RESUMO
Hepatitis C virus (HCV) infection is a serious public health problem, since 80 percent to 85 percent of HCV carriers develop a persistent infection that can progress into liver cirrhosis and hepatocarcinoma. Considering that the response of hepatitis C patients to combination therapy with interferon and ribavirin depends on HCV characteristics as well as on host features, we made a retrospective analysis of demographic and anthropometrical data and HCV genotype distribution of chronic hepatitis C patients treated in public and private reference centers in Brazil. The medical records of 4,996 patients were reviewed, 81 percent from public and 19 percent from private institutions. Patients' median age was 46 years, and there was a higher prevalence of male (62 percent) and white patients (80 percent). The analysis of HCV-infecting strains showed a predominance of genotype 1 (64 percent) over genotypes 2 and 3. The patients' mean weight was 70.6 kg, and 65 percent of the patients weighed less than 77kg. Overweight and obesity were observed in 37.8 percent and 13.6 percent of the patients, respectively. Since a body weight of 75 kg or less has been considered an independent factor that significantly increases the odds of achieving a sustained virological response, the Brazilian population seems to have a more favorable body weight profile to achieve a sustained response than the American and European populations. The finding that 65 percent of chronic hepatitis C patients have a body weight of 77 kg or less may have a positive pharmacoeconomic impact on the treatment of genotype 1 HCV patients with weight-based doses of peginterferon.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Pesos e Medidas Corporais , Hepacivirus/genética , Hepatite C Crônica/virologia , Brasil , Genótipo , Setor Privado , Setor Público , Estudos RetrospectivosRESUMO
Hepatitis C virus (HCV) infection is a serious public health problem, since 80% to 85% of HCV carriers develop a persistent infection that can progress into liver cirrhosis and hepatocarcinoma. Considering that the response of hepatitis C patients to combination therapy with interferon and ribavirin depends on HCV characteristics as well as on host features, we made a retrospective analysis of demographic and anthropometrical data and HCV genotype distribution of chronic hepatitis C patients treated in public and private reference centers in Brazil. The medical records of 4,996 patients were reviewed, 81% from public and 19% from private institutions. Patients' median age was 46 years, and there was a higher prevalence of male (62%) and white patients (80%). The analysis of HCV-infecting strains showed a predominance of genotype 1 (64%) over genotypes 2 and 3. The patients' mean weight was 70.6 kg, and 65% of the patients weighed less than 77 kg. Overweight and obesity were observed in 37.8% and 13.6% of the patients, respectively. Since a body weight of 75 kg or less has been considered an independent factor that significantly increases the odds of achieving a sustained virological response, the Brazilian population seems to have a more favorable body weight profile to achieve a sustained response than the American and European populations. The finding that 65% of chronic hepatitis C patients have a body weight of 77 kg or less may have a positive pharmacoeconomic impact on the treatment of genotype 1 HCV patients with weight-based doses of peginterferon.
Assuntos
Pesos e Medidas Corporais , Hepacivirus/genética , Hepatite C Crônica/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The aim of this study was to evaluate the incidence of postoperative pain and the type of periapical repair, after one-appointment endodontic treatment in asymptomatic patients who presented with pulpal necrosis and radiographically visible chronic periapical lesions. For that, after biomechanical preparation through the step down followed by the step back technique, aided by copious irrigation with 5.0% sodium hypochlorite solution, the filling of the root canals was carried out through the conventional technique, with gutta-percha cones and zinc oxide-eugenol cement. In the immediate postoperative period, 16.6% of all patients presented with spontaneous pain, although the incidence of severe pain--flare-ups--was 3.3%. After twelve months, all patients were asymptomatic and free of fistula, nevertheless only 46.4% exhibited complete resolution of the radiolucent periapical areas. Therefore, in a medium term, the one-appointment endodontic treatment showed 100% of clinical success, but showed a reduced rate of radiographic success.
