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Odontoid fractures represent one of the most common and controversial injury types affecting the cervical spine, being associated with a high incidence of nonunion, morbidity, and mortality. These complications are especially common and important in elderly patients, for which ideal treatment options are still under debate. Stable fractures in young patients maybe treated conservatively, with immobilization. Although halo-vest has been widely used for their conservative management, studies have shown high rates of complications in the elderly, and therefore current evidence suggests that the conservative management of these fractures should be carried out with a hard cervical collar or cervicothoracic orthosis. Elderly patients with stable fractures have been reported to have better clinical results with surgical treatment. For these and for all patients with unstable fractures, several surgical techniques have been proposed. Anterior odontoid fixation can be used in reducible fractures with ideal fracture patterns, with older patients requiring fixation with 2 screws. In other cases, C1-C2 posterior fixation maybe needed with the best surgical option depending on the reducibility of the fracture and vertebral artery anatomy. In this paper, current evidence on the management of odontoid fractures is discussed, and an algorithm for treatment is proposed.

Study design This was a retrospective cohort study to objectively analyze the behavior of single-level thoracic (T), thoracolumbar (TL), and lumbar (L) fractures treated with posterior instrumentation alone and to understand which factors influence the ability to restore and maintain normal spinal alignment. Summary of background data Posterior screw fixation of dorsal and lumbar spine fractures allows fracture stabilization, correction of kyphotic deformity and restoration of vertebral height. The load-sharing classification identifies fractures that may need anterior instrumentation. Materials and methods Patients submitted to pedicle screw fixation of single-level T, TL, and L fractures were retrospectively analyzed. Data on patient demographics, neurological injury [American Spinal Injury Association (ASIA) score], and comorbidities were collected. Fractures were classified according to their anatomic region (T, TL, or L) and using the AO Spine and the load-sharing classifications. Local kyphosis angle, Cobb angle (CA), and changes in anterior vertebral height (AVH) were measured, to quantify intraoperative correction and loss of correction at 6 weeks and at last follow-up. A multivariate analysis was performed to identify the factors influencing the intraoperative correction and the loss of correction over time. Results From a total of 230 fractures, 115 patients with a mean age of 51.48 years were included. Pedicle screw fixation achieved a significant intraoperative correction of the CA, local kyphosis angle, and AVH. This correction was partially lost over time, but, at last follow-up, radiographic parameters were still significantly better than preoperatively. A regression model identified that age and body mass index influenced the correction of CA; ASIA classification influenced the correction of AVH. Conclusion Posterior screw fixation allows for the restoration of spinal alignment, but this correction is less effective in elderly people and in patients with higher body mass index and higher degree of neurological injury.Level of Study: Level III.

A tuberculose do sistema nervoso central é uma doença encontrada em todo o mundo, principalmente nos países subdesenvolvidos. No final do século passado, a incidência de tuberculomas era alta entre as lesões expansivas intracranianas, mesmo em países desenvolvidos. Esta incidência caiu acentuadamente (de 30 para 3%) na metade deste século, devido à introdução da estreptomicina, e a tuberculose praticamente desapareceu nos países desenvolvidos nas décadas de 50 e 60. Posteriormente, casos esporádicos começaram a surgir, principalmente entre imigrantes. No Brasil, casos clínicos isolados de tuberculomas intracranianos têm sido descritos, mas eles constituem aproximadamente 5,5% dos processos expansivos intracranianos observados em necrópsias. Neste trabalho, foram analisadas retrospectivamente as evoluções clínicas de sete pacientes portadores de tuberculomas cerebrais atendidos no Serviço de Neurocirurgia do HCFMRP, no período de 1979 a 1991. O diagnóstico de tuberculoma cerebral foi efetuado com base nos exames neuroradiológicos (radiografia simples e tomografia computadorizada), associados a antecedentes de meningite tuberculosa ou tuberculose extraneural, em cinco pacientes (três confirmados com exame histopatológico) e em dois, através do exame histopatológico da peça cirúrgica. Os sinais e sintomas mais frequentemente observados foram os de hipertensão intracraniana e os de compressão/irritação do parênquima cerebral. Um paciente foi tratado apenas clinicamente com esquema tríplice (isoniazida, rifampicina e etambutol) e apresentou boa evolução. Três pacientes foram submetidos à exérese total ou subtotal da lesão e dois foram submetidos à exérese parcial da lesão e à DVP e um paciente foi submetido apenas à DVP. Para todos os pacientes, foi indicado tratamento com tuberculostáticos, embora um paciente não o tenha completado. Os três pacientes que foram submetidos à exérese total da lesão, um dos pacientes submetidos à exérese parcial da lesão e à DVP e o paciente submetido apenas à DVP apresentaram boa evolução, com regressão e/ou calcificação das lesões, com ou sem seqüelas neurológicas moderadas. O outro paciente submetido à ressecção parcial e à DVP evoluiu mal e faleceu. Para os pacientes com tuberculomas intracranianos, indicamos inicialmente o tratamento clínico; o tratamento cirúrgico é indicado quando há hidrocefalia com hipertensão intracraniana, quando a lesão exerce efeito de massa importante, quando não há resposta ao tratamento clínico ou quando há dúvida quanto ao diagnóstico.

