ABSTRACT Background and aims: Treatment of hepatitis C with direct antiviral agents (DAA) is associated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, frequently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs. Patients and methods: Institutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included. Results: As previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions. Conclusion: The retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country.

ABSTRACT Objective to identify the evidence on safe use of therapeutic hypothermia in newborns. Method integrative review of the literature, conducted between June and July of 2018, in electronic sources from the Virtual Health Library and PubMed, through the question: “What evidence can support nursing care aimed at reducing sequelae in newborns undergoing therapeutic hypothermia?”. Analysis was conducted for nine selected article, being eight from international literature and one from Brazilian national literature. Results cooling should occur for 72 hours with mild hypothermia. Indications for inclusion in the protocol were: first six hours of life, gestational age greater than 35 weeks and acidosis in the first hour of life. Essential care includes hemodynamic monitoring, skin observation, rectal thermal control, Integrated Amplitude Electroencephalogram surveillance. Conclusion the therapy has benefits, but its application depends on institutional protocol and team training focusing on potential complications.

RESUMEN Objetivo identificar la evidencia sobre el uso seguro de la hipotermia terapéutica en recién nacidos. Método revisión integradora de la literatura, realizada entre junio y julio de 2018, en fuentes electrónicas de la Biblioteca Virtual de Salud y PubMed, a través de la pregunta: “¿Qué evidencia puede apoyar la atención de enfermería dirigida a reducir las secuelas en los recién nacidos que sufren hipotermia terapéutica?”. Se realizaron análisis para nueve artículos seleccionados, ocho de literatura internacional y uno de literatura nacional brasileña. Resultados el enfriamiento debe ocurrir durante 72 horas con hipotermia leve. Las indicaciones para la inclusión en el protocolo fueron: primeras seis horas de vida, edad gestacional mayor de 35 semanas y acidosis en la primera hora de vida. El cuidado esencial incluye monitoreo hemodinámico, observación de la piel, control térmico rectal, vigilancia integrada de electroencefalograma de amplitud. Conclusión la terapia tiene beneficios, pero su aplicación depende del protocolo institucional y del entrenamiento del equipo, enfocándose en posibles complicaciones.

RESUMO Objetivo identificar evidências acerca do uso seguro da hipotermia terapêutica em recém-nascidos. Método revisão integrativa realizada entre junho e julho de 2018, em fontes eletrônicas da Biblioteca Virtual de Saúde e PubMed, por meio da pergunta: “Que evidências podem subsidiar o cuidado de enfermagem voltado para a redução de sequelas em recém-nascidos submetidos à hipotermia terapêutica?”. Foram eleitos nove artigos para análise, sendo oito internacionais e um nacional. Resultados o resfriamento deve acontecer por 72 horas, com hipotermia leve. As indicações para inclusão no protocolo foram: primeiras seis horas de vida, idade gestacional maior que 35 semanas e acidose na primeira hora de vida. São cuidados essenciais: monitoração hemodinâmica, observação da pele, controle térmico retal, vigilância do Eletroencefalograma de Amplitude Integrada. Conclusão a terapêutica apresenta benefícios, porém sua aplicação depende de protocolo institucional e treinamento das equipes com foco nas potenciais complicações.

The standard of care therapy of chronic hepatitis C with the combination of pegylated interferon and ribavirin for 24 or 48 weeks was a remarkable accomplishment of the past decade. However, sustained virological responses rates of about 80% (genotypes 2-3) and 50% (geno 3 type 1) were not satisfactory especially for patients infected with genotype 1. Important advances in the biology of HCV have made possible the development of the direct-acting antiviral agents boceprevir and telaprevir with substantial increase in the rates of sustained virological response with shorter duration of therapy for a large number of patients. However, the complexity of triple therapy is higher and several new side effects are expected suggesting greater expertise in the patient management. Anemia and disgeusia are frequent with boceprevir while cutaneous rash, ranging from mild to severe, is expected with telaprevir. Higher risk of drug-drug interactions demand further clinical consideration of the previous well-known adverse events of pegylated interferon and ribavirin. Identification and prompt management of these potential new problems with boceprevir and telaprevir are crucial in clinical practice for optimizing treatment and assuring safety outcomes to HCV-genotype 1 patients.