Assuntos
Dor Pós-Operatória/epidemiologia , Doenças Periapicais/diagnóstico por imagem , Tratamento do Canal Radicular/métodos , Adulto , Agendamento de Consultas , Doença Crônica , Humanos , Incidência , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Doenças Periapicais/complicações , RadiografiaRESUMO
The hydrogen chromate anion (HCrO4-), which is the predominant species in acidic solutions and solutions with low chromium concentration, was determined by capillary zone electrophoresis (CZE) using UV detection on-column at 200 nm. A fused-silica capillary (55 cm x 50 microm i.d.) was employed with a high negative voltage of 20 kV. Total chromium was determined after reduction by H2O2 and its complexation by EDTA. The use of H2O2 as reducing agent is advantageous, as it does not increase the conductivity of the solution. Detection limits achieved (for 200 s injection time) were 30 and 8 microg/L for Cr(VI) and Cr(III), respectively. The CZE results obtained for Cr(III) and Cr(VI) were compared with those obtained by ion exchange with subsequent AAS.
RESUMO
BACKGROUND: Spontaneous Bacterial Peritonitis (SBP) is a common and potentially fatal complication of cirrhosis. Multiple variants of this infection have been described during the past decade. Few studies have investigated SBP in Brazil. MATERIAL AND METHOD: In order to investigate prospectively prevalence, predictive factors and prognosis of the episode of SBP, we studied 143 in and outpatients with cirrhosis admitted to HUCFF and HUPE between January, 1995 and January, 1996. All patients were submitted to a questionnaire, physical examination, blood analysis and abdominal paracentesis with ascitic fluid analysis. They were followed for a mean follow-up period of 4 months and survival was determined. RESULTS: The prevalence of SBP was 20%. Culture-positive SBP, Culture-negative Neutrocytic Ascites and Bacterascites were identified in 24%, 66% and 10%, respectively. After uni- and multivariate analysis, only anterior gastrointestinal hemorrhage, serum albumin and ascitic fluid C4 reached statistical significance (p = 0.05) as predictive factors for the development of the SBP. The in-hospital and follow-up mortality rates were 33.3% and 53.8% for the SBP patients and 8.5% and 31.9% for the non-SBP patients, respectively (p = 0.01 and p = 0.04). The cumulative probability of survival in the SBP group was significantly lower than the probability of the non-SBP group (p = 0.05). CONCLUSIONS: We conclude that SBP is a frequent complication, depends of the severity of liver failure and is a marker for poor prognosis in patients with liver cirrhosis.
Assuntos
Infecções Bacterianas/epidemiologia , Cirrose Hepática/complicações , Peritonite/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/complicações , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Brasil/epidemiologia , Feminino , Humanos , Cirrose Hepática Alcoólica/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peritonite/complicações , Peritonite/diagnóstico , Peritonite/microbiologia , Valor Preditivo dos Testes , Prevalência , PrognósticoRESUMO
Objetivo. Investigar prevalência, fatores preditivos e prognóstico dos episódios de Peritonite Bacteriana Espontânea (PBE) na cirrose hepática. Metodologia. Estudamos, prospectivamente, 143 pacientes com cirrose hepática, ambulatoriais ou internados, que foram atendidos nos Serviços de Clínica Médica do HUCFF e de Gastroenterologia do HUPE no período de janeiro/95 a janeiro/96. Estes pacientes foram submetidos a questionário, exame físico, colheita de sangue e paracentese abdominal com colheita de líquido ascítico (LA) e, entao, acompanhados por um período médio de 4 meses, onde a taxa de mortalidade foi determinada. Resultados. A prevalência de PBE foi cerca de 20 por cento, sendo 24 por cento PBE cultura positiva, 66 por cento Ascite Neutrofílica cultura negativa e 10 por cento Bacterioascite. Na análise univariada, alcançaram significância estatísitica (p=0.05) como fatores preditivos do episódio de PBE:HGI na semana anterior; passado de encefalopatia hepática; classificaçao de Child; dosagens séricas de proteínas, albumina, C3, C4 e uréia; dosagens no LA de C3 e C4. Após serem introduzidas na análise multivariada, apenasHGI na semana anterior, albumina sérica e C4 do LA foram independentemente correlacionadas ao episódio de PBE (p=0.05). A mortalidade hospitalar e durante o acompanhamento foi de 33,3 por cento e 53,8 por cento para o grupo com PBE; 8,5 por cento e 31,9 por cento para o grupo sem PBE; respectivamente (p=0.01 e p=0.04). A probabilidade cumulativa de sobrevida foi significativamente menor no grupo com PBE. Conclusoes. A PBE é uma complicaçao freqüente, depende, principalmente, da gravidade da doença hepática e é um marcador de prognóstico desfavorável nos pacientes com cirrose hepática.
