Resumo Objetivou-se relatar a experiência no gerenciamento de pesquisa-ação sobre inquérito de hepatite C junto à comunidade carcerária no Triângulo Mineiro, Minas Gerais. A proposta foi desenvolvida entre março de 2019 e março de 2020, alcançando 240 pessoas, com o intuito de conter a disseminação do agravo por meio de inquérito, testagem e acompanhamento dos casos positivos. Adotou-se ação intersetorial, com articulação entre universidades, sociedade médica, hospital de ensino e Secretaria de Estado de Justiça e Segurança Pública. As estratégias para o gerenciamento da pesquisa-ação foram: cenários e atores do estudo, registro e formalização da atividade, aplicação dos testes e manejo dos internos reagentes. Dificuldades foram identificadas quanto à acomodação de rotinas entre equipe de pesquisadores e funcionamento próprio da penitenciária, o que exigiu treinamento ostensivo entre as partes e articulações gerenciais. Considera-se que o relato, quando destaca as estratégias adotadas para a condução da pesquisa, colabora para a organização de investigações futuras que visem acessar essa população ainda invisibilizada.

Abstract We aimed to report the experience in managing action research on hepatitis C investigation in the prison community in the Triângulo Mineiro region, Minas Gerais, Brazil. The proposal was developed from March 2019 to March 2020, reaching 240 people to contain the spread of the disease through a survey, testing, and monitoring of positive cases. We adopted intersectoral action with articulation between Universities, Medical Society, Teaching Hospital, and State Secretariat for Justice and Public Security. Strategies for the management of action research are described: study settings and stakeholders, registration and formalization of the activity, application of tests, and management of reagent inmates. We identified difficulties regarding the accommodation of routines among the research team and the proper functioning of the penitentiary, which required extensive training between the parties and managerial articulations. We consider that the report collaborates with the organization of future research aimed at accessing this still invisible population, the prison community when it highlights the strategies adopted to conduct the research.

Abstract We aimed to report the experience in managing action research on hepatitis C investigation in the prison community in the Triângulo Mineiro region, Minas Gerais, Brazil. The proposal was developed from March 2019 to March 2020, reaching 240 people to contain the spread of the disease through a survey, testing, and monitoring of positive cases. We adopted intersectoral action with articulation between Universities, Medical Society, Teaching Hospital, and State Secretariat for Justice and Public Security. Strategies for the management of action research are described: study settings and stakeholders, registration and formalization of the activity, application of tests, and management of reagent inmates. We identified difficulties regarding the accommodation of routines among the research team and the proper functioning of the penitentiary, which required extensive training between the parties and managerial articulations. We consider that the report collaborates with the organization of future research aimed at accessing this still invisible population, the prison community when it highlights the strategies adopted to conduct the research.

Resumo Objetivou-se relatar a experiência no gerenciamento de pesquisa-ação sobre inquérito de hepatite C junto à comunidade carcerária no Triângulo Mineiro, Minas Gerais. A proposta foi desenvolvida entre março de 2019 e março de 2020, alcançando 240 pessoas, com o intuito de conter a disseminação do agravo por meio de inquérito, testagem e acompanhamento dos casos positivos. Adotou-se ação intersetorial, com articulação entre universidades, sociedade médica, hospital de ensino e Secretaria de Estado de Justiça e Segurança Pública. As estratégias para o gerenciamento da pesquisa-ação foram: cenários e atores do estudo, registro e formalização da atividade, aplicação dos testes e manejo dos internos reagentes. Dificuldades foram identificadas quanto à acomodação de rotinas entre equipe de pesquisadores e funcionamento próprio da penitenciária, o que exigiu treinamento ostensivo entre as partes e articulações gerenciais. Considera-se que o relato, quando destaca as estratégias adotadas para a condução da pesquisa, colabora para a organização de investigações futuras que visem acessar essa população ainda invisibilizada.

OBJECTIVE: To determine peroxisome proliferator activated receptor α and γ mRNA expression in liver tissue of hepatitis C virus-infected patients with and without human immunodeficiency virus and its possible contribution to an acceleration of liver disease progression. METHODS: We measured peroxisome proliferator-activated receptor α and γ mRNA expression by real-time polymerase chain reaction in liver tissues from 40 subjects infected only with hepatitis C virus, 36 subjects co-infected with hepatitis C virus and human immunodeficiency virus and 11 normal adults. RESULTS: Hepatic mRNA expression of both peroxisome proliferator-activated receptors was significantly lower in hepatitis C virus-infected subjects with and without human immunodeficiency virus co-infection compared to the controls. Non-black race was also identified as a predictor of lower peroxisome receptor α and γ mRNA expression. Compared to subjects infected only with hepatitis C virus, liver peroxisome receptor γ mRNA expression was significantly lower in hepatitis C virus/human immunodeficiency virus-co-infected subjects (0.0092 in hepatitis C virus/human immunodeficiency virus-co-infection vs. 0.0120 in hepatitis C virus-only; p=0.004). Hepatic peroxisome receptor α mRNA expression in the hepatitis C virus-infected patients was lower in the presence of human immunodeficiency virus co-infection in non-black subjects (0.0769 vs. 0.1061; p=0.02), whereas the levels did not vary based on human immunodeficiency virus status among black subjects. CONCLUSION: mRNA expression of both peroxisome proliferator-activated receptors is impaired in hepatitis C virus-infected liver and further reduced by human immunodeficiency virus co-infection, although the suppressive effects of the viruses are substantially mitigated in black patients.

