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Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

https://doi.org/10.36660/abc.20220151

Mortality rates and epidemiological changes in critically ill Coronavirus Disease 2019 patients after a vaccination program in Brazil
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Braz Junior, Donato da Silva

; Costa, Guilherme Jorge

; Lyra, Nathália Alves de Barros e

; Viana, Mirela Muniz Arantes

; Borba, Vinícius Santos

; Thuler, Luiz Claudio Santos

; Lima, Eduardo Jorge da Fonseca

; Mello, Maria Júlia Gonçalves de

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 5 elocation e20220268

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20220268

Anurans of the Caparaó National Park and surroundings, southeast Brazil
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Zornosa-Torres, Camila

; Augusto-Alves, Guilherme

; Lyra, Mariana L.

; Silva Júnior, José Cassimiro da

; Garcia, Paulo C.A.

; Leite, Felipe

; Verdade, Vanessa

; Rodrigues, Miguel T.

; Gasparini, João Luiz

; Haddad, Célio F.B.

; Toledo, Luís Felipe

Biota Neotropica

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2020, Volume 20 N. 3 elocation e20190882

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A Mata Atlântica (MA) é considerada um dos hotspots de biodiversidade do mundo, sendo o bioma mais degradado no Brasil. Este bioma compreende muitas fitofisionomias, como floresta ombrófila, semidecidual, e campos de altitude. Esta complexidade, aliada à enorme variação latitudinal e altitudinal, disponibiliza habitats e condições diversas à especiação dos anfíbios. Como resultado, atualmente são conhecidas mais de 600 espécies de anfíbios que ocorrem na MA. Dentro deste bioma o Parque Nacional do Caparaó (PNC) é relevante, pois inclui o ponto mais alto da Mata Atlântica, o Pico da Bandeira com cerca de 3000 m de elevação, assim como diferentes fitofisionomias, como campos rupestres e florestas úmidas. Apesar disso, sua fauna de anfíbios é ainda pobremente descrita. Realizamos inventários de anfíbios no PNC e entorno de 2016 a 2018 e registramos 47 espécies de anuros, das quais duas são endêmicas e pelo menos seis ainda não foram descritas. Adicionalmente, compilamos dados de coletas anteriores (2004 a 2008) e dados secundários de coleções científicas. Ao juntar todos os dados registramos um total de 61 espécies de anuros de 12 famílias para o PNC e arredores, colocando esta área entre as 10 áreas mais ricas em anfíbios da MA. Algumas destas espécies estão representadas apenas por um ou dois exemplares em coleções e não foram registradas no PNC desde a década de 1980, como Thoropa lutzi e Hylodes vanzolinii. Estas espécies podem ser exemplos de declínios populacionais ou mesmo de extinções locais, destacando a necessidade de maiores esforços amostrais neste local altamente biodiverso.

Abstract The Atlantic Forest (AF) is one of the biodiversity hotspots of the world, and the most fragmented biome of Brazil. This biome includes different phytophysiognomies, as riparian, slope, cloudy forests, and grasslands. Such complexity, allied to huge latitudinal and high elevational range, provides diverse habitats and conditions for amphibian speciation. As a result, there are over 600 amphibian species known to occur in the AF. Within this biome the Caparaó National Park (CNP) is relevant, as it includes the highest peak of the biome, the Pico da Bandeira at almost 3,000 m above sea level, as well as different phytophysiognomies as rocky fields and humid forests. In spite of that, its amphibian fauna is still poorly described. We inventoried amphibians at the CNP and surrounding areas from 2016 to 2018 and recorded 47 anuran species, of which two are locally endemic and at least six have not been described yet. Additionally, we compiled data from previous surveys (2004 to 2008) and secondary data from scientific collections. All together, we registered a total of 61 anuran species from 12 families for the CNP and surroundings, placing this area among the 10 amphibian richest sites in the AF. Some of these species are represented by only one or two collected specimens and have not been registered in the CNP since the 1980’s, such as Thoropa lutzi and Hylodes vanzolinii. These species could be examples of population declines or even past local extinctions, highlighting the need of further sampling efforts in that highly biodiverse site.

