ABSTRACT Background: Excessive weight gain is a current concern among People Living with HIV (PLHIV) starting ART. Objectives: To evaluate the weight gain after 48-weeks of ART in naive patients, according with baseline CD4 count. Methods: PLHIV starting 3TC + TDF + DTG with at least 48-weeks of follow up in two AIDS referral centers were stratified by baseline CD4 count (lower or higher than 200 cells/mm3). Data on CD4 count, HIV viral load, weight/Body Mass Index (BMI), lipids and glucose levels were collected at baseline, 24 and 48 weeks of treatment. For analysis purpose, patients were categorized according to their BMI progression. Results: A total of 270 patients were included in the study. Mean CD4 count were 78.3 ± 61.7 and 536.7 ± 273 cells/mm3 for low and high CD4 count groups, respectively (p < 0.001). Baseline BMI was significantly lower in low CD4 group (21.7 vs. 23.6 Kg/m2, p < 0.001). Patients in low CD4 group gained more weight than those in high CD4 group (11.2 ± 8.5 kg vs. 2.2 ± 4.2 Kg, p = 0.004). Overall weight gain was higher in women, regardless group (13.1 ± 7.9 Kg vs. 1.4 ± 3.6 Kg for women and men, respectively, p < 0.001). The proportion of overweight/obesity significantly increased in low CD4 group. Viral suppression rate was high for both groups. At week 48 the overall proportion of overweight/obesity was like that reported for the Brazilian population. Conclusions: Weight gain in the present study indicates a “return to health” phenomenon. Excessive weight gain was more frequent in women.

Abstract: The state of Espírito Santo is the major producer of Coffea canephora in Brazil. Knowledge of genetic reserves is fundamental to plant breeding. Therefore, the present study characterized and analyzed the genetic diversity of 600 C. canephora accessions from the germplasm bank of Incaper based on 38 traits evaluated in 24-30-month-old plants. Further, the predominant descriptors or traits were identified, and high phenotypic variability was determined. Genetic distances for the grouped (Gower), quantitative, and qualitative datasets were 0.48, 0.61, and 0.92, respectively, with accessions 76 (Conilon) and 407 (Robusta) being the most divergent ones at Incaper. In clustering using the Tocher optimization method, 30 groups were formed, with three accessions introduced from Epamig’s Robusta collection being the most dissimilar ones. Graphical dispersion analysis using the principal coordinate method revealed the predominance of three groups formed by the Robusta, Conilon, and hybrid Robusta × Conilon genotypes.

Abstract INTRODUCTION: Human immunodeficiency virus (HIV) and human T-cell leukemia virus-1 (HTLV-1) viruses are associated with a high global burden of disease, and coinfection is a frequently reported event. We aimed to compare the functioning and health-related quality of life (HRQoL) of patients infected with HTLV-1, HIV, and HIV-HTLV-1. METHODS: We conducted a cross-sectional study of patients older than 18 years who had an HTLV-1 infection (Group A), HIV infection (Group B), or HIV-HTLV-1 coinfection (Group C). The functioning profiles were evaluated using handgrip strength, Berg balance scale (BBS), timed “up and go” (TUG) test, and 5-m walk test (m/s). We used the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire to measure disability. The HRQoL was evaluated using a 36-item short-form health survey. For data with parametric and non-parametric distribution, we used analysis of variance with Bonferroni correction and the Kruskal-Wallis test, followed by Dunn’s pairwise tests with Bonferroni correction. RESULTS: We enrolled 68 patients in Group A, 39 in Group B, and 29 in Group C. The scores for handgrip strength, BBS, TUG test, all the WHODAS domains, and HRQoL were poorer for Groups A and C than for Group B. CONCLUSIONS: Compared to patients with HIV infection, those with HIV-HTLV-1 coinfection and HTLV-1 infection had poor functioning and HRQoL scores. HTLV-1 infection was associated with reduced functioning and HRQoL in patients with a single HTLV-1 infection and HIV-HTLV-1 coinfection.