Introdução: doença valvar é importante causa de insuficiência cardíaca. Existe relação direta entre a deterioração valvar e o estado inflamatório do paciente, sendo as citocinas interleucina-6, interleucina-1, fator de necrose tumoral e a proteína C reativa as principais envolvidas nesse estado de estimulação. Objetivo: relatar uma série de casos de troca valvar, bioprótese ou mecânica e seu perfil inflamatório. Métodos: pacientes maiores de 18 anos e portadores de bioprótese ou protética mecânica, com período mínimo de 6 meses e máximo de 2 anos, foram incluídos. Além das características demográficas de cada paciente, colheram-se os marcadores inflamatórios e comparou-se o ecocardiograma conforme registro de prontuário antes e depois da cirurgia. Um total de 46 pacientes foi incluído, tendo sido 23 com valva mecânica e 23 de bioprótese. Resultados: dos 46 pacientes, chegamos ao total de 20 pacientes com dados completos, sendo 12 com bioprótese e 8 com protética mecânica. Não houve diferença entre tipo de prótese ou local de implante para os valores dos marcadores inflamatórios, contudo, na média, seus valores estavam aumentados. Discussão: pacientes submetidos ao implante de valva protética mecânica aórtica beneficiaram-se mais do que os submetidos ao implante de bioprótese e ambos com resultado bem superior às trocas realizadas na valva mitral. Não houve diferença em relação aos biomarcadores inflamatórios.

Introduction: valve disease is an important cause of heart failure. There is a direct relationship between valve deterioration and the patient’s inflammatory status and cytokines: interleukin-6, interleukin-1, tumor necrosis factor, and C-reactive protein, involved in this major state of inflammation. Objective: to report a series of cases of valve replacement, using a bioprosthetic or mechanical valve, and the inflammatory profile of them. Methods: patients older than 18 years and with bioprosthetic or mechanical valve placed for a minimum of 6 months and maximum of 2 years were included. In addition to the demographic characteristics of each patient, inflammatory markers were measured and a comparison was made of echocardiographic results before (based on medical records) and after surgery. A total of 46 patients were enrolled, 23 with mechanical valve and 23 with bioprosthetic valve. Results: of the 46 patients, 20 presented complete data were included, 12 with bioprosthetic and 8 with mechanical valve. There was no difference between types of prosthesis or implant site for the values of inflammatory markers although they were all above reference range. Discussion: patients undergoing aortic mechanical valve implant benefited more than those undergoing bioprosthetic implant and both with much better results than those of valve replacements performed on mitral valve. In short, there was no difference in relation to inflammatory biomarkers.

The coexistence of pregnancy and liver disease represents a complex clinical situation. Pregnancy develops hypervolemic state due to increased splachnic blood flow, which contributes to increased portal pressure transmitted to collateral veins that increase the risk of variceal bleeding in these patients. We report the case of a 39 years old patient in the sixth pregnancy and without any previous medical history that presented pre-sinusoidal portal hypertension, and thanks to appropriate multidisciplinary management had an uncomplicated delivery. We review the literature relevant to the case

La coexistencia de embarazo y enfermedad hepática representa una situación clínica compleja. Durante el embarazo se desarrolla un estado hipervolémico debido a un flujo esplácnico incrementado, que contribuye a mayor presión portal transmitida a las venas colaterales que incrementan el riesgo de hemorragia varicosa en este grupo de pacientes. Se reporta el caso de una paciente de 39 años en el sexto embarazo y sin ningún antecedente médico previo que presenta hipertensión portal pre-sinusoidal y que gracias al manejo multidisciplinario adecuado, tuvo un parto sin complicaciones. Se revisa la literatura pertinente al caso