https://doi.org/10.1590/1676-0611-bn-2019-0882 1083 downloads

Início da tuberização, duração do ciclo vegetativo e tolerância ao calor em genótipos de batata
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Lyra, Danilo Hottis

; Ribeiro, Guilherme Henrique Martins Rodrigues

; Figueiredo, Izabel Cristina Rodrigues de

; Guedes, Marcio Lisboa

; Carneiro, Otávio Luiz Gomes

; Pinto, César Augusto Brasil Pereira

; Pereira, Arione da Silva

Pesquisa Agropecuária Brasileira

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jul 2015, Volume 50 N. 7 Pages 582 - 592

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo: O objetivo deste trabalho foi avaliar a relação do tempo para o início da tuberização e da duração do ciclo vegetativo com a tolerância ao calor em batata. Grupos de clones com diferentes tempos para o início de tuberização e durações do ciclo vegetativo foram definidos e avaliados em dois ambientes, e seus índices morfofisiológicos foram estimados em condições de estresse de calor. A amplitude para o início da tuberização foi de 31,8 dias e para a duração do ciclo vegetativo de 30,3 dias. Os grupos de clones formados apresentaram os seguintes parâmetros: tuberização precoce e ciclo vegetativo curto, tuberização precoce e ciclo longo (PL), tuberização tardia e ciclo curto e tuberização tardia e ciclo longo. Em condições de estresse de calor, a produção de tubérculos graúdos do grupo PL apresentou média superior à dos demais grupos. Seis clones (IRF 10-24, IRF 7-61, IRF 2-71, IRF 2-14, IRF 6-104 e IRF 10-44) e três testemunhas ('Markies', CBM 16-16 e CBM 9-10) foram considerados tolerantes ao estresse de calor (média diária de 21,2ºC) e responderam favoravelmente ao ambiente com temperaturas amenas (média diária de 19,0ºC). A partição de matéria seca para os tubérculos foi mais rápida nos clones do grupo PL. Os clones de tuberização precoce e ciclo vegetativo longo apresentaram maior tolerância ao calor, com maior produção de tubérculos do que os demais grupos.

Abstract: The objective of this work was to determine the relationship of the time for tuber initiation and of the duration of the vegetative cycle with heat tolerance in potato. Clone groups with different tuber initiation times and duration of the vegetative cycle were defined and evaluated in two environments, and their morphophysiological indices were determined under heat stress conditions. The amplitude for the beginning of tuberization was 31.8 days, and for the duration of vegetative cycle was 30.3 days. The formed groups of clones showed the following parameters: early tuberization and short cycle, early tuberization and long cycle (PL), late tuberization and short cycle, and late tuberization and long cycle. Under heat stress conditions, the production of large tubers of the PL group was higher than that of the other groups. Six clones (IRF 10-24, IRF 7-61, IRF 2-71, IRF 2-14, IRF 6-104, and IRF 10-44) and three checks ('Markies', CBM 16-16, and CBM 9-10) were considered tolerant to heat stress (21.2ºC daily average), and responded favorably to environment at mild temperatures (19.0ºC daily average). Dry matter partitioning to the tubers was faster in the PL clone group. Clones of early tuberization and long vegetative cycle showed higher tolerance to heat stress, with higher tuber production than the other groups.

https://doi.org/10.1590/S0100-204X2015000700008 2512 downloads

Richness, composition and trophic groups of an avian community in the Pernambuco Endemism Centre, Alagoas, Brazil
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TOLEDO-LIMA, GUILHERME S.

; MACARIO, PHOEVE

; LYRA-NEVES, RACHEL M. DE

; TEIXEIRA, BRUNO P.

; LIMA, LUIZ A.F. DE

; SUGLIANO, GABRIEL O.S.

; TELINO-JÚNIOR, WALLACE R.

