 50 years (PR = 1.36; 95%CI 1.12–1.65) and non-Caucasians (PR = 1.53; 95%CI 1.27–1.84). CONCLUSIONS About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments