José Milton de Castro Lima

Prevalence and associated factors to hepatitis C in hemodialysis patients in Brazil

OBJECTIVE The prevalence of hepatitis C virus (HCV) is higher in patients on hemodialysis than in the general population, probably due to greater exposure to risk situations. The purposes of the study were to determine anti-HCV antibodies prevalence among hemodialysis patients and dialysis clinics and patients factors associated with HCV transmission. METHODS A cross-sectional study was conducted in 752 hemodialysis patients in all 12 dialysis clinics of Fortaleza, Brazil, and were screened using third generation ELISA. Sociodemographic, clinical, and epidemiological data of 663 patients were collected through interviews. Nosocomial factors were assessed using a specific questionnaire tool. Statistical analysis was conducted using Students t test, odds ratio and multivariate analysis. RESULTS The prevalence of anti-HCV was 52% (390/746; ranged from 6% to 72%). The anti-HCV positivity was higher in patients who had previous peritoneal dialysis (OR=1.76; 95% CI 1.12-2.76) and blood transfusion (OR=2.75; 95% CI 1.25-6.03). Dialysis age has been associated with anti-HCV positivity (OR=1.47; 95% CI 1.35-1.61). Clinics practices associated with anti-HCV positivity were: previous preparing of heparin (OR=2.92; 95% CI 1.23-6.92), failure in gloves use or change (OR=5.73; 95% CI 1.75-18.72), unsatisfactory dialysis machine disinfection (OR=2.79; 95% CI 1.57-4.96), and patient isolation in dialysis room (OR=0.18; 95% CI 0.05-0.61). CONCLUSIONS The results show high anti-HCV prevalence among hemodialysis patients and the association of nosocomial factors with new HCV infection cases.

The spectrum of non alcoholic fatty liver disease in morbidly obese patients: prevalence and associate risk factors

PURPOSE To determine the prevalence of non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery and to identify risk factors associated with the disease spectrum. METHODS Liver biopsy was performed in 60 patients who underwent bariatric surgery, after other causes of liver disease were excluded. Clinical, biochemical and histological features were evaluated. RESULTS NAFLD was detected in fifty-seven patients (95%) of the sample and forty patients (66.7%) of the total sample met the criteria for NASH. Perisinusoidal fibrosis was only found in three (7.5%) patients with NASH. The γGT was an independent predictive factor associated with the degree of hepatic steatosis. The variables such as dyslipidemia and ALT were independently associated with the presence of Mallorys corpuscles with the following values, respectively, OR 0, 05, 95% CI 0.002 to 0.75, P = 0.031 and OR 10, 99, 95% CI 1.44 to 83.93, P = 0.021. CONCLUSIONS Non alcoholic fatty liver disease seems to be an obese-related condition with approximately half of asymptomatic morbidly obese patients having histological NASH. The γGT was an independent predictor of the degree of steatosis.

Smoking habits of sixth year medical students and anti-smoking measures in Portugal

OBJECTIVES To study the smoking habits of 6th year Portuguese medical students and assess their knowledge and acceptance of anti-smoking measures and how they felt these would impact on public health. MATERIAL AND METHODS We conducted a descriptive cross-sectional study, in which a self-administered, anonymous questionnaire was made available online to the target population (6th year Portuguese medical students). The relationships between some of the variables were analysed using contingency tables and the chi2 test, with p<0.05 taken as statistically significant. RESULTS We obtained 255 answers to our questionnaire. We found an 18.04% prevalence of smokers. The majority of smokers smoked 1 - 10 cigarettes per day, with men smoking more, and most of them had begun their habit between 13 and 18 years of age, with women beginning later. 36.96% of smokers had already made an attempt to quit smoking. The great majority of the respondents agreed with the anti-smoking measures listed in the questionnaire. Furthermore, they expected these measures to have a positive impact on smoking and on smoking-related morbidity and mortality. Only 34.90% of the students judged smoking cessation to be sufficiently taught in their curricula. CONCLUSIONS The results are in accordance with the population in general in terms of the prevalence of smokers, the age of beginning smoking and a high prevalence of women smokers. There appears to be across-the-board agreement with anti-smoking measures, along with hope for a reduced general and individual consumption and morbi-mortality.

Valor da ultra-sonografia abdominal com transdutor multifreqüencial de 5 a 10 mhz no diagnóstico de apendicite

The aim of the present study was to establish the diagnostic value of abdominal ultrasonography in the diagnosis of appendicitis using 5¾10 MHz multifrequency transducers. A transversal study of 240 consecutive patients examined from April 1996 to September 1998 due to suspected acute appendicitis was conducted. The ultrasonography criteria for acute appendicitis were noncompressible appendix with thickness above 6.0 mm, with or without apendicolith and/or collection. The adopted gold standard were surgical findings and clinical follow-up during one year. The prevalence of appendicitis was 59%. Abdominal ultrasound showed: sensitivity = 90%, specificity = 97%, accuracy = 93%, predictive positive value = 98%, predictive negative value = 87%, false positive = 2% and false negative = 13%. Ultrasonography using 5¾10 MHz multifrequency transducers showed to be a very effective imaging diagnosis method for acute appendicitis.

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil

INTRODUCTION In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

Smoking habits in sixth year medicine students and anti-smoking measures in Portugal.

OBJECTIVES To study the smoking habits of 6th year Portuguese medical students and assess their knowledge and acceptance of anti-smoking measures and how they felt these would impact on public health. MATERIAL AND METHODS We conducted a descriptive cross-sectional study, in which a self-administered, anonymous questionnaire was made available online to the target population (6th year Portuguese medical students). The relationships between some of the variables were analysed using contingency tables and the chi2 test, with p<0.05 taken as statistically significant. RESULTS We obtained 255 answers to our questionnaire. We found an 18.04% prevalence of smokers. The majority of smokers smoked 1 - 10 cigarettes per day, with men smoking more, and most of them had begun their habit between 13 and 18 years of age, with women beginning later. 36.96% of smokers had already made an attempt to quit smoking.