Background/aims: The frequency of Human Leucocyte Antigens/alleles associated with rapid progression from Human Immunodeficiency Virus infection to Acquired Immunodeficiency Syndrome was evaluated in Brazilian patients with Acquired Immunodeficiency Syndrome with and without Toxoplasmic Encephalitis. Methods: 114 patients with Acquired Immunodeficiency Syndrome (41 with Toxoplasmic Encephalitis, 43 with anti-Toxoplasma gondii antibodies, without Toxoplasmic Eencephalitis, and 30 without anti-Toxoplasma gondii antibodies circulating and without Toxoplasmic Encephalitis) were studied. Results: Human Leucocyte Antigens/alleles associated with rapid progression to Acquired Immunodeficiency Syndrome, particularly HLA-B35, -DR3, and -DR1 allele group, were significantly less represented in patients with Toxoplasmic Encephalitis and Acquired Immunodeficiency Syndrome. Conclusion: The presence of these Human Leucocyte Antigens/Alleles that predispose to Acquired Immunodeficiency Syndrome progression was associated with resistance to Toxoplasmic Encephalitis among Human Immunodeficiency Virus-1 carriers. Keywords: HLA, AIDS, Encephalitis, T. gondii

BACKGROUND CONTEXT Surgical treatment of cervical spine degenerative pathology involving 2 levels can be performed anteriorly through a double discectomy or through a corpectomy. It is not clear, however, what is the capacity of each technique in the restoration of cervical lordosis and what is its effect over time. PURPOSE Compare the 2 techniques with respect to clinical and radiographic results, namely in the restoration and maintenance of sagittal cervical balance. METHODS Clinical files and radiographs of patients submitted to a 2-level discectomy (Group A) or a 1-level corpectomy (Group B) were evaluated retrospectively in the treatment of degenerative cervical disease between 2010 and 2017. Radiological parameters were measured (C2-C7 sagittal Cobb, regional cervical lordosis and graft collapse) preoperatively, after 3-6 weeks and at the last follow-up. Patient variables, surgery and perioperative parameters (length of stay, blood loss, surgical time and complications) were compared. RESULTS A total of 100 patients (43 men and 57 women) with a mean age of 60.4 years (40-86) were included. Average follow-up of 3.5 years (8 months-7.3 years). Group A: 18 patients, mean age 60.3, 39% (n = 7) with radiculopathy and 61% (n = 11) with myelopathy; Group B: 82 patients, mean age 61.4; 69.5% (n = 56) with myelopathy, 30.5% (n = 25) with radiculopathy. There was no statistically significant difference between the 2 groups regarding length of hospital stay, blood loss or surgical time. Patients submitted to a corpectomy had a lower lordosis than those who underwent discectomy at 2 levels (p = 0.083). However, the gain of lordosis with surgery was similar in both groups, 7.8° in Group B and 6,1° in Group A (p = 0.582). After surgery, there was a progressive loss of lordosis gain mainly in the first 6 weeks but without significant differences between the groups. (p = 0.08 at 6 weeks and p = 0.690 at the last follow-up). CONCLUSIONS In the presence of myelopathy, corpectomy was the preferred surgical option. Preoperatively, these patients had a lower degree of lordosis than those operated by radiculopathy. Both surgical options allowed an equivalent gain in lordosis, which was partially lost during follow-up. There were no advantages of one surgical technique over the other in lordosis gain. Therefore, the decision on the technique to be used must be based on factors other than the concern with the gain of lordosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Approximately two thirds of cervical spine injuries affect the subaxial cervical spine, with fractures occurring most often at C6 and C7 and dislocations at C5-C6 and C6-C7. In the spectrum of these injuries, facet joint dislocation represents a severe injury, frequently associated with spinal cord injury (SCI). PURPOSE The purpose of this study was to analyze a cohort of surgically treated subaxial cervical spine dislocations and to identify factors associated with higher risk of SCI and predictors of surgical failure. METHODS All patients operated in a single institution during a 10-year period (2007-2016) for traumatic single-level cervical facet joint dislocation were retrospectively reviewed. Age, gender, injury characteristics (dislocation or subluxation, uni- or bilateral, level of injury and presence of associated facet fracture), mechanism of trauma, presence of SCI (determined by the American Spinal Injury Association Impairment Scale [ASIA]), surgical data and follow-up records were reviewed. All patients had a minimum follow-up of 2 years. RESULTS A total of 71 patients, 53 men and 18 women, with mean age of 57 ± 18 years (18-90) were identified. Motor-vehicle accidents were the most frequent trauma mechanism, followed by fall from height. Young adults were mostly represented among motor-vehicle accidents, whereas falls contributed to a majority of facet joint dislocations sustained by the elderly. The C6-C7 level was the most affected (37/71 cases). Forty-seven patients had unilateral and 24 bilateral dislocation, with 47 of these cases (66%) having associated facet fractures. Spinal cord injury was present in 37% of the cases. Rigid columns (p = 0.009) and bilateral dislocations (p = 0.004) were associated with the presence of spinal cord injury. Patients with bilateral dislocation were 4.7 times more likely to have a spinal cord injury (OR: 4.7, 95% CI = 1.6-13.8). The closed reduction with cranial traction was attempted in 51 cases, with a success rate of 86%. 59 cases were submitted to isolated anterior cervical arthrodesis and 7 to anterior cervical corpectomy. Five were submitted to combined anterior and posterior fixation (360°). There were 3 failures after the previous isolated fixation, which required revision surgery with 360 ° fusion. All cases of failure occurred after an isolated anterior fusion in the C7-T1 transition (p CONCLUSIONS Patients with rigid spines or with bilateral facet dislocations are at higher risk for SCI. After successful reduction, anterior discectomy and fusion, as a single procedure, offers an excellent surgical option in the management of many cervical facet fracture dislocations, has showed in this analysis. Failure occurred always at the C7-T1 level, suggesting that here; a 360 degree fusion may be needed. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