Assuntos
Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Peritonite/epidemiologia , Cirrose Hepática/complicações , Peritonite/diagnóstico , Prognóstico , Ascite/complicações , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Prevalência , Análise Multivariada , Valor Preditivo dos Testes , Cirrose Hepática Alcoólica/epidemiologiaRESUMO
Metabolic abnormalities are usually reported in hypertensive patients. These metabolic alterations seem to begin in childhood. The young offspring of hypertensive parents have not been studied thoroughly for metabolic alterations. The aim of this study was to examine the level of total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, uric acid, glycemia, aldosterone, and plasma renin activity in a population of 42 young, slender normotensive subjects with positive family history of hypertension (FH+) or negative family history of hypertension (FH-). Measurements were made in 20 young normotensive subjects (age 21.1+/-2.2 years, 11 males, 15 white, 5 oriental, body mass index of 22.1+/-2.3 kg/m2) with FH+ and 22 young normotensive subjects (age 19.9+/-1.4 years, 17 males, 17 white, 5 oriental, body mass index of 22.1+/-2.3 kg/m2) with FH-. The total cholesterol (4.47+/-0.8 versus 3.95+/-0.6 mmol/L), LDL cholesterol (2.74+/-0.63 versus 2.36+/-0.61 mmol/L), VLDL cholesterol (0.5+/-0.25 versus 0.35+/-0.09 mmol/L), and triglycerides (2.52+/-1.26 versus 1.76+/-0.5 mmol/L) were significantly elevated (P<.05) in the FH+ group compared with the FH- group. The total cholesterol/HDL cholesterol ratio was significantly higher in the group with a positive family history of hypertension (3.75+/-0.02 versus 3.11+/-0.02, P<.05). Glycemia was slightly elevated in the FH+ group (2.16+/-0.29 mmol/L) but was not significantly different from that of the FH- group (2+/-0.2 mmol/L). Uric acid, plasma renin activity, and aldosterone were similar in both groups. We conclude that young, slender normotensive subjects with a positive history of hypertension show alterations in lipid metabolism, suggesting a positive correlation between lipid metabolism and hypertension heredity.
Assuntos
Hipertensão/genética , Metabolismo dos Lipídeos , Adulto , Colesterol/sangue , Feminino , Humanos , Hipertensão/metabolismo , MasculinoRESUMO
Para estudar a resposta superovulatória em cobaias, frente a vários esquemas de tratamentos com diferentes gonadotrofinas, foram utilizadas 60 fêmeas, divididas em 10 grupos de 6 animais cada um. Em uma 1§ fase, formada por 6 grupos, cada grupo recebeu um dos seguintes tratamentos: PMSG; FSH-p em dose única; FSH-p em 3 doses; FSH-h; HMG e soluçäo de NaCl 0,9 por cento (grupo controle), respectivamente. Numa 2§ fase, constituída por 4 grupos, cada um recebeu 22 UI de FSH-h, 15 UI de FSH-h; HMG e soluçäo de NaCl 0,9 por cento (grupo controle), respectivamente. Nos 3 grupos experimentais da 2§ fase foi aplicada também PGF2alfa. Todos os grupos, com exceçäo dos 2 controles, receberam também HCG. Os 3 primeiros grupos da 1§ fase tiveram ovulaçäo bloqueada, sendo que a PMSG causou luteinizaçäo generalizada dos folículos e as demais gonadotrofinas induziram luteinizaçäo folicular precoce com aprisionamento dos óvulos. Na 2§ fase, obteve-se um número médio de ovulaçöes em um grupo e a superovulaçäo de 2 animais. Concluiu-se que a PGF2alfa participa dos mecanismos de ovulaçäo na cobaia e que é possível obter aumento do crescimento folicular múltiplo com o emprego de FSH-h + HCG e HMG + HCG, associados ou näo à PGF2alfa
Assuntos