O tratamento da hepatite C crônica apresenta efeitos colaterais frequentes como citopenias e sintomas neuropsiquiátricos. Contudo, a toxicidade pulmonar associada ao interferon é raramente descrita. Relatamos o caso de uma paciente com 67 anos que apresentou início agudo de tosse, dispnéia e febre após 36 semanas de uso do interferon peguilado alfa-2a e ribavirina. A biópsia pulmonar confirmou o diagnóstico de bronquiolite obliterante com pneumonia em organização, com significativa melhora clínico-radiológica após instituída a corticoterapia. Este relato de caso visa alertar os médicos para a possibilidade desse ocasional, embora grave, evento adverso associado ao tratamento da hepatite C.

The treatment of chronic hepatitis C has frequent side effects such as cytopenias and neuropsychiatric symptoms. However, pulmonary toxicity associated with interferon is rarely described. This paper describes the clinical case of a 67-year-old female patient with chronic hepatitis C who presented an acute onset of dry cough, dyspnoea, and fever 36 weeks after the use of pegylated interferon alfa-2a and ribavirin. The lung biopsy confirmed the diagnosis of a bronchiolitis obliterans organizing pneumonia (BOOP). Corticotherapy was initiated, with clinical and radiological improvement. This paper aims to advise physicians to this occasional, though severe, adverse event related to hepatitis C virus (HCV) treatment.

O objetivo deste trabalho foi avaliar a eficiência de diferentes embalagens no ensacamento de maçãs para o controle de pragas e doenças, e sua influência na maturação e qualidade dos frutos, em pomar sob sistema orgânico. O experimento foi conduzido em pomar com plantas de dez anos de idade da cultivar Imperial Gala, sobre porta-enxerto 'Marubakaido', com filtro EM-9, localizado no município de São Joaquim-SC, nas safras 2007/2008 e 2008/2009. Os frutos foram ensacados, após o raleio, com embalagens plásticas transparentes microperfuradas ou de tecido não texturizado (TNT). Frutos não ensacados constituíram o tratamento-controle. Na colheita, os frutos foram avaliados quanto aos danos provocados por mosca-das-frutas (Anastrepha fraterculus), mariposa-oriental (Grapholita molesta), lagarta-enroladeira (Bonagota salubricola) e pulgão-lanígero (Eriosoma lanigerum), incidência das doenças sarna-da-macieira (Venturia inaequalis) e podridão-amarga (Colletotrichum gloeosporioides), e atributos físico-químicos de maturação e qualidade e teor de cálcio (Ca) nos frutos. O ensacamento, independentemente do tipo de material utilizado, reduziu os danos de insetos-praga, porém não foi eficiente no controle de doenças nos frutos. O ensacamento não comprometeu o desenvolvimento de coloração vermelha na casca e o teor de Ca nos frutos. De modo geral, o ensacamento antecipou o processo de maturação, caracterizado pela redução na firmeza de polpa e na textura da casca e da polpa, e pelo aumento no índice de iodoamido.

This work was carried out to evaluate the efficiency of different fruit bagging materials to insect pests and diseases control, and its influence on maturity and quality of the fruits in an organic apple orchard. The experiment was conducted in an orchard with ten years old 'Imperial Gala' apple trees grafted on 'Marubakaido' rootstock (with a filter of EM-9), in São Joaquim, State of Santa Catarina, in 2007/08 and 2008/09. The apples were bagged after fruit thinning, with bags made of transparent micro-perforated plastic or non-textured fabric. The control treatment consisted of unbagged fruit. At harvest, fruits were assessed for damages caused by fruit fly (Anastrepha fraterculus), oriental fruit moth (Grapholita molesta), apple leafroller (Bonagota salubricola) and woolly apple aphid (Eriosoma lanigerum), incidence of the apple scab (Venturia inaequalis) and bitter rot (Colletotrichum gloeosporioides) diseases, as well as for physico-chemical attributes of maturity and quality, and calcium (Ca) content of the fruit. Fruit bagging, regardless of the material used, reduced the damages caused by insect pests, but it did not protect fruit against diseases caused by the evaluated fungus. Fruit bagging did not affect the development of the red color and Ca content of the fruit. In general, the bagging anticipated the fruit maturation process, characterized by the reduction on flesh firmness and skin and pulp texture, and by the increase of the starch-iodine index.