A infecção pelo vírus da hepatite C acomete cerca de 180 milhões de pessoas em todo mundo. Trata-se de doença com pouca manifestação clinica, onde cerca de 75% a 85% dos casos evolui para cronificação e aproximadamente 15% para hepatocarcinoma. Entre os fatores de risco mais conhecidos estão a realização de transfusões de sangue e hemoderivados anterior a 1993, uso de drogas endovenosas e relações sexuais desprotegidas. Este trabalho tem por objetivo estimar a prevalência de sorologia positiva para hepatite C e seus possíveis fatores de risco no distrito de Botafogo, município de Bebedouro, SP, onde a elevada freqüência de casos de hepatite chamou a atenção dos seus próprios moradores. Da população de 1318 habitantes, 353 foram sorteados para participar da pesquisa, sendo submetidos a questionário padronizado e coleta de sangue. Infecção pelo vírus da hepatite C foi pesquisada através de exames imunoenzimáticos e de PCR, no Instituto Oswaldo Cruz (Fiocruz), e por teste imunocromatográfico, no Laboratório de Sorologia do Hospital da Clínicas de Ribeirão Preto-USP . A prevalência encontrada foi de 8,8% (IC95%: 5,8 11,7). As variáveis que mostraram associação na análise univariada foram submetidas a um procedimento multivariado por aplicação do modelo de log binomial. As variáveis preditoras independentes de infecção pela hepatite C foram sexo masculino, tempo de residência acima de trinta anos e uso de medicações parenterais com material esterilizado por técnica de fervura. Uma possível explicação para a elevada prevalência nessa população reside na possibilidade de disseminação do vírus a partir de um antigo morador, que exercia informalmente atividades ligadas ao atendimento à saúde, especialmente aplicação de injeções, numa época anterior ao uso de seringas descartáveis. Approximately 180 million people worldwide are infected by the hepatitis C virus. It is an illness with little clinical manifestation where about 75% - 85% of the cases evolve to chronification and about 15% to hepatocarcinoma. Among the bestknown risk factors are blood and blood by-product transfusions prior to 1993, use of intravenous drugs and unprotected sexual relations. This study has the objective of estimating the prevalence of positive serology for hepatitis C and its possible risk factors in the district of Botafogo, municipality of Bebedouro, São Paulo, where the high frequency of hepatitis cases caught the attention of the population itself. Out of a population of 1318 inhabitants, 353 were selected to participate in the research, being submitted to a standard questionnaire and blood collection. Hepatitis C infection was researched through immunoenzimatic and PCR exams at the Oswaldo Cruz Institute (FIOCRUZ), and by immunochromatographic tests at the Serology Laboratory of the Hospital das Clinicas in Ribeirão Preto USP. The prevalence found was of 8,8% (CI95%: 5,8 11,7). The variables that demonstrated an association in the univariate analysis were submitted to a multivariate procedure through the application of the binomial log model. The independent predictors for hepatitis C infection were male sex, local residence time over thirty years and use of parenteral medication with material sterilized through boiling technique. A possible explanation for the high prevalence in this population lies in the possibility of dissemination of the virus from an older inhabitant who informally exercised medical activities, especially the application of injections in a period before there was use of dischargeable syringes.

Infecções pelos vírus da hepatite B (HBV) e vírus da hepatite C (HCV) na população prisional apresentam prevalências bastante elevadas, alcançando taxas, algumas vezes, de mais de 40%. Contribuem para isso diversos comportamentos de risco, adotados já antes do encarceramento ou desenvolvidos durante o período de reclusão. Entre eles, destacam-se o uso de drogas ilícitas intravenosas com compartilhamento de agulhas, tatuagens e atividade sexual desprotegida. Esta pesquisa objetivou estimar a prevalência dos marcadores do HBV e HCV com seus respectivos fatores de risco para estas exposições na população masculina carcerária da Penitenciária de Ribeirão Preto - SP, no período de maio a agosto de 2003. Do total de 1030 presidiários, foram sorteados 333 participantes por amostragem casual simples, os quais foram submetidos à aplicação de um questionário padronizado e tiveram coletada uma amostra de sangue. Para diagnóstico do HBV e HCV foi utilizado o ensaio imunoenzimático para detecção do HBsAG, anti-HBc total, anti-HBs e anti-HCV. A confirmação deste foi feita através de reação de polimerase em cadeia (HCV RNA). As prevalências encontradas para HBV e HCV nos presidiários foram de 19,5%% (IC 95% : 15,2 - 23,8) e 8,7% (IC 95% : 5,7 - 11,7), respectivamente . Todas as variáveis que apresentaram \"p\" abaixo de 0,25, através de análise univariada, foram submetidas a um modelo multivariado de regressão logística. Nesta análise, as variáveis que se mostraram preditoras de forma independente da infecção pelo HBV foram: idade acima de 30 anos e passado de droga injetável. Já para o HCV, as variáveis foram idade acima de 30 anos, história prévia de hepatite, tatuagem, passado de droga injetável e passado de compartilhamento de agulhas. The hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in correctional settings have quite high prevalences, reaching rates of up to 40%. Several risk behaviors, adopted before or during the imprisonment, accounts for that. Among them, the use of intravenous illicit drugs, sharing of needles, tattoos and unprotect sexual activity are the most important. This survey aimed to estimate the prevalence of HBV and HCV serological marker and risk factors for these infections in men inmates at the Penitentiary of Ribeirão Preto, State of São Paulo, Brazil, between May and August 2003. Out of 1030 inmates, a simple random sample of 333 participants was chosen. The participants were interviewed in a standardized questionnaire and provided blood for serological tests. An enzyme-linked immunosorbent assay (ELISA) was used for diagnosis of HBV and HCV infection (HBsAg, anti-HBs, anti-HBc, anti-HCV). Polymerase chain reaction (HCV RNA) was used to confirm HCV infection. The overall prevalence for HBV and HCV markers in inmates was 19,5% (CI 95%: 15,2 - 23,8) and 8,7% (CI 95%: 5,7 - 11,7), respectively. The variables that displayed p 30 years and previous injecting drug use. For HCV infection, age > 30 years, previous injecting drug use, previous sharing of needles, tattoos and previous hepatitis.