Anais da Academia Brasileira de Ciências

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sep 2014, Volume 86 N. 3 Pages 1207 - 1220

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

No Nordeste do Brasil, a redução da cobertura florestal original a pequenos fragmentos isolados tem trazido consequências negativas para a avifauna local, em particular, uma perda de espécies mais especializadas e o aumento populacional de algumas espécies generalistas. O presente estudo foca na composição e nos grupos tróficos de uma comunidade de aves de uma propriedade rural em Alagoas, nordeste do Brasil. Amostragens mensais foram realizadas entre novembro de 2008 e outubro de 2009, através de capturas com redes-de-neblina e observações de campo. De forma geral, foram identificadas 112 espécies, das quais 76 estiveram associadas aos dois fragmentos florestais estudados, com as demais ocorrendo apenas na matriz de pasto e pomares. A avifauna da área de estudo demonstrou um predomínio de espécies insetívoras seguidas por onívoras. No entanto, insetívoros especialistas como os forrageadores de troncos e de subosque, corresponderam a apenas ∼15% dos insetívoros como um todo. A baixa diversidade de algumas guildas e espécies com dietas mais específicas e a total ausência de outras espécies sensíveis, tais como grandes rapineiros e papagaios, é reflexo da fragmentação acentuada e degradação das florestas locais, o que reduziu a disponibilidade de recursos alimentares e eliminou seus sítios reprodutivos.

In northeastern Brazil, the reduction of the natural forest cover to a series of small, isolated fragments has had negative consequences for the local avian fauna, in particular, a loss of the more specialized species, while the populations of some generalists have tended to increase. The present study focuses on the composition and trophic groups of a bird community on a farm in the northeastern Brazilian state of Alagoas. Monthly surveys were conducted between November 2008 and October 2009, based on mist-netting and systematic observations. Overall, 112 species were recorded, of which 76 were associated with the two forest fragments surveyed, while all the others were observed exclusively in the surrounding matrix of pasture and orchards. The bird community presented a predominance of insectivorous species, followed by omnivores. However, specialized trunk-creeping and understory insectivores accounted for only around 15% of the species in this feeding category. The reduced diversity of other guilds and species with more specialized diets, and the complete absence of sensitive species such as large parrots and raptors, reflects the severe fragmentation and degradation of the local forests, which has greatly reduced the availability of dietary resources and breeding sites.

https://doi.org/10.1590/0001-3765201420130129 2119 downloads

Myxovirus resistance, osteopontin and suppressor of cytokine signaling 3 polymorphisms predict hepatitis C virus therapy response in an admixed patient population: comparison with IL28B
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Angelo, Ana Luiza Dias

; Cavalcante, Lourianne Nascimento

; Abe-Sandes, Kiyoko

; Machado, Taisa Bonfim

; Lemaire, Denise Carneiro

; Malta, Fernanda

; Pinho, Joao Renato

; Lyra, Luiz Guilherme Costa

; Lyra, Andre Castro

Clinics

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oct 2013, Volume 68 N. 10 Pages 1325 - 1332