O objetivo deste trabalho foi avaliar a eficiência de embalagens de diferentes materiais para a proteção contra pragas e doenças e seu efeito sobre a qualidade físico-química, maturação e teor de cálcio (Ca) em maçãs 'Fuji Suprema'. O experimento foi desenvolvido nas safras de 2007/2008 e 2008/2009, em pomar manejado sob o sistema orgânico, localizado na região de São Joaquim (SC). O pomar era composto por plantas de dez anos de idade da cultivar Fuji Suprema, sobre porta-enxerto 'Marubakaido', com interenxerto 'EM-9'. Depois do raleio manual, aproximadamente 40 dias após a plena floração, os frutos foram ensacados com embalagens plásticas transparentes microperfuradas ou de tecido não texturizado (TNT). Os frutos foram mantidos ensacados até a colheita. A testemunha foi constituída por frutos não ensacados. Na colheita, os frutos foram avaliados quanto aos danos provocados por mosca-das-frutas (Anastrepha fraterculus), mariposa oriental (Grapholita molesta) e lagarta enroladeira (Bonagota salubricola). As doenças foram avaliadas pela incidência de sarna da macieira (Venturia inaequalis), podridão amarga (Colletotrichum gloeosporioides) e podridão carpelar (Alternaria sp., Fusarium sp.). Também foi avaliada a incidência de distúrbios fisiológicos "russeting" e "bitter pit", atributos físico-químicos de maturação e qualidade e o teor de Ca nos frutos. Independentemente do tipo de embalagem verificou-se que o ensacamento é prática eficaz na proteção contra o ataque de insetos, mas não reduz a incidência e o desenvolvimento de doenças nos frutos. Na safra de 2008/2009, o ensacamento dos frutos aumentou o teor de Ca e reduziu a incidência de "bitter pit", e aumentou a incidência do "russeting". O ensacamento dos frutos antecipou a maturação, especialmente com embalagem plástica transparente microperfurada, e reduziu a coloração vermelha, especialmente com embalagem TNT.

This work aimed to evaluate the efficiency of fruit bagging with different materials on the protection of apples against pests and diseases, as well as its influence on the quality, maturity and calcium (Ca) content of apple fruit. The experiment was carried out in 2007/2008 and 2008/2009, in an organic apple orchard located at São Joaquim region, State of Santa Catarina, Brazil. Ten year-old 'Fuji Suprema' apple trees grafted on 'Marubakaido' rootstock, with a 'EM-9' interstem, had their fruits bagged with a transparent micro-holed plastic and non-textured fabric bags. Fruits were bagged right after hand-thinning, from nearly 40 days after flowering until harvesting. The control treatment consisted of unbagged fruit. At harvest, fruits were assessed for damages caused by fruit-fly (Anastrepha fraterculus), oriental fruit moth (Grapholita molesta) and apple leafroller (Bonagota salubricola). The incidence of apple scab (Venturia inaequalis), bitter rot (Colletotrichum gloeosporioides), and moldy core (Alternaria sp.; Fusarium sp.) diseases, and of physiological disorders (russeting and bitter pit) were also assessed. The physico-chemical attributes of maturity and quality, and fruit Ca content were evaluated. Regardless of the bag material used, bagged fruit were protected against insect damages, but not against diseases caused by the evaluated fungus. In 2008/2009, bagged fruit showed a significantly higher Ca content and lower incidence of bitter pit and higher incidence of russeting than the control treatment. Bagging advanced fruit maturity, especially in transparent micro-holed plastic, and reduced skin red color, mainly in non-textured fabric bag.