O objetivo deste trabalho foi estudar a ocorrência de meningites não meningo cócicas no município de Ribeirão Preto, Estado de São Paulo, no período compreendido entre 1998 e 2005. Foi realizado um estudo epidemiológico descritivo centralizado na Divisão de Vigilância Epidemiológica da Secretaria Municipal de Saúde de Ribeirão Preto, a partir dos registros do Sistema Nacional de Informação das Doenças de Notificação Compulsória (SINAN W). No período avaliado foram notificados e confirmados 1411 casos de meningites não meningocócicas. Observou-se ocorrência predominante no sexo masculino (62.9%), em todas as faixas de idade. O grupo etário mais atingido foi o das crianças de 5 a 9 anos (24.7%), seguido pelos indivíduos de 1 a 4 anos (23.5%). O grupo de 30 anos ou mais correspondeu a 20.5% dos casos, enquanto os menores de um ano de idade representaram 8.9% das ocorrências. No que diz respeito à etiologia, verificou-se predomínio das meningites virais (58.7%), seguidas das bacterianas (26.3%), de etiologia pneumocócica (5.7%) e das causadas por outros agentes (4.2%). Em 3.1% dos casos a etiologia não foi determi nada. Quanto à evolução clínica, observou-se cura em 89.2% e ocorrência de óbito em 9.4%, sendo que em 1.4% dos casos essa informação não foi registrada. Seqüelas foram referidas em 1.7% dos pacientes, com ausência dessa informação em 65.5% do total de casos. The purpose of this investigation was to study the incidence and some charac teristics of non-meningococcal meningitis in Ribeirao Preto (Brazil) in the years 1998 to 2005. A descriptive epidemiological study was carried out using data from the National System of Compulsory Diseases Notification (SINAN W) of Ribeirao Preto Health Department. A total of 1411 cases of non-meningococcal meningitis were reported and confirmed. The general occurrence was higher for males (62.9%). The most affected groups were children from 5 to 9 years of age (24.7%), followed by the group from 1 to 4 years (23.5%). The age group of 30 years or above represented 20.5% of the cases and children under one year registered 8.9% of the total. Regarding etiology, the most frequent was viral (58.7%), followed by bacterial (26.3%), pneumococcal (5.7%), and other parasites (4.2%). For 3.1% of the cases the etiology of meningitis was not ascertained. Recovery occurred in 89.2% of the patients, 9.4% died from the disease and the information was unknown for 1.4% of them. Sequelae were reported in 1.7% of cases, but this information was lacking for 65.5% of the patients.

Sabe-se que o vírus da imunodeficiência humana (HIV) pode modificar a história natural da infecção pelo HCV, acelerando a progressão da fibrose hepática e conseqüente evolução para cirrose. O tratamento com interferon-alfa pode levar à melhora da histologia hepática, reduzindo a inflamação e fibrose, principalmente nos pacientes que apresentam resposta virológica sustentada. O impacto do tratamento sobre a evolução histológica em pacientes não-respondedores ao tratamento da hepatite C apresenta resultados controversos. Objetivos: Avaliar, nos pacientes com hepatite C crônica, co-infectados pelo HIV, o impacto do tratamento da hepatite C, sobre as modificações de parâmetros indicativos de fibrose e atividade inflamatória, em biópsias de fígado realizadas antes e após o tratamento da hepatite C. Métodos: Foram estudados 26 pacientes co-infectados pelo HCV e HIV-1, submetidos à biópsia hepática antes e, em média, 25,2 meses após o término do tratamento da hepatite C. Fragmentos da biópsia hepática foram comparados, antes e após o tratamento, em relação aos seguintes parâmetros: Índice de Atividade Histológica (HAI) e o grau de Fibrose (Knodell); intensidade do depósito de colágeno (coloração pelo picrosirius) e o grau de ativação das células estreladas (marcação com alfa-actina de músculo liso). Os índices destas variáveis histológicas, pós e pré-tratamento, foram relacionadas com o resultado do teste qualitativo RNA HCV (RT-PCR-AMPLICOR?) na 24a semana de tratamento, com a duração do tratamento da hepatite C e com o intervalo de tempo entre a interrupção do tratamento e a biópsia-controle. Foi avaliada a relação de possíveis fatores prognósticos de resposta virológica com a resposta histológica e foram realizadas correlações dos parâmetros histológicos entre si. Resultados: Os parâmetros histológicos avaliados de forma global foram semelhantes nas biópsias pré e pós-tratamento. As razões pós/pré-tratamento, em todos os parâmetros avaliados nas biópsias hepáticas, diminuíram de forma significativa nos pacientes que apresentaram pesquisa negativa para o RNA HCV na 24ª semana de tratamento. Os parâmetros histológicos foram semelhantes nos grupos com duração de tratamentos diferentes (? 24 semanas e > 24 semanas), exceto as CEH células ?