Abstract: En | Text: En | PDF: En

OBJECTIVES: Suppressor of cytokine signaling 3, myxovirus resistance protein and osteopontin gene polymorphisms may influence the therapeutic response in patients with chronic hepatitis C, and an association with IL28 might increase the power to predict sustained virologic response. Our aims were to evaluate the association between myxovirus resistance protein, osteopontin and suppressor of cytokine signaling 3 gene polymorphisms in combination with IL28B and to assess the therapy response in hepatitis C patients treated with pegylated-interferon plus ribavirin. METHOD: Myxovirus resistance protein, osteopontin, suppressor of cytokine signaling 3 and IL28B polymorphisms were analyzed by PCR-restriction fragment length polymorphism, direct sequencing and real-time PCR. Ancestry was determined using genetic markers. RESULTS: We analyzed 181 individuals, including 52 who were sustained virologic responders. The protective genotype frequencies among the sustained virologic response group were as follows: the G/G suppressor of cytokine signaling 3 (rs4969170) (62.2%); T/T osteopontin (rs2853744) (60%); T/T osteopontin (rs11730582) (64.3%); and the G/T myxovirus resistance protein (rs2071430) genotype (54%). The patients who had ≥3 of the protective genotypes from the myxovirus resistance protein, the suppressor of cytokine signaling 3 and osteopontin had a greater than 90% probability of achieving a sustained response (p<0.0001). The C/C IL28B genotype was present in 58.8% of the subjects in this group. The sustained virological response rates increased to 85.7% and 91.7% by analyzing C/C IL28B with the T/T osteopontin genotype at rs11730582 and the G/G suppressor of cytokine signaling 3 genotype, respectively. Genetic ancestry analysis revealed an admixed population. CONCLUSION: Hepatitis C genotype 1 patients who were responders to interferon-based therapy had a high frequency of multiple protective polymorphisms in the myxovirus resistance protein, osteopontin and suppressor of cytokine signaling 3 genes. The combined analysis of the suppressor of cytokine signaling 3 and IL28B genotypes more effectively predicted sustained virologic response than IL28B analysis alone.

https://doi.org/10.6061/clinics/2013(10)06 1352 downloads

Metabolic syndrome in patients with chronic hepatitis C virus genotype 1 infection who do not have obesity or type 2 diabetes
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Oliveira, Lucivalda Pereira Magalhães

; Jesus, Rosangela P. de

; Boulhosa, Ramona SSB

; Mendes, Carlos Mauricio C.

; Lyra, Andre Castro

; Lyra, Luiz Guilherme C.

Clinics

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2012, Volume 67 N. 3 Pages 219 - 223

Abstract: En | Text: En | PDF: En

OBJECTIVE: The individual components of metabolic syndrome may be independent predictors of mortality in patients with liver disease. We aimed to evaluate the prevalence of metabolic syndrome and its related components in hepatitis C virus-infected patients who are not obese and do not have type 2 diabetes. METHODS: This cross-sectional study included 125 patients infected with hepatitis C virus genotype 1. Metabolic syndrome was defined according to the International Diabetes Federation. Anthropometric data were measured according to standardized procedures. Bioimpedance analysis was performed on all patients. RESULTS: Metabolic syndrome was diagnosed in 21.6% of patients. Of the subjects with metabolic syndrome, 59.3% had hypertension, 77.8% had insulin resistance, 85.2% were overweight, 48.1% had a high waist circumference, 85.2% had an increased body fat percentage, and 92.3% had an elevated waist:hip ratio. In the bivariate analysis, female sex (OR 2.58; 95% CI: 1.09-6.25), elevated gamma-glutamyl transferase (γGT) (OR 2.63; 95% CI: 1.04-7.29), elevated fasting glucose (OR 8.05; 95% CI: 3.17-21.32), low HDL cholesterol (OR 2.80; 95% CI: 1.07-7.16), hypertriglyceridemia (OR 7.91; 95% CI: 2.88-22.71), elevated waist circumference (OR 10.33; 95% CI: 3.72-30.67), overweight (OR 11.33; 95% CI: 3.97-41.07), and increased body fat percentage (OR 8.34; 95% CI: 2.94-30.08) were independent determinants of metabolic syndrome. Using the final multivariate regression model, similar results were observed for abdominal fat (OR 9.98; 95% CI: 2.63-44.41) and total body fat percentage (OR 8.73; 95% CI: 2.33-42.34). However, metabolic syndrome risk was also high for those with blood glucose >5.55 mmol/L or HDL cholesterol <0.9 mmol/L (OR 16.69; 95% CI: 4.64-76.35; OR 7.23; 95% CI: 1.86-32.63, respectively). CONCLUSION: Metabolic syndrome is highly prevalent among hepatitis C virus-infected patients without type 2 diabetes or obesity. Metabolic syndrome was significantly associated with hypertension, insulin resistance, increased abdominal fat, and overweight.

