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INTRODUCTION: The prevalence of hepatitis C virus (HCV) infection is affected by demographic, virological, clinical, and lifestyle-related factors and varies in different regions in Brazil or worldwide. The present study aimed to clarify the epidemiological patterns of HCV infection in the interior region of Brazil. METHODS: This study was conducted in the Southern Triangle Macro-region of the state of Minas Gerais, Brazil, according to the guidelines of the National Program for the Prevention and Control of Viral Hepatitis. The participants answered a structured questionnaire on social and epidemiological factors. Immunochromatographic rapid tests were used for the qualitative detection of antibodies against HCV in whole blood (Alere HCV® Code 02FK10) in adult subjects by a free-standing method. RESULTS: Of 24,085 tested individuals, 184 (0.76%) were anti-HCV positive. The majority of anti-HCV-positive individuals were born between 1951 and 1980 (n=146 [79.3%]), with 68 women and 116 men. Identified risk factors included syringe and/or needle sharing (p = 0.003), being in prison (p = 0.004), and having tattoos or piercings (p = 0.005) and were significantly associated with the decade of birth. CONCLUSIONS: The study shows the importance of testing populations at risk for HCV infection, including incarcerated individuals, those with tattoos or piercings, those who share or have shared syringes or needles, and those in high-risk birth cohorts (1950s, 1960s, and 1970s) in the Southern Triangle Macro-region.

Trata-se de um estudo exploratório, descritivo, transversal, retrospectivo, de abordagem epidemiológica, realizado nas unidades de atenção primária à saúde de Uberaba entre 2014 e março de 2017, com objetivo de conhecer a prevalência e positividade do anticorpo Anti-hepatite C na população adulta acima de 40 anos. Foram testadas 17.845 pessoas através do teste de imunocromatográficos e, depois, aos 131 positivos aplicou-se o teste de genotipagem e estadiamento da fibrose hepática. Encontrou-se 0,73% de positivos, sendo 79,3% nascidos nas décadas de 1950 a 1970; e 24% apresentavam fibrose hepática moderada, avançada ou cirrose. As formas de transmissão mais citadas foram uso de drogas (qualquer via); múltiplos parceiros sexuais e transfusões, hemodiálise ou transplante de órgãos. É importante capacitar os profissionais da rede de atenção primária sobre a importância da hepatite C, de seu diagnóstico precoce e dos grupos de risco prioritários, além de propiciar a ampliação do acesso ao diagnóstico.

While most of those infected with hepatitis C virus (HCV) are asymptomatic or only develop liver manifestations, a significant percentage evolves with autoimmune and lymphoproliferative disorders, resulting in a clinical condition called HCV syndrome. This work involving case studies of six patients with hepatitis C and varied skin manifestation aimed to report skin lesions occurring with HCV infection and its treatment. Skin manifestations in hepatitis C have been based on epidemiological studies. This justifies the need for studies that correlate HCV infection and its treatment with skin manifestations.

Background: Cardiac autonomic function in the indeterminate chronic form of Chagas’ disease deserves better clearing-up and understanding, since the existing findings are scarce and controversial. This work analyzed the short-term heart interval variability in order to verify the cardiac autonomic modulation in indeterminate Chagas’ disease subjects examined in a Brazilian endemic area. Methods: Variability in time and frequency domain of 5-minute electrocardiogram (ECG) series of R-R intervals in supine and active standing positions were obtained from 18 age-, gender-, body mass index, lifestyle-, and physical activity-matched chagasics and 18 control healthy subjects examined in ´ Agua Comprida city, MG, Brazil. Mann-Whitney test was used for analysis of the data and spread of the individual indices in both groups. Results: The median of the all variability indices in the chagasic group were statistically similar (P = 0.17‐0.87) to that in the control group. A wide dispersion of the almost all individual indices values, ranging from normal to variably reduced or increased ones, was noted in the majority of the chagasics in relation to the control interquartile range, in both postural positions. Conclusion: As a group, indeterminate Chagas’ disease subjects showed unaltered short-term heart interval variability. Individual somewhat widespread of majority of time- and frequency-domain indices, from depressed to exacerbated ones appears to exist. This conforms to a variable cardiac autonomic modulation in this form of disease, suggesting that the majority of chagasics has no lesions, and a minority has subtle lesions of the efferent innervation-sinus node complex. (PACE 2007; 30:772‐780)

Chagas' disease is a common cause of cardiac autonomic impairment. In an endemic area there is a predominance of the indeterminate form and the number of elderly individuals committed by the disease is increasing. This study aimed to investigate the profile of heart rate variability (HRV) in elderly chagasic patients. 28 aged chagasic (CH), 28 non-chagasic (NC) aged individuals and 28 adults between 20 and 40 years old (YG) were studied. R-R intervals were assessed in time and frequency domains applying an autoregressive algorithm. There was no difference regarding temporal and spectral indices among the elderly groups in baseline. The values of the variance in CH, NC and YG individuals were 891.80, 283.60, 2557.00, showing a reduction of the total HRV in the aged groups when compared to the young control (p < 0.001). During the cold face test, the pNN50 response was significantly different only in the young group (p < 0.001). The temporal and spectral indices were not different among the elderly groups. The percentile changes of the R-R intervals induced by the tilt test in CH, NC and YG were respectively -7.04%, -9.35%, -15.81%, being significantly higher in the young individuals (p < 0.001). There was no difference regarding the percentile changes of the temporal and spectral indices between CH and NC elderly patients. The cardiac autonomic function assessed by HRV parameters presented no differences among the elderly individuals (CH and NC) living in an endemic area.