-positivas, que teve melhora no grupo com tratamento mais prolongado. O intervalo de tempo entre o final do tratamento e a biópsia-controle não influenciou a melhora histológica. Na análise de regressão logística, houve associação da melhora dos parâmetros histológicos com o resultado negativo do RNA HCV na 24ª semana de tratamento. Houve correlação significativa entre todos os parâmetros histológicos avaliados. Conclusões: Os pacientes avaliados em conjunto tiveram seus parâmetros histológicos nas biópsias pré e pós-tratamento com valores semelhantes, porém quando se definiu melhora histológica, como a manutenção, ou melhora dos parâmetros histológicos avaliados individualmente, verificou-se que uma substancial parcela da população estudada apresentou melhora histológica. O efeito benéfico do tratamento parece se relacionar com o controle da viremia do HCV durante o tratamento e se verifica também em pacientes que não sustentaram a resposta virológica após a suspensão dos medicamentos. Os achados fazem supor que a redução da viremia do HCV teria como conseqüência a diminuição da inflamação e fibrose hepáticas, inclusive com diminuição do estado de ativação das células estreladas hepáticas, mesmo nos casos em que não houve resposta virológica sustentada. Os resultados do presente estudo são sugestivos de que o tratamento da hepatite C pode modificar a história natural da evolução da hepatite crônica nos pacientes co-infectados pelo HIV. Human immunodeficiency virus (HIV) is known to be able to modify the natural history of HCV infection, accelerating the progression of hepatic fibrosis and the consequent evolution to cirrhosis. Treatment with interferon-alpha can lead to improved hepatic histology, reducing inflammation and fibrosis, especially in patients who present a sustained virologic response. The impact of treatment on histological evolution in patients who do not respond to treatment of hepatitis C is a controversial matter. Objectives: To evaluate in patients with chronic hepatitis C co-infected with HIV the impact of treatment of hepatitis C on the modifications of the parameters indicative of fibrosis and of inflammatory activity in liver biopsies obtained before and after treatment of hepatitis C. Methods: Twenty-six patients co-infected with HCV and HIV-1 were submitted to a liver biopsy before and, on average, 25.2 months after the end of treatment of hepatitis C. Fragments of the liver biopsy were compared before and after treatment regarding the following parameters: histological activity index (HAI) and grade of fibrosis (Knodell); intensity of collagen deposition (picrosirius staining), and grade of stellate cell activation (labeling with smooth muscle alpha-actin). The post- and pretreatment ratios of these histological variables were related to the result of the quantitative HCV-RNA test (RT-PCR-AMPLICOR?) during the 24th week of treatment, to the duration of treatment of hepatitis C and to the time interval between the discontinuation of treatment and the control biopsy. The relationship between possible factors of the virologic response and the histological response was evaluated and correlations between the various histological parameters were calculated. Results: The histological parameters evaluated in a global manner were similar in the pre- and post-treatment biopsies. The post-pretreatment ratios for all parameters evaluated in the liver biopsies were significantly reduced in patients who were negative for HCV RNA during the 24th week of treatment. The histological parameters were similar in the groups with different durations of treatment (? 24 weeks and > 24 weeks), except for ?-positive stellate hepatic cells, which were improved in the group with a more prolonged treatment. The time interval between the end of treatment and the control biopsy did not affect the histological improvement. In logistic regression analysis, the improvement of the histological parameters was found to be associated with a negative result of HCV RNA during the 24th week of treatment. There was a significant correlation between all histological parameters evaluated. Conclusions: When evaluated as a whole, the patients showed similar values for their histological parameters in the pre- and post-treatment biopsies. However, when histological improvement was defined as the maintenance or improvement of the histological parameters evaluated individually, a substantial part of the study population was found to present histological improvement. The beneficial effect of treatment seemed to be related to the control of HCV viremia during treatment and was also observed in patients who did not sustain the virologic response after the discontinuation of the medications. These findings lead us to assume that the reduction of HCV viremia causes a reduction of hepatic inflammation and fibrosis, as well as a reduction of the state of activation of stellate hepatic cells even in cases in which there is no sustained virologic response. The results of the present study suggest that treatment of hepatitis C can modify the natural history of the course of chronic hepatitis in patients co-infected with HIV.