O vírus da hepatite C é caracterizado pela significativa heterogeneidade genética e é atualmente classificado em seis genótipos principais e diversos subtipos. A determinação do genótipo do vírus tem importância na prática clínica para orientar o tratamento dos pacientes portadores de hepatite C crônica. A prevalência dos diferentes genótipos e subtipos do vírus da hepatite C não tem sido amplamente estudada em algumas regiões do Brasil. Neste estudo foram analisadas 788 amostras de pacientes portadores de hepatite C crônica atendidos nos Centros de Referência em Hepatites Virais de Belo Horizonte, entre 2002 e 2006. A genotipagem do vírus foi realizada por seqüenciamento direto da região 5’ UTR. Adicionalmente, foi realizada análise filogenética incluindo todas as variantes genotípicas obtidas. Observou-se alta prevalência do genótipo 1 (78,4%; 1b [40,4%], 1a [37,5%] e 1a/b [0,5 %]), seguida pelo genótipo 3a (17,9%) e pelo 2b (3,1%). Foram identificadas três amostras (0,4%) com o genótipo 2a/c e duas amostras (0,2%) com o genótipo 4. A análise filogenética mostrou a segregação esperada das seqüências obtidas junto às seqüências de referência para os genótipos 1, 2, 3 e 4, exceto em duas amostras do genótipo 1a. A alta prevalência do genótipo 1 (78,4%), encontrada na população de Belo Horizonte é semelhante à previamente descrita em outras cidades, como Rio de Janeiro, mas superior à encontrada em São Paulo e no Sul do país. A presença de raras seqüências atípicas da região 5’UTR sugere a presença de variantes do vírus da hepatite C nesta população.

The hepatitis C virus is characterized by significant genetic heterogeneity. It is currently classified into six main genotypes and several subtypes. Determining the genotype of the virus is important in clinical practice for guiding the treatment for individuals with chronic hepatitis C. The prevalence of different genotypes and subtypes of the hepatitis C virus has not been fully studied in some regions of Brazil. In this study, 788 samples from patients with chronic hepatitis C who were attended at the Viral Hepatitis Reference Centers in Belo Horizonte were analyzed between 2002 and 2006. The genotyping of the virus was performed by direct sequencing of the 5’ UTR region. Additionally, phylogenetic analysis was performed, including all of the genotypic variants obtained. High prevalence of genotype 1 (78.4%; 1b [40.4%], 1a [37.5%] and 1a/b [0.5%]) was observed, followed by genotypes 3a (17.9%) and 2b (3.1%). Three samples were identified as genotype 2a/c (0.4%) and two as genotype 4 (0.2%). The phylogenetic analysis showed the expected segregation of the sequences obtained, with regard to the reference sequences for genotypes 1, 2, 3 and 4, except for two samples of genotype 1a. The high prevalence of genotype 1 (78.4%) found in this population from Belo Horizonte was similar to previous reports from other cities such as Rio de Janeiro, but it was higher than what has been described in São Paulo and in the south of the country. The presence of rare atypical sequences from the 5’ UTR region suggests that variants in the hepatitis C virus exist in this population.

O objetivo deste trabalho é verificar a potencialidade do aproveitamento tecnológico da carne do coelho, através do processamento de hambúrguer, e submeter o produto a análises físico-químicas (composição centesimal) e sensorial (teste de aceitabilidade, representado por Escala Hedônica de sete pontos). Os resultados obtidos para as análises físico-químicas foram: Umidade (68,34 ± 0,80)%, Cinzas (1,01 ± 0,06)%, Proteínas (18,37 ± 0,03)%, Lipídios (3,59 ± 0,04)% e Carboidratos (8,69 ± 0,07)% resultados estes condizentes com a legislação. A análise sensorial indicou uma ótima aceitação do produto, obtendo média de 5,85 classificando o produto entre os pontos "gostei moderadamente" e "gostei muito". Os resultados confirmam o potencial tecnológico da carne de coelho para a elaboração de produtos cárneos, e sua viabilidade de produção e comercialização para consumo humano.