OBJECTIVE: To assess the effectiveness of treatment for hepatitis C virus (HCV) infection in low- and middle-income countries and identify factors associated with successful outcomes. METHODS: We performed a systematic review and meta-analysis of studies of HCV treatment programmes in low- and middle-income countries. The primary outcome was a sustained virological response (SVR). Factors associated with treatment outcomes were identified by random-effects meta-regression analysis. FINDINGS: The analysis involved data on 12 213 patients included in 93 studies from 17 countries. The overall SVR rate was 52% (95% confidence interval, CI: 48-56). For studies in which patients were predominantly infected with genotype 1 or 4 HCV, the pooled SVR rate was 49% (95% CI: 43-55). This was significantly lower than the rate of 59% (95% CI: 54-64) found in studies in which patients were predominantly infected with other genotypes (P = 0.012). Factors associated with successful outcomes included treatment with pegylated interferon and ribavirin, infection with an HCV genotype other than genotype 1 or 4 and the absence of liver damage or human immunodeficiency virus infection at baseline. No significant difference in the SVR rate was observed between weight-adjusted and fixed-dose ribavirin treatment. Overall, 17% (95% CI: 13-23) of adverse events resulted in treatment interruption or dose modification, but only 4% (95% CI: 3-5) resulted in treatment discontinuation. CONCLUSION: The outcomes of treatment for HCV infection in low- and middle-income countries were similar to those reported in high-income countries.

OBJETIVO: Determinar la efectividad del tratamiento para la infección por el virus de la hepatitis C (VHC) en países de ingresos medios y bajos e identificar los factores asociados con unos resultados satisfactorios. MÉTODOS: Realizamos un examen sistemático y un meta-análisis de estudios de programas de tratamiento del VHC en países de ingresos medios y bajos. El resultado fundamental fue una respuesta viral sostenida (RVS). Los factores asociados con los resultados del tratamiento se identificaron mediante un análisis de metarregresión de efectos aleatorios. RESULTADOS: El análisis incluyó datos sobre 12 213 pacientes en 93 estudios de 17 países. La tasa global de RVS fue del 52% (intervalo de confianza, IC del 95%: 48-56). Para estudios en los que los pacientes estaban predominantemente infectados con VHC del genotipo 1 o 4, la tasa de RVS combinada fue del 49% (IC del 95%: 43-55). Esta fue significativamente menor que la tasa del 59% (IC del 95%: 54-64) encontrada en estudios en los que los pacientes estaban predominantemente infectados con otros genotipos (P = 0,012). Los factores asociados con los resultados satisfactorios incluyeron el tratamiento con interferón pegilado y ribavirina, la infección del VHC de un genotipo distinto al 1 o al 4 y la ausencia de lesión hepática o de infección por el virus de la inmunodeficiencia humana en el inicio. No se observaron diferencias significativas en la tasa de RVS entre el tratamiento de ribavirina adaptado al peso del paciente y el de dosis fijas. En conjunto, el 17% (IC del 95%: 13-23) de los eventos adversos provocó la interrupción del tratamiento o la modificación de la dosis, mientras que el 4% (IC del 95%: 3-5) causó el abandono del tratamiento. CONCLUSIÓN: Los resultados del tratamiento de la infección del VHC en países de ingresos bajos y medios fueron similares a los de países de ingresos elevados.

OBJECTIF: Évaluer l'efficacité du traitement de l'infection par le virus de l'hépatite C (VHC) dans les pays à revenu faible et moyen et identifier les facteurs associés aux résultats positifs. MÉTHODES: Nous avons effectué une évaluation systématique et une méta-analyse des études sur les programmes de traitement du VHC dans les pays à revenu faible et moyen. Le résultat principal consistait en une réponse virologique soutenue (RVS). Les facteurs liés aux résultats du traitement ont été identifiés à l'aide d'une analyse de méta-régression des effets aléatoires. RÉSULTATS: L'analyse portait sur les données de 12 213 patients inclus dans 93 études provenant de 17 pays différents. Le taux de RVS général était de 52% (intervalle de confiance de 95%, IC: 48-56). Pour les études dans lesquelles les patients étaient principalement atteints par le VHC de génotype 1 ou 4, le taux de RVS groupé était de 49% (IC de 95%: 43-55). Ce taux était largement inférieur à celui de 59% (IC de 95%: 54-64) présenté dans les études dans lesquelles les patients étaient principalement atteints par d'autres génotypes (P = 0,012). Les facteurs liés aux résultats positifs incluaient le traitement à l'interféron pégylé et à la ribavirine, l'infection à un VHC de génotype autre que 1 ou 4 et l'absence de lésions au foie ou d'infection par le virus de l'immunodéficience humaine initialement. Aucune différence significative dans le taux de RVS n'a été observée entre les traitements de ribavirine adaptés au poids et ceux à dose fixe. Dans l'ensemble, 17% (IC de 95%: 13-23) des effets indésirables ont entraîné une interruption du traitement ou une modification des doses, tandis que 4% (IC de 95%: 3-5) d'entre eux ont entraîné un abandon du traitement. CONCLUSION: Les résultats du traitement de l'infection du VHC dans les pays à revenu faible et moyen étaient similaires à ceux qui étaient indiqués dans les pays à revenu élevé.