A infecção pelo HIV em presidiários alcança uma das maiores prevalências entre subgrupos populacionais específicos, com taxas de até 17% já tendo sido descritas no Brasil e no mundo. Contribuem para isso diversos comportamentos de risco, adotados já antes do encarceramento ou desenvolvidos durante o período de reclusão. Entre eles, destacam-se o uso de drogas ilícitas intravenosas, compartilhamento de agulhas e seringas e atividade sexual desprotegida. Esta pesquisa objetivou estimar a prevalência do marcador do HIV e fatores de risco para esta infecção na população masculina carcerária da Penitenciária de Ribeirão Preto – SP, no período de maio a agosto de 2003. Do total de 1030 presidiários, foram sorteados 333 participantes por amostragem casual simples, os quais foram submetidos à aplicação de um questionário padronizado e tiveram coletada uma amostra de sangue. Para diagnóstico sorológico do HIV foi utilizado inicialmente o ensaio imunoenzimático (ELISA), como teste de triagem, com a confirmação sendo feita através de reação de imunofluorescência indireta (IFI). A prevalência global encontrada para o HIV nos presidiários foi de 5,7% (IC 95% : 3,2 – 8,2). Todas as variáveis que mostraram associação com a presença do anti-HIV, através de análise univariada, foram submetidas a um modelo multivariado de regressão logística utilizando o método Baysiano. Nesta análise, as variáveis que se mostraram preditoras de forma independente da infecção pelo HIV foram: Incircuncisão, homossexualismo masculino, tempo total da pena a ser cumprida inferior a cinco anos, uso de droga injetável e compartilhamento de agulhas e seringas. The human immunodeficiency virus (HIV) infection in prisoners reaches one of the highest prevalence among specific population subgroups, with rates up to 17% already described in Brazil and in some parts of the world. Several risk behaviours, adopted before or during the imprisonment, accounts for that. Among them, the use of intravenous illicit drugs, sharing of needles and syringes and unprotect sexual activity are the most important. This survey aimed to estimate the prevalence of HIV serological marker and risk factors for this infection in men inmates at the Penitentiary of Ribeirão Preto, State of São Paulo, Brazil, between May and August 2003. Out of 1030 inmates, a simple random sample of 333 participants was chosen. Demographic information, as well as risk factors for HIV infection, were obtained through the application of a standardized questionnaire. A blood sample of 10 ml was taken from each participant. An enzyme-linked immunosorbent assay (ELISA) was used as a screening test for HIV, with the diagnosis being confirmed by indirect immunofluorescence. The overall prevalence for HIV in inmates was 5,7% (CI 95%: 3,2 – 8,2). All the variables identified as associated with HIV infection, through univariate analysis, were assessed by a logistic regression multivariate model, using the Baysian method. At the level of 5%, HIV infection was associated with history of sharing of needles/syringes and total time of punishment less than five years. Associations at the level of 10% were observed with the variables lack of circumcision, homosexuality and history of intravenous illicit drugs.

Este estudo, que envolveu todos os doadores de sangue (25.891) que compareceram pela primeira vez ao Hemocentro de Ribeirão Preto, de junho de 1996 a junho de 2001, teve os seguintes objetivos: 1) Estudar a positividade de marcadores sorológicos das hepatites B e C em testes da triagem dos doadores. 2) Analisar o fluxo dos doadores positivos para os marcadores das hepatites B e C ao Ambulatório de Hepatites (AH) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. 3) Estimar a prevalência de infecção atual ou pregressa pelos vírus das hepatites B e C entre os doadores, através da análise dos resultados de testes confirmatórios para essas doenças. 4) Avaliar a importância da determinação da transaminase glutâmico-pirúvica (TGP) como marcador indireto de infecção pelos vírus das hepatites B e/ou C. Foram levantados dados registrados no Hemocentro, no Núcleo de Vigilância Epidemiológica (NVE) e no AH, coletando-se informações referentes ao doador, ao tipo de doação e ao resultado de teste da triagem sorológica (HBsAg, anti-HBc, anti-HCV, TGP, anti-HIV, anti-HTLV, doença de Chagas e sífilis). Foram estudados ainda: os resultados dos testes de repetição – realizados no Hemocentro – dos doadores positivos para os marcadores das hepatites B e C na triagem sorológica; o comparecimento ao NVE; e a confirmação, no AH, dos resultados para esses marcadores. A população dos doadores foi composta majoritariamente por homens (83,6%) e indivíduos de 26 a 45 anos de idade (64,0%). Predominaram as doações vinculadas (85,4%), e as maiores motivações foram solicitação e estímulo familiar ou de amigos. Os valores da prevalência, nos testes da triagem sorológica, foram iguais a 0,63% (IC95%: 0,54 – 0,72), para o HBsAg e 1,15% (IC95%: 1,02 – 1,28), para o anti-HCV. O total de doadores positivos que deveriam ser avaliados no AH, sofreu uma perda de 55,5% entre os suspeitos de ter hepatite B e de 58,7% entre os suspeitos de ter hepatite C, totalizando 266 doadores perdidos quanto ao acompanhamento. Os valores da prevalência, nos testes confirmatórios, foram iguais a 0,22% (IC95%: 0,16 – 0,28), para a hepatite B, e 0,31% (IC95%: 0,24 – 0,38), para a hepatite C. As co-positividades entre os valores de TGP e os marcadores de hepatites, nos testes de triagem sorológica, foram de 8,8%, para o vírus C, e de 0,5%, para o vírus B, indicando que a determinação dessa enzima não auxilia na seleção de doadores em bancos de sangue. This study, which involved all blood donors (25.891) that attended the Blood Center of Ribeirão Preto for the first time from June 1996 to June 2001 had the following objectives: 1) To study the positiveness for hepatitis B and C serologic markers in donors screening tests. 