https://doi.org/10.6061/clinics/2012(03)03 2788 downloads

Daily interferon induction regimen using different manufactured interferons (alpha-2a or alpha-2b) in combination with ribavirin for treatment of chronic hepatitis C: a prospective randomized study
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Braga, Eduardo Lorens

; Lyra, André Castro

; Nascimento, Lourianne

; Netto, Eduardo

; Kalabrik, Luciano

; Lyra, Luiz Guilherme Costa

Arquivos de Gastroenterologia

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dec 2006, Volume 43 N. 4 Pages 275 - 279

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RACIONAL: Estudos em cinética viral na hepatite C demonstraram que há uma queda dos níveis séricos de interferon 48 h após a sua administração, quando a carga viral do vírus C volta a se elevar. Antes da disponibilidade do interferon peguilado, diversos ensaios clínicos investigaram a terapia de indução com interferon standard OBJETIVOS: Avaliar a segurança e eficácia do esquema de indução diário com interferon alfa associado à ribavirina. PACIENTES E MÉTODOS: Noventa e três pacientes com hepatite crônica C foram incluídos. Através de randomização, foram alocados em um de dois braços terapêuticos: 44 indivíduos no grupo A: IFN 3MU três vezes por semana + ribavirina 1,0-1,2 g diariamente por 48 semanas e 49 indivíduos no grupo B: IFN 3MU diariamente por 12 semanas, seguindo-se por IFN 3MU três vezes por semana até completar 48 semanas + ribavirina 1,0-1,2 g diariamente por 48 semanas. A genotipagem do vírus C foi realizada em 85 indivíduos. Considerou-se resposta virológica sustentada a persistência do HCV-RNA negativo 6 meses após o término da terapia RESULTADOS: Oitenta e três pacientes completaram o tratamento. Houve cinco abandonos (um do grupo A e quatro do grupo B) e em cinco pacientes a terapia foi retirada devido a efeitos adversos (dois do grupo A e três do grupo B). Não houve diferença estatisticamente significante entre os grupos quanto à interrupção do tratamento. A freqüência de cirrose foi 29%, semelhante entre os grupos. Na análise "intention to treat" a resposta virológica sustentada foi 39,8%. Não houve diferença estatística na taxa de resposta virológica sustentada entre ambas as estratégias terapêuticas (36,4% grupo A vs 42,9% grupo B). Nos 83 pacientes que finalizaram o estudo, a resposta virológica sustentada foi 44,6%. Entre os pacientes com genótipo 1, a resposta virológica sustentada foi 42% (40,9% grupo A vs 42,9% grupo B) e entre os pacientes com genótipo 2/3, a resposta virológica sustentada foi 55,6% (50% grupo A vs 63,6% grupo B) CONCLUSÕES: A taxa de resposta virológica sustentada foi 39,8% para a terapia combinada (análise "intention to treat"). Não houve diferença entre as taxas de RVS do grupo de indução comparado ao regime padrão. Efeitos adversos, mesmo mais freqüentes no grupo de indução, não interferiram nas estratégias terapêuticas.