RESUMO Introdução: A classificação citopatológica tireoidiana com base no Sistema de Bethesda para Relatos de Citopatologia da Tireoide (SBRCT) padronizou os resultados provenientes de punção aspirativa por agulha fina (PAAF). Seu uso tem facilitado a comunicação entre clínicos, parece reduzir o número de tireoidectomias não necessárias e também melhora a qualidade na detecção de malignidade. Objetivo: Avaliar a correlação entre amostras citopatológicas classificadas de acordo com o SBRCT e seu achado histológico após análise da amostra pós procedimentos cirúrgico. Métodos: Amostras citopatológicas classificadas de acordo com Sistema de Bethesda foram correlacionadas com o achado anatomopatológico respectivo após tireoidectomia. Foram incluídos todos os casos de tireoidectomia com PAAF anterior, na mesma lateralidade do órgão, ocorridos no período de dois anos. Resultados: Os 200 casos de PAAF de tireoide analisados foram distribuídos em 25 casos não diagnósticos ou insatisfatórios (I; 12,5%), 45 casos benignos (II; 22,5%), 48 atipias ou lesões foliculares de significado indeterminado [(AUS/FLUS), III, 24%], 23 casos suspeitos para neoplasia folicular ou neoplasias foliculares [(SFN/FN), IV; 11,5%), 40 casos suspeitos para malignidade (V; 20%) e 19 casos malignos (VI; 9,5%). As taxas de malignidade observadas para as categorias I a VI foram 12%, 13,3%, 29,2%, 43,5%, 85% e 100%, respectivamente. Conclusão: A prevalência da categoria II de Bethesda foi menor do que a recomendada pelo SBRCT (60%-70%), bem como a categoria III, a qual foi maior do que a recomendada (7%), porém os índices correspondentes de malignidade encontraram-se dentro das variações esperadas.

ABSTRACT Introduction: The thyroid cytopathologic classification based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) standardized results derived from fine-needle aspiration (FNA). It has facilitated communication among clinicians, seems to reduce the number of unnecessary thyroidectomies and also improves the quality of malignancy detection. Objective: To evaluate the correlation between cytopathological samples classified according to TBSRTC and their histological finding after specimen examination following surgical procedure. Methods: Cytopathological samples classified according to TBSRTC were correlated with the respective anatomopathological finding after thyroidectomy. There were retrospectively included all cases of thyroidectomy with previous FNA in the same lateral position of the organ that occurred within two years. Results: The 200 cases of thyroid FNA analyzed were distributed in 25 nondiagnostic or unsatisfactory cases (I; 12.5%), 45 benign cases (II; 22.5%), 48 atypia or follicular lesions of undetermined significance [(AUS/FLUS), III; 24%], 23 suspected cases for follicular neoplasia or follicular neoplasias [(SFN/FN), IV; 11.5%], 40 cases suspected for malignancy (V; 20%), and 19 malignant cases (VI; 9.5%). The malignancy rates observed for categories I to VI were 12%, 13.3%, 29.2%, 43.5%, 85%, and 100%, respectively. Conclusion: The prevalence of Bethesda II category was lower than predicted by TBSRTC (60%-70%), as well as Bethesda III was higher than recommended (7%). Nevertheless, the corresponding malignancy rates were within the expected ranges.

Abstract The objective of this study was to evaluate the separation of fructooligosaccharides (FOS) from yacon extract by an ultrafiltration process using membranes of 10 and 30 kDa. The total resistance (Rt), membrane resistance (Rm), fouling resistance (Rf), and concentration polarization (Rc) during the separation process were also assessed. The operating pressures were 1.2 and 0.75 bar for UF-10 and UF-30, respectively. The permeate flux increased upon increasing the pressure from 0.5 to 2 bar and the resistance values showed a slight increase with increasing pressure. The fouling percentages were 61.24% and 57.33% for the membranes UF-10 and UF-30, being reversible after the cleaning procedure with acidic and basic solution, resulting in high percentages of flux recovery of 76.46% and 83.56% for U-10 and UF-30, respectively. The FOS retention values were 24.48% and 6.49% for both membranes UF-10 and UF-30, corresponding to 24% and 18.4% purity.