2) To analyze the flow of positive donors for hepatitis B and C markers to the Hepatitis Ambulatory (HA) in the Clinical Hospital of the Faculty of Medicine of Ribeirão Preto of the University of São Paulo. 3) To estimate the predominance of present or former infection by hepatitis B and C viruses among donors, by analyzing results of screening tests that confirm these diseases. 4) To evaluate the importance of determining the glutamic-piruvic transaminase (GTP) as an indirect marker of infection by hepatitis B and C viruses. Registered data from the Blood Center as well as from the Epidemiological Surveillance Nucleus (ESN) and HA were used with the purpose of collecting information about donors, type of donation and results in serologic screening tests (HBsAg, anti-HBc, anti-HCV, GTP, anti-HIV, anti-HTLV, Chagas disease and syphilis). In addition, a study was performed on the results in repetition tests – that took place in the Blood Center – of positive donors for hepatitis B and C markers in serologic tests as well as on their attendance at the ESN and the confirmation in the HA of the results for these markers. The population of donors was composed in its majority by men (83,6%) and individuals from 26 to 45 year-old (64,0%). Linked donations predominated (85,4%), and the greatest reasons for donation arose from solicitation and stimulus coming from family and friends. The value of prevalence in serologic screening tests was 0,63% (IC95%: 0,54 – 0,72) for HBsAg and 1,15% (IC95%: 1,02 – 1,28) for anti-HCV. The total of positive donors that should have been evaluated in the HA suffered a loss of 55,5% among the suspects of having hepatitis B and of 58,7% among the suspects of having hepatitis C, reaching a total of 266 donors lost during follow-up. The value of prevalence in confirmatory tests was 0,22% (IC95%: 0,16 – 0,28) for hepatitis B and 0,31% (IC95%: 0,24 – 0,38) for hepatitis C. The copositiveness between GPT and hepatitis markers in serologic screening tests was 8.8% for hepatitis C virus and 0.5% for hepatitis B virus, indicating that determination of this enzyme is not helpful in selection of donors in blood banks.

Os pacientes infectados pelo vírus da imunodeficiência humana (HIV) freqüentemente apresentam alterações digestivas, sendo o esôfago um alvo comum de lesões estruturais. A etiologia infecciosa é a mais freqüente neste grupo de pacientes. Múltiplos agentes já foram implicados como causadores de lesões esofágicas. As infecções virais são uma das principais causas de tais lesões, sendo os vírus mais implicados o citomegalovirus (CMV) e o vírus herpes simples (HSV). Muitas lesões ulceradas permanecem sem diagnóstico etiológico, mesmo após exaustiva investigação, sendo denominadas úlceras idiopáticas ou aftosas. Os métodos de diagnóstico usuais são demorados e pouco sensíveis. Assim, nosso estudo tem como principal objetivo estudar o papel do método da reação em cadeia da polimerase (PCR) no diagnóstico destas lesões. Durante o período de outubro de 1996 a outubro de 1997, foram estudados 79 pacientes HIV-positivos, que foram submetidos ao exame de endoscopia digestiva alta por indicação clínica. Estes foram submetidos a 89 exames endoscópicos, sendo colhidas 96 biópsias, as quais foram armazenadas em nitrogênio líquido (50) ou em freezer a –70oC (46). O DNA foi extraído usando método baseado na lise hipotônica, digestão com proteinase K, extração com fenol-clorofórmio e precipitação em etanol. Uma quantidade fixa foi usada para amplificação em ciclador térmico, utilizando primers específicos para CMV, Herpesvirus, HPV, HIV, Haemophilus ducreyi, Treponema pallidum e as micobactérias M. tuberculosis, M. avium e M. intracellulare. O produto final foi submetido a uma eletroforese em gel de agarose e corado com brometo de etídeo. A endoscopia não revelou alterações esofágicas em 26 exames (29,2%). As alterações observadas foram monilíase esofágica em 33 exames (37,1%), úlceras em 22 (24,7%); esofagite em 10 (11,2%) e áreas lugol-negativas em 9 (10,1%). A PCR resultou positiva para o CMV em 19 amostras (19,8%), para o Herpes em 4 (4,2%), para o HPV em 17 (17,7%), para o HIV em 37 (38,5%) e para o H. ducreyi em 3 (3,1%). Nenhuma amostra foi positiva para o T. pallidum e para micobactérias. No estudo de 29 amostras de 22 úlceras esofágicas a PCR detectou o CMV em 9 amostras (31%), o Herpes em 3 (10,3%), o HPV em 6 (20,7%), o HIV em 19 (65,5%) e o H. ducreyi em 2 (6,9%) e em 8 (36,4%) não foi detectado nenhum agente. O CMV foi detectado com freqüência nas úlceras esofágicas, sendo difícil diferenciar se havia infecção ativa ou latente. O HIV teve uma incidência elevada nas biópsias de úlceras, o que pode sugerir um possível papel etiológico deste agente em tais lesões. O HPV foi o terceiro agente mais freqüente, mas não foi possível caracterizá-lo como causador de lesões esofágica ulceradas. A PCR apresentou potencial para tornar-se um método útil na investigação das lesões esofágicas em pacientes infectados pelo HIV. Patients infected by Human Immunodeficiency Virus (HIV) usually present digestive abnormalities and the esophagus is a common target of structural lesions. Infections are the most frequent cause of esophageal lesions in these patients. Several agents were already implied in this process. Viral infections are one of the main causes of such lesions and cytomegalovirus (CMV) and herpes simplex virus (HSV) were the most involved agents. Many ulcerated lesions persist without