BACKGROUD: Studies on hepatitis C virus kinetics showed that serum levels of interferon fall 48 h after drug administration, when viral load is increasing again. Previously to the availability of pegylated interferon, daily induction therapy with standard interferon was under evaluation. AIMS: To evaluate the safety and efficacy of interferon alpha daily induction regimen in combination with ribavirin. PATIENTS AND METHODS: A randomized trial including 93 patients with chronic hepatitis C was carried out. On satisfying all eligibility criteria, patients were randomly allocated to two different treatment groups: 44 individuals in treatment arm A: IFN 3 MU thrice weekly + ribavirin 1.0-1.2 g daily for 48 weeks (IFN TIW) and 49 individuals in treatment arm B: IFN 3 MU daily + ribavirin 1.0-1.2 g daily for 12 weeks followed by IFN 3 MU thrice weekly + ribavirin 1.0-1.2 g daily, until completion of 48 weeks of therapy (IFN QD). HCV genotyping was obtained in 85 subjects. A negative HCV-RNA 6 months after cessation of therapy was considered a sustained virological response RESULTS: Eighty three patients completed treatment, five dropped out (one from IFN TIW and four from IFN QD) and in five patients therapy was discontinued due to medical request (two from IFN TIW and three from IFN QD). There was no statistically significant difference between groups with respect to therapy interruption. The frequency of cirrhosis was 29%, similar in both groups. In the "intention to treat" analysis the overall sustained virological response was 39.8%. There was no significant difference in sustained virological response rate between both treatment strategies (36.4% IFN TIW vs 42.9% IFN QD). In the 83 patients who finished the trial, sustained virological response was 44.6%. Among subjects with HCV genotype-1, the sustained virological response was 42% (40.9% IFN TIW vs 42.9% IFN QD) and among patients with HCV genotype 2 or 3, the sustained virological response was 55.6% (50% IFN TIW vs 63.6% IFN QD) CONCLUSIONS: Combination therapy had an overall sustained virological response rate of 39.8% ("intention to treat analysis"). There was no difference with respect to sustained virological response rates between patients who used daily induction schedule compared to standard regimen. Adverse events, even more frequent in the daily induction group, did not interfere with the treatment strategies.

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Esteato-hepatite relacionada ao vírus da hepatite C: perfil clínico-histológico
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Pereira, João Eduardo

; Cotrim, Helma Pinchemel

; Freitas, Luiz Antônio Rodrigues de

; Paraná, Raymundo

; Portugal, Marcelo

; Lyra, Luiz Guilherme

Jornal Brasileiro de Patologia e Medicina Laboratorial

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apr 2006, Volume 42 N. 2 Pages 115 - 122

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: Esteatose ocorre com freqüência na hepatite crônica pelo vírus C (HCV) e parece estar relacionada a fatores clínicos e/ou virológicos. Contudo, a presença de esteato-hepatite, uma condição indutora de fibrose, tem sido pouco estudada. OBJETIVO: Estudar a associação de HCV com esteato-hepatite em material de biópsia hepática, correlacionando-a com dados clínicos. MÉTODOS: As biópsias hepáticas de pacientes com HCV foram avaliadas quanto a atividade, estádio e presença de alterações morfológicas de esteato-hepatite. Os dados morfológicos foram correlacionados a parâmetros clínicos que incluíam: consumo alcoólico, IMC, colesterol, triglicérides, glicemia, exposição a petroquímicos e genótipo viral. RESULTADOS: Esteato-hepatite foi encontrada em 42 de 252 (16,6%) pacientes com HCV. Entre os 42 casos, critérios para obesidade, diabetes e dislipidemia foram encontrados em 16,7%; 16,7% e 21,4%, respectivamente. O genótipo 3 esteve presente em 38,1% dos casos. Fatores de risco para esteato-hepatite não-alcoólica (NASH) foram encontrados em 73% dos casos em genótipos diferentes do 3, enquanto tais fatores foram presentes em 37,5% dos casos com genótipo 3 (p = 0,05). O padrão morfológico mais freqüente foi a esteatose macrovacuolar de moderada intensidade (61,9%) com distribuição difusa (64,3%). Tanto o padrão de fibrose de NASH quanto o de HCV foram notados: fibrose perissinusoidal (87,8%), portal (87,8%), septal (69,0%) e cirrose (30,9%). CONCLUSÕES: Esteato-hepatite é freqüente em pacientes com HCV, apresentando padrão peculiar de distribuição da esteatose e alta freqüência de cirrose. Em genótipos diferentes do 3, a esteato-hepatite parece estar relacionada à sobreposição de fatores de risco para NASH.