This study reviewed the use of the Strengths and Weaknesses of Attention-Deficit/Hyperactivity-symptoms and Normal-behaviors (SWAN) rating scale in diagnostic and evolutive approaches to attention deficit hyperactivity disorder (ADHD) and in correlational studies of the disorder. A review of articles published in indexed journals from electronic databases was conducted and 61 articles on the SWAN scale were analyzed. From these, 27 were selected to a) examine use of SWAN in research on attention disorders and b) verify evidence of its usefulness in the areas of genetics, neuropsychology, diagnostics, psychiatric comorbidities, neuroimaging, pharmacotherapy, and to examine its statistical reliability and validity in studies of diverse populations. This review of articles indicated a growing use of the SWAN scale for diagnostic purposes, for therapy, and in research on areas other than ADHD, especially when compared with other reliable scales. Use of the scale in ADHD diagnosis requires further statistical testing to define its psychometric properties.

Resumo: Para determinar as concentrações plasmáticas de proteínas e metabólitos de cascavéis em cativeiro, foram utilizadas 60 serpentes adultas, sendo 30 machos e 30 fêmeas. O sangue foi coletado através de punção do seio venoso paravertebral cervical e armazenado em tubos com heparina. As análises bioquímicas foram processadas colorimetricamente em Analisador Automático de Bioquímica Chemwell (Awareness Technology®, Inc). Foram calculadas as médias e desvios padrão dos seguintes constituintes: proteínas totais, albumina, globulinas, relação albumina/globulinas, ácido úrico, creatinina, ureia, colesterol, colesterol HDL e triglicérides. Os valores obtidos foram semelhantes aos descritos na literatura para repteis e serpentes, sendo as diferenças observadas provavelmente decorrentes da diferença entre espécies, clima, estação do ano e metodologia utilizada. Não houve diferenças significativas entre machos e fêmeas para os parâmetros estudados. Estes resultados podem ser úteis no estabelecimento de valores de referência para planos de conservação destes ofídios em cativeiro.

Abstract: For determining plasma concentrations of proteins and metabolites of rattlesnakes in captivity, 60 adult snakes, 30 males and 30 females were used. Blood was collected by puncture of the cervical paravertebral venous sinus and stored in tubes with heparin. Biochemical analyzes were colorimetrically processed using an Automatic Biochemistry Analyzer Chemwell (Awareness Technology®, Inc). The mean and standard deviation were calculated for the following constituents: total protein, albumin, globulin, albumin/globulin ratio, uric acid, creatinine, urea, cholesterol, HDL cholesterol and triglycerides. The values were similar to those previously reported for reptiles and snakes, with the differences observed probably due to the difference between species, climate, season and the methodology used. There were no significant differences between males and females for the parameters studied. These results may be useful in establishing normal biochemical values for conservation plans for these snakes in captivity.

BACKGROUND: The human retroviruses HIV-1 and HTLV-1 share the routes of infection with hepatitis viruses B and C. Co-infection by these agents are a common event, but we have scarce knowledge on co-infection by two or more of these agents. OBJECTIVE: To evaluate the characteristics and risk factors for co-infections by HBV and HCV in patients infected by HIV-1 or/and HTLV-1, in Salvador, Brazil. METHODS: In a case-control study we evaluated patients followed in the AIDS and HTLV clinics of Federal University of Bahia Hospital. Clinical and epidemiological characteristics were reviewed, and patients were tested for the presence of serological markers of HBV and HCV infections. HCV-infected patients were tested by PCR to evaluate the presence of viremia. RESULTS: A total of 200 HIV-1, 213 HTLV-1-infected, and 38 HIV-HTLV-co-infected individuals were included. HIV-infected patients were more likely to have had more sexual partners in the lifetime than other patients' groups. HIV-HTLV-co-infected subjects were predominantly male. Patients infected by HTLV or co-infected had a significantly higher frequency of previous syphilis or gonorrhea, while HIV infection was mainly associated with HPV infection. Co-infection was significantly associated to intravenous drug use (IVDU). HBV and/or HCV markers were more frequently found among co-infected patients. HBV markers were more frequently detected among HIV-infected patients, while HCV was clearly associated with IVDU across all groups. AgHBs was strongly associated with co-infection by HIV-HTLV (OR = 22.03, 95% CI: 2.69-469.7), as well as confirmed HCV infection (p = 0.001). Concomitant HCV and HBV infection was also associated with retroviral co-infection. Patients infected by HTLV-1 had a lower chance of detectable HCV viremia (OR = 0.04, 95% CI: 0.002-0.85). CONCLUSIONS: Infection by HCV and/or HBV is frequent among patients presenting retroviral infection, but risk factors and prevalence for each infection are distinct for each agent. Retroviral co-infection increases the risk of a positive AgHBs, but HTLV-1 infection seems to increase the likelihood of HCV spontaneous clearance.