Arterial hypertension and Chagas' disease are prevalent pathologies in Latin America. It has been demonstrated that each one of them may cause cardiac autonomic dysfunction. This study aimed to investigate the pattern of cardiac autonomic modulation in chagasic-hypertensive patients.Subjects (n=120) without left ventricular dysfunction were distributed in four groups: healthy control (n=30); hypertensive (n=30); chagasic (n=30) and chagasic-hypertensive (n=30). Patients were evaluated by autoregressive spectral analysis of heart rate variability in three different conditions: baseline, cold face and passive tilt tests. Power spectral densities in low (0.04-0.15 Hz) and high (0.15-0.50 Hz) frequency bands were estimated in both absolute and normalized units.Baseline median values (percentile 25 to percentile 75) of mean arterial pressure (in mmHg) were 93.3 (85.0-96.7), 116.7 (*, #) (110.0-129.2), 86.7 (83.3-92.5) and 106.7 (*, #) (106.7-110.0) for healthy control, hypertensive, chagasic and chagasic-hypertensive patients, respectively (*p0.05 versus healthy control, #p0.05 against chagasic group). Heart rate at rest did not differ among groups. Regarding to spectral parameters in baseline conditions, the absolute power of high frequency component of heart rate variability of the chagasic-hypertensive group was significantly lower than that found in healthy control and hypertensive patients. There were no differences in spectral parameters responses during cold face test. After passive tilt test, however, decreases in high frequency oscillations and increases in sympathovagal balance (low and high frequency ratio) were significantly lower in hypertensive, chagasic and chagasic-hypertensive patients as compared with healthy control.These data indicate that chagasic-hypertensive patients presented an impairment of cardiac parasympathetic modulation at baseline conditions as well as in response to passive orthostatic stress.

Background: In HIV-infected patients the risks for cardiovascular disease are multifactorial. Autonomic dysfunction has been detected in the early phase of HIV infection as well as in AIDS patients with advanced cardiomyopathy. Methods: Forty AIDS patients receiving highly active antiretroviral therapy (HAART), 40 HIV+ naive of HAART, and 40 control subjects were studied. Computerized analysis of heart rate variability was performed using an analog to digital converter. R-R intervals were obtained from a standard ECG, recorded in DII lead in supine rest and after the cold-face and tilt tests. The series of R-R intervals were assessed in time and frequency domains using an autoregressive algorithm. Results: There was no difference regarding to mean values of R-R intervals and variance in baseline. The normalized power of the low-frequency (LF) component and the low-frequency/high-frequency (HF) ratio (LF/HF) was significantly decreased in the HIV group. Responses of normalized HF and LF/HF ratio during the cold-face test were significantly decreased in the HIV group, as compared to the control. During the tilt test, a higher augmentation of normalized LF and the LF/HF ratio was observed in the HIV group compared with the control. The AIDS group was similar to the control in baseline and after cold-face and tilt tests. Conclusion: The HIV group presented in baseline conditions, a shift of cardiac sympathovagal balance, an exacerbated response of the LF component during the tilt test, and an ineffective cardiac vagal response to the cold-face test suggesting sympathetic and parasympathetic dysfunction. AIDS patients receiving HAART did not present these autonomic alterations.

Saprophytic fungi are being increasingly recognized as etiologic agents of mycoses in immunosuppressed patients. We report a case of subcutaneous infiltration by Aureobasidium pullulans, likely due to traumatic inoculation, in a neutropenic patient during chemotherapy for chronic lymphocytic leukemia. The patient was treated with amphotericin B deoxycholate but was subsequently switched to itraconazole, which improved the lesion. This case highlights the importance of considering unusual fungal infections in critically ill patients such as those who are immunosuppressed due to chemotherapy. Diagnostic techniques and effective antifungal therapy have improved the prognosis of these cases.

Background There is no consensus regarding large-scale use of benznidazole to treat Chagas disease, because of its toxicity and low efficacy during the chronic phase. Objectives To evaluate heart rate variability in chronic Chagas patients before and after treatment with benznidazole. Methods Twenty-one Chagas patients with positive blood cultures and/or PCR received benznidazole (5 mg/kg twice daily for 60 days) and were matched for age and gender with 24 Chagas individuals with negative blood cultures, as controls. R–R intervals were assessed in time and frequency domains using an autoregressive algorithm under three different conditions: baseline, cold face and active tilt tests. Power spectral densities in low and high-frequency bands were estimated in absolute and normalized units. Data were expressed as mean ± SD or medians (lower and upper quartiles). Groups were compared using non-paired or paired Student's T, Mann–Whitney or Wilcoxon tests, as required. The significance level was 5%. Results The groups were comparable regarding age, gender and clinical disease forms. There were no differences in temporal and spectral indices between groups in baseline and cold face tests. Treated patients presented significantly lower tachycardic responses in mean R–R intervals during the active tilt test (p = 0.0200) than controls did. Genetic characterization of T. cruzi isolates from treated group samples showed that 100% belonged to genotype II. Conclusion For the first time in the medical literature, we detected sympathetic impairment during the active tilt test in chronic Chagas patients treated with benznidazole. This finding may be partially explained by benznidazole neurotoxicity.

This report describes two patients who presented acute disseminated and severe toxoplasmosis as the first opportunistic disease related to acquired immunodeficiency syndrome. At admission, clinical and laboratory findings were similar to sepsis or septic shock and a fast evolutive course to death occurred in both cases. At necropsy, an inflammatory reaction and presence of a great number of Toxoplasma gondii cysts and tachyzoites were observed in most organs examined.