Animais , Feminino , Folículo Ovariano/crescimento & desenvolvimento , Gonadotropinas , Cobaias/anatomia & histologia , OvulaçãoRESUMO
Introduçao. A hepatite crônica pelo vírus C apresenta tendência evolutiva para cirrose hepática e hepatocarcinoma. Tratamento, com drogas antivirais, está indicado numa tentativa de modificar a evoluçao da doença. Objetivo. Avaliar a resposta de pacientes com hepatite crônica ou cirrose pós-hepatite C ao tratamento com interferon alfa recombinante e identificar os fatores associados com boa resposta terapêutica. Métodos. Foram estudados 38 pacientes com hepatite crônica ativa ou cirrose pelo vírus C, tratados com 2,5 a 3,0MU de interfon três vezes por semana, por períodos de 6 a 12 meses. Considerou-se resposta completa e duradoura quando a ALT e AST se mantinham normais por período de seis meses após o término do tratamento, e resposta completa com recidiva naqueles em que houve elevaçao das enzimas após a suspensao da droga. Resultados. Houve normalizaçao da ALT e AST em 17 dos 38 pacientes (44,7 por cento). Deste grupo, 9/17 tiveram resposta completa e duradoura, e em 8/17 houve aumento das enzimas após a interrupçao do tratamento. Houve uma tendência de melhor resposta ao interferon nos pacientes jovens e naqueles com hepatite crônica ativa (ao invéz da cirrose). Os efeitos colaterais mais frequentes foram febre (80 por cento), mialgia (60 por cento), astenia (50 por cento), cefaléia (40 por cento) e artralgia (36 por cento). Conclusoes. O tratamento com interfon alfa recombinante mostrou resposta satisfatória e duradoura em 23 por cento dos casos, com melhor resultado em pacientes jovens e sem cirrose associada.
Assuntos
Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Adulto , Interferon Tipo I/uso terapêutico , Hepatite C/terapia , Hepatite Crônica/terapia , Cirrose Hepática/terapia , Aspartato Aminotransferases/sangue , Idoso de 80 Anos ou mais , Seguimentos , Hepatite C/enzimologia , Alanina Transaminase/sangue , Hepatite Crônica/diagnóstico , Hepatite Crônica/enzimologia , Cirrose Hepática/enzimologia , Cirrose Hepática/etiologia , Fatores EtáriosRESUMO
BACKGROUND: Chronic hepatitis C usually progresses to cirrhosis and hepatocarcinoma. Treatment with antiviral drugs is indicated attempting to modify the evolution of the disease. OBJECTIVE: To evaluate the treatment of chronic hepatitis C or post-hepatitis C cirrhosis with interferon-a-R (IFN) and to identify the factors associated with good therapeutic result. METHODS: Thirty eight patients with chronic hepatitis C or post-hepatitis C cirrhosis were treated with 2.5 or 3.0 MU of IFN three times a week for 6 to 12 months. We considered as a complete and sustained response when ALT and AST were normal for a 6 months period after finishing treatment. We considered complete response with relapse those in whom elevation of the enzymes was detected after drug suspension. RESULTS: There was normalization of ALT and AST in 17 out of 38 patients (44%). In this group, 9 out of 17 presented a complete and sustained response and in 8 out of 17 there was elevation of the enzymes after drug interruption. There was a trend of better response to interferon in patients below 40 years of age and in those with chronic active hepatitis. The most frequent side effects were fever (80%), myalgia (60%), asthenia (50%), headache (40%), and arthralgia (36%). CONCLUSION: Treatment with interferon showed a satisfactory and sustained response in 23% of the subjects, with better results in young patients and without cirrhosis.