A study was made of the extraction of clavulanic acid (CA) from a fermented medium and its concentration and purification. The fermented broth was obtained by cultivation of Streptomyces clavuligerus in complex medium containing glycerol as the Carbon and energy source, and soybean protein isolate as the Nitrogen source. The extraction steps proposed here were evaluated from the standpoint of Yield, purification factor and concentration factor. The extractions were carried out with ethyl acetate, butyl acetate, 2-butanol, n-butanol and methyl isobutyl ketone. The distribution coefficient was related to the solvent properties and it was found that distribution coefficient is directly proportional to the product of the dielectric constant, with solubility. It was observed that extraction with butanol leads to a higher distribution coefficient than ethyl acetate; however, the higher solubility of water in butanol impairs the final precipitation of clavulanic acid. The optimal condition with ethyl acetate occurs at pH 1.63, yielding an extraction factor of 35.6% with a distribution coefficient of 0.73.

Background Renal dysfunction is strongly associated with chronic heart failure, and is a frequent and progressive complication of this condition, with clinical outcomes which depend on the functional class and pharmacological treatment. Objectives To define the prevalence and the clinical and functional profile of patients with renal dysfunction in the setting of heart failure with depressed ejection fraction. Material and Methods Creatinine clearance was measured in 132 patients with heart failure and an ejection fraction <40%. Renal dysfunction was defined as a creatinine clearance <60 ml/min. Patients underwent routine lab tests, echocardiogram, bioelectrical impedance analysis and 6-minute walk test. Results The prevalence of renal dysfunction was 43.2% (57 patients). Among these patients, there was a greater prevalence of women and elder subjects, yet the prevalence of coronary artery disease was low. Lab tests showed lower levels of hemoglobin, albumin, ferritin and triiodothyronine, and greater prevalence of measurable levels of troponin T. Body mass index (BMI), basal metabolic rate, muscle mass and phase angle were lower, while the ratio of extracellular water to total body water was greater in patients with renal dysfunction. The distance walked in the 6-minute test was lower. The use of beta blockers and amiodarone was the only difference in therapy. At multivariate analysis, age, NTproBNP level, the presence of positive troponin T and muscle mass as a continuous variable were independent predictors of renal dysfunction in patients with systolic heart failure. Conclusions Renal dysfunction is frequent in patients with heart failure with depressed ejection fraction and is associated with distinctive features that may contribute to explain the clinical picture.

Introducción La disfunción renal está fuertemente asociada con la insuficiencia cardíaca crónica. Es una complicación habitual y progresiva de esta condición, con una evolución clínica que fluctúa con la clase funcional y el tratamiento farmacológico. Objetivos Definir la prevalencia y el perfil clínico y funcional de pacientes con disfunción renal en el contexto de insuficiencia cardíaca con baja fracción de eyección. Material y métodos En 132 pacientes con insuficiencia cardíaca y fracción de eyección < 40% se midió la depuración de creatinina. Se definió disfunción renal a una depuración de creatinina < 60 ml/ min. Se realizaron analítica sanguínea, ecocardiograma, bioimpedanciometría y caminata de 6 minutos. Resultados La prevalencia de disfunción renal fue del 43,2% (57 pacientes). Comparados con el resto, en estos pacientes hubo mayor prevalencia de sexo femenino, mayor edad y menos frecuentemente etiología coronaria. En el laboratorio tuvieron valores menores de hemoglobina, albúmina, ferritina y triyodotironina y mayor prevalencia de troponina T dosable. Fueron menores el índice de masa corporal (IMC), la tasa metabólica basal, la masa muscular y el ángulo de fase, mientras que la relación agua extracelular/agua corporal total fue mayor. La distancia recorrida en la prueba de 6 minutos fue menor. Respecto del tratamiento, sólo difirió el uso de betabloqueantes y amiodarona. En el análisis multivariado, la edad, el nivel de NT-proBNP, la presencia de troponina T positiva y la masa muscular como variable continua fueron predictores independientes de disfunción renal en pacientes con insuficiencia cardíaca sistólica. Conclusiones La disfunción renal es frecuente en pacientes con insuficiencia cardíaca con baja fracción de eyección y se vincula con características distintivas que pueden contribuir a explicar el cuadro clínico.