INTRODUCTION: Steatohepatitis and hepatitis C virus (HCV) have been related to several clinical and virological factors and fibrosis progression. OBJECTIVE: To describe clinical and morphological aspects of steatohepatitis associated to HCV. METHODS: The study included patients with HCV without treatment. Biopsies were evaluated by METAVIR score and steatohepatitis was evaluated according to criteria of Sociedade Brasileira de Patologia (SBP). Clinical parameters included alcoholic intake history and determination of risk factors for non-alcoholic steatohepatitis (NASH). RESULTS: Steatohepatitis was observed in 42 out of 252 patients (16.6%) with HCV, and 76.2% were male. Risk factors for NASH were present in 37.5% of the patients with genotype 3 and in 73% of the patients with other genotypes (p = 0.05). Obesity was present in 16.7%, diabetes in 16.7%, hyperlipidemia in 21.4%, and genotype 3 in 38.1%. Macrovacuolar steatosis presented mild intensity in 61.9% and was diffuse in 64.3%. Cirrhosis was present in 33.3% of the patients. CONCLUSIONS: Diffuse steatosis and ballooning of mild to moderate intensity characterized steatohepatitis related to HCV. Patients with genotype different from genotype 3 presented with known risk factors for NASH, whereas most of the patients with genotype 3 had only viral genotype as risk factor for steatosis. The frequency of cirrhosis was relevant and suggests that the association of steatohepatitis with HCV contribute to fibrosis progression.

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10.

Clinical and epidemiological features of patients with chronic hepatitis C co-infected with HIV
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Eduardo Lorens, Braga

; André Castro, Lyra

; Fabrizio, Ney-Oliveira

; Lourianne, Nascimento

; Adriano, Silva

; Carlos, Brites

; Rosicreuza, Marbak

; Luiz Guilherme Costa, Lyra

; Manuel L., Ribeiro Neto

; Koonj Asvin, Shah

Brazilian Journal of Infectious Diseases

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feb 2006, Volume 10 N. 1 Pages 17 - 21

Abstract: En | Text: En | PDF: En

Co-infection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) is increasingly common and affects the clinical course of chronic hepatitis C. Highly active antiretroviral therapy has improved the life expectancy of HIV infected patients, but, by extending survival, it permits the development of HCV cirrhosis. This study tried to evaluate clinical and epidemiological features of patients with chronic hepatitis C co-infected with HIV. We evaluated 134 HCV-infected patients: i) group A - 65 co-infected HCV/HIV patients, ii) group B - 69 mono-infected HCV patients. The impact of HIV infection on HCV liver disease was analyzed using Child's score, ultrasound findings and liver histology. Patients were subjected to HCV genotyping and anti-HBs dosage. Patients mean age was 42.4 years (±9.1) and 97 (72.4%) were males. Injected drug use and homo/bisexual practice were more frequently encountered in the co-infected group: 68.3% and 78.0%, respectively. Antibodies against hepatitis B virus (anti-HBs) were found in only 38.1% of the patients (66.7% group A x 33.3% group B). Ten out of 14 individuals (71.4%) who had liver disease (Child B or C) and 25 out of 34 (73.5%) who showed ultrasound evidence of chronic liver disease were in the co-infection group. HCV genotype-2/3 was more frequently encountered in co-infected patients (36.9% group A vs. 21.8% group B). Conclusions: a) HIV infection seems to adversely affect the clinical course of chronic hepatitis C, b) injected drug use, bi/homosexual practice and genotype-2/3 were more frequently encountered in co-infected patients, c) immunization against HBV should be encouraged in these patients.

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11.

Concomitant high prevalence of Hepatitis C virus antibodies and Hepatitis B virus markers in a small village fo the Amazon Region, Mato Grosso State, Brazil
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Souto, Francisco José Dutra

; Fontes, Cor Jésus Fernandes

; Gaspar, Ana Maria Coimbra

; Paraná, Raymundo

; Lyra, Luiz Guilherme Costa

Revista do Instituto de Medicina Tropical de São Paulo

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jun 1996, Volume 38 N. 3 Pages 221 - 223

Abstract: En | Text: En | PDF: En

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