This study consisted of an evaluation of the technological potential of rabbit meat processed into hamburger, and its physicochemical and sensorial analysis. The physicochemical analyses indicated the following contents: moisture (68.34 ± 0.80)%, ashes(1.01 ± 0.06)%, proteins (18.37 ± 0.03)%, lipids (3.59 ± 0.04)% and carbohydrates (8.69 ± 0.07)%, all of which meet the requirements of Brazilian legislation. The sensorial analysis indicated excellent acceptance of the product, with an average score of 5.85, classifying it as "like it moderately" and "like it very much." The results confirm the technological potential of rabbit as a food product, and the viability of its production, processing and commercialization for human consumption.

The association between pyogenic liver abscesses and schistosomiasis has been confirmed by clinical and experimental studies. In this retrospective study of 78 patients with pyogenic liver abscesses the association with schistosomiasis has been investigated. Pyodermitis, a known focus of bacteremia, was observed in 19 patients (24%). Blood eosinophilia was observed in 30 patients (39%). Staphylococcus aureus was cultured from abscesses in 17 out of 38 patients (45%). Forty-one out of 57 patients (53%) had stool examination. Schistosoma mansoni was the main parasite identified. Eggs of S. mansoni were also identified in liver biopsies in 7 out of 19 patients who did the exam. The large number of young patients with liver abscesses described here is different from what has been observed in developed countries. This clinical study provide support for the concept that granulomas of S. mansoni in the liver are foci for colonization with S. aureus, which in presence of staphylococcal bacteremia can form liver abscesses.

Nos últimos cinco anos, em uma área endêmica para esquistossomose no nordeste de Minas Gerais, 561 indivíduos submeteram-se a exames clínico, laboratoriais, ultra-sonografia abdominal e dopplerecocardtografia visando definir a morbidade da doença antes e após o tratamento. Revelaram-se altas a prevalência de esquistossomose (66,3%) e de formas graves (9,5% com baço palpável). A prevalência de indivíduos sem fibrose hepática e com fibrose teve, moderada e intensa ao ultra-som foi de 46,0%, 19,6%, 27,6%) e 6,8%, respectivamente. Vinte um (39,6%:) de 53 indivíduos com baço palpável não apresentavam fibrose periportal ao ultrasom. Linfonodos periportais foram identificados em 33,8% dos indivíduos examinados e anticorpos anti-KLH no soro de 40,7%,. Observaram-se alterações urinárias compatíveis com glomerulopatia esquistossamótica em 4,5% da população e 11,7% apresentavam achados dopplerecocardiográficos de hipertensão pulmonar. Doze meses após o tratamento da esquistossomose, a prevalência da doença reduziu-se de 66,3% para 25,0%. Em Queixadinha, um perfil da morbidade da doença e de sua evolução após o tratamento começa a ser delineado.

In an endemic area for schistosomiasis in the northeast of the slate of Minas Gerais in Brazil 516 individuals have been submitted to clinical and laboratory examination, ultrasonography of the abdomen and dopplerecocardiography in order to define the morbidity of schistosomiasis before and after treatment. A high prevalence of schistosomiasis (66.3%) and of severe disease (9.5% with palpable spleens) were recorded. Ultrasonography classified liver periportal fibrosis as light (19.4%), moderate (27.6%) and intense (6.8%), and 46.0% presented no periportal fibrosis. Twenty one out of the 53 individuals (39.6%) with palpable spleens did not present liver fibrosis on ultrasound. Periportal lymph nodes were described in 33.8% of the population and anti-KLH antibodies were found in the serum of 40.7%. Urinary alterations compatible with the glomerulopathy of schistosomiasis were observed in 4.5% of the population, and 11.7% of the individuals examined by dopplerecocardiography had pulmonary hypertension. Twelve months after treatment for schistosomiasis the prevalence of the disease dropped from 66.3% to 25.0%. In Queixadinha, a profile of the morbidity of schistosomiasis has just been established.