etiologic diagnosis even after exhaustive investigation, being denominated idiopathic or aphthous ulcers. The usual diagnostic methods are difficult and have low sensitivity. Thus, the main objective of our study was to evaluate the role of the polimerase chain reaction (PCR) method in the diagnosis of these lesions. During the period of October of 1996 to October of 1997, 79 HIV-positive patients were studied. They were submitted to upper digestive endoscopies, which were indicated on clinical basis. These patients were submitted to 89 upper digestive endoscopies, being obtained 96 biopsies, which were stored in liquid nitrogen or in a 70oC freezer. DNA was extracted using a method based on hypotonic lyses, proteinase K digestion, extraction with phenol-chloroform and precipitation in ethanol. A fixed amount was used for amplification in thermal cycler, using specific primers for CMV, herpesvirus, human papillomavirus (HPV), HIV, Haemophilus ducreyi, Treponema pallidum, Mycobacterium tuberculosis, Mycobacterium avium and Mycobacterium intracellulare. The final products were submitted to an electrophoresis in agarose gel and stained with ethidium bromide. The endoscopies did not reveal esophageal alterations in 26 exams(29,2%). The abnormalities observed were esophageal candidiasis in 33 exams (37,1%), ulcers in 22 (24,7%); esophagitis in 10 (11,2%) and lugol-negative areas in 9 (10,1%). The PCR was positive to CMV in 19 samples (19,8%), for Herpes in 4 (4,2%), for HPV in 17 (17,7%), for HIV in 37 (38,5%) and for the H. ducreyi in 3 (3,1%). No sample was positive for T. pallidum or micobacterium. In the study of the esophageal ulcers by PCR, CMV was detected in 9 samples (31%), Herpes in 3 (10,3%), HPV in 6 (20,7%), HIV in 19 (65,5%), H. ducreyi in 2 (6,9%) and any agent was detected in 8 samples (36,4%). CMV was frequently detected in esophageal ulcers, being difficult to differentiate between active and latent infections. The HIV had an elevated incidence in ulcer biopsies, which may suggest a possible etiologic role of this virus in such lesions. HPV was the third more frequent agent, but it was not possible to attribute the esophageal lesions to that virus. In conclusion, this study suggests that the PCR can be an useful method in the investigation of esophageal lesions in HIV infected patients.

O presente estudo tem como principal objetivo o emprego da reação em cadeia da polimerase (PCR) na elucidação da etiologia dos derrames pleurais dos pacientes com suspeita de pleurite tuberculosa, comparando-o com as técnicas diagnósticas disponíveis na atualidade. O diagnóstico da tuberculose pleural costuma ser feito por meio dos dados clínicos e radiológicos, teste tuberculínico, exames bioquímicos, microbiológicos, e citológicos do líquido pleural e da histopatologia de fragmento de pleura obtido por punção-biópsia. Ainda assim estes métodos apresentam muitas limitações, dentre as quais a baixa sensibilidade e o longo período necessário para a confirmação do diagnóstico. Estudamos 58 amostras de 45 pacientes. Destes, 16 pacientes tiveram diagnóstico clínico ou laboratorial confirmado de tuberculose, totalizando 22 amostras. Consideramos como caso de tuberculose todos os pacientes com baciloscopia, cultura ou histopatológico positivos no líquido pleural ou outro material biológico, ou que tenham apresentado melhora clínica após a introdução do tratamento empírico. Das 22 amostras com o diagnóstico de tuberculose, a PCR foi positiva em 6 amostras de 6 pacientes. A reação foi positiva em 1 amostra de um paciente em que o diagnóstico de tuberculose foi descartado. A sensibilidade, especificidade e os valores preditivo positivo e negativo nos 16 pacientes com diagnóstico de tuberculose foram 31,3%, 96,6%, 83% e 71% respectivamente. A PCR, apesar de ter apresentado uma baixa sensibilidade, demonstrou uma especificidade ótima em relação aos métodos convencionais. Está técnica pode ter utilidade como método complementar às técnicas disponíveis, na tentativa de obter um diagnóstico mais precoce e preciso nos casos de tuberculose pleural. The present study evaluates the use of the polimerase chain reaction (PCR) to confirm the etiology of pleural effusions in patients with suspicion of pleural tuberculosis, comparing it to the current available techniques. The diagnosis of pleural tuberculosis is made through the combination of clinical data, radiologic findings, biochemical, microbiological and cytological examination of the pleural fluid and by the pathology of pleural fragment obtained by biopsy. However, these methods present a lot of limitations, including a low sensitivity and a long incubation period to confirm the diagnosis by culture. We studied 58 samples of 45 patients with pleural effusion. Of these, 16 patients had clinical diagnosis or confirmed by laboratory, in a total of 22 samples. We defined as case of tuberculosis all patients with culture or positive pathology in the fluid pleural or other biological material and those with clinical improvement after empirical treatment. Of the 22 samples with the tuberculosis diagnosis PCR was positive in 6 samples of 6 patients. The reaction was positive in a sample of a patient whose diagnosis of tuberculosis was later discarded. The sensitivity, specificity, positive predictive value and negative predictive value in the 16 patients with tuberculosis diagnosis were 31,3%, 96,6%, 83% and 71% respectively. In spite of having presented a low sensitivity, PCR specificity was greater than the conventional methods. This technique can be useful as an additional method to the available techniques, in the attempt of obtaining a more precocious and precise diagnosis in the cases of pleural tuberculosis.