This study defined the normal variation range for different subsets of T-lymphocyte cells count in two different Brazilian regions. We analysed the T-lymphocytes subpopulations (CD3+, CD4+, CD8+) in blood donors of two Brazilian cities, located in North (Belem, capital state of Para, indian background) and Northeast (Salvador, capital state od Bahia, African background) regions of Brazil. Results were compared according to gender, stress level (sleep time lower than 8 hours/day), smoking, and alcohol intake. Lymphocytes subpopulations were measured by flow cytometry. Five hundred twenty-six blood donors from two Brazilians cities participated in the study: 450 samples from Bahia and 76 samples from Pará. Most (60%) were men, 59% reported alcohol intake, 12% were smokers, and 80% slept at least 8 h/day. Donors from Bahia presented with significantly higher counts for all parameters, compared with Para. Women had higher lymphocytes levels, in both states, but only CD4+ cells count was significantly higher than men's values. Smokers had higher CD4+ counts, but sleep time had effect on lymphocytes levels only for Para's donors (higher CD3+ and CD4+ counts). That state had also, a higher proportion of donors reporting sleep time <8 h/day. The values for CD3, CD4 and CD8+ cells count were significantly higher in blood donors from Bahia than among those from Pará. Female gender, alcohol intake, stress level, and smoking were associated with higher lymphocyte counts. The use of a single reference range for normal lymphocytes count is not appropriate for a country with such diversity, like Brazil is.

A pesquisa foi realizada em uma amostra de 75 produtores rurais utilizando-se questionário do tipo estruturado/semi-aberto. Verificou-se que o produtor rural decide, sob a luz do modelo econômico vigente, fundamentando suas decisões em elementos voltados à priorização de resultados econômicos, ou seja, a maximização do lucro. Neste sentido, seu processo decisório é conduzido na lógica da obtenção de maior volume de produção ao menor custo, fazendo uso de sua experiência e tradição, da tecnologia disponível e da assistência técnica, atento às condições do clima, à obtenção de um produto de qualidade e às sinalizações do mercado, em especial às relacionadas ao preço. Os aspectos ambientais só são contemplados, de forma prioritária, quando participam ou interferem de forma direta nos resultados econômicos da atividade; caso contrário, o equacionamento de suas questões se resumirá à simples utilização de algumas práticas e procedimentos específicos, considerados suficientes à solução do problema. A incorporação da dimensão ambiental ao processo decisório do produtor rural deve considerar, além da lógica de suas decisões, o papel do Estado como agente indutor de mudanças.

The research was accomplished in a sample of 75 farmers with the application of an open structured questionnaire. It was verified that farmers decide, under the actual economic model, make their decisions focused on the economic results, that is to say, the maximization of profit. In this sense, their decision is made by the logic of obtaining a larger production at the smallest cost making use of available technology and technical assistance, with regard to climatic conditions, obtaining a good quality product, observing market demands, mainly those related to price. The environmental aspects are only observed with priority when they participate or interfere in a direct way in the economic results, otherwise, the actions are summarised to simple practices and procedures considered enough by farmers to solve the problems. The integralization of environmental aspects in the farmers' decision process besides the logic of their decision must consider the role of State as a promoter of changes.

Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (± 30 days) of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases), C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each). The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC), use of parenteral nutrition support (PNS), previous exposure to antibiotics, and chronic renal failure (CRF). No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity of the underlying diseases, than as a direct consequence of Candidemia.

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.