Hepatitis D virus (HDV) is a satellite virus that requires the presence of a helper virus, the hepatitis B virus (HBV). Soon after its discovery by Mario Rizzetto in 1977, severe outbreaks of fulminant hepatitis D occurred in the past century, in indigenous populations from the Western and Southern (Amazon) regions of Venezuela, while the indigenous population from the Eastern region (Orinoco Delta) has been found to be free of this virus. Data on the prevalence of HDV infection in Venezuela are still highly imprecise. The aim of this study is to provide insights into the current situation of this disease in the country. Evidence of exposure and infection with HDV was found again mainly in indigenous populations, although also one patient with hepatitis B from the capital was found to be infected with HDV genotype 1. The genotype found in the indigenous Bari population was HDV genotype 1, the same lineage (a putative new subgenotype 1j) previously identified in this region in both Venezuela and Colombia. Although scarce information is still available about the burden of HDV infection in Venezuela, the few studies available are consistent in showing an epidemic concentrated mainly in some, but not all, indigenous populations. Reflex testing is needed to have a better appraisal of this disease in the country.
Objetivo: Proponer un protocolo de práctica clínica para el tratamiento del accidente cerebrovascular a nivel hospitalario y evaluar su viabilidad e impacto inicial tras un periodo de prueba en el Hospital Vargas. Métodos: Estudio tipo proyecto factible, cuantitativo, no experimental y descriptivo. El proceso incluyó cuatro fases: diagnóstico situacional, diseño del protocolo, implementación y evaluación. La recolección de datos se realizó mediante encuesta estructurada validada por juicio de expertos; la confiabilidad del instrumento se evaluó con alfa de Cronbach (α = 0,90). Se empleó estadística descriptiva, expresada en frecuencias y porcentajes. Resultados: Participaron 35 médicos residentes de Medicina Interna. Antes de la intervención, 73,9 % de los encuestados respondió que la falta de un protocolo estandarizado generaba demoras en la atención; 60,9 % señaló carencia de equipamiento diagnóstico; 95,7% aplicaba guías internacionales no adaptadas al contexto local. Tras la implementación del protocolo propuesto, se observó reducción de los tiempos de respuesta diagnóstica, mayor coordinación interservicios y uso racional de recursos de imagenología mediante alternativas para centros sin tomografía. Conclusión: El protocolo propuesto mejoró la atención inicial del accidente cerebrovascular en el Hospital Vargas, redujo tiempos críticos y fortaleció la comunicación entre servicios. El modelo es aplicable en centros con recursos limitados y puede servir de base para protocolos nacionales adaptados.
A Estratégia Saúde da Família (ESF) destaca-se como principal modelo de atenção básica no Brasil, buscando promover o cuidado contínuo, humanizado e integrado às necessidades reais da população. Nesse contexto, o vínculo entre médico e comunidade assume papel central, contribuindo para o fortalecimento da confiança, da comunicação e da corresponsabilidade no processo de cuidado. O estabelecimento de um vínculo sólido favorece não apenas a adesão ao tratamento, mas também a prevenção de doenças e a promoção da saúde, considerando os aspectos sociais, culturais e emocionais que influenciam o bem-estar das famílias
Abstract Objectives To compare the impact of COVID-19 on the clinical status and psychological distress of patients with immune-mediated rheumatic disease (IMRD) caused by SARS-CoV-2 infection with that of noninfected IMRD controls during a 6-month follow-up period. Methods The ReumaCoV Brazil is a longitudinal study designed to follow IMRD patients for 6 months after COVID-19 (patients) compared with IMRD patients without COVID-19 (controls). Clinical data, disease activity measurements and current treatments regarding IMRD and COVID-19 outcomes were evaluated in all patients. Disease activity was assessed through validated tools at inclusion and at 3 and 6 months post-COVID-19. Fatigue, using FACIT-F (Functional Assessment of Chronic Illness Therapy) and psychological distress, using DASS 21 (Depression, Anxiety and Stress Scale − 21 Items), used to evaluated psychological distress, were evaluated at 6 months after COVID-19 in both groups. The significance level was set as p < 0.05, with a 95% confidence interval. Results A total of 601 patients were evaluated—321 patients (IMRD COVID-19 + patients) and 280 controls (IMRD COVID-19- patients)—who were predominantly female with similar median ages. Disease activity assessment over a 6-month follow-up showed no significant difference between cases and controls. Although the mean activity scores did not differ significantly, some patients reported worsened disease activity post-COVID-19, particularly in rheumatoid arthritis (RA) (32.2%) and systemic lupus erythematosus (SLE) patients (23.3%). Post-COVID-19 worsening in RA patients correlated with medical global assessment (MGA) and CDAI scores, with a moderate to large effect size. Diabetes mellitus showed a positive association (OR = 7.15), while TNF inhibitors had a protective effect (OR = 0.51). Fatigue, depression, anxiety, and stress were significantly greater in patients than in controls. Worse disease activity post-COVID-19 correlated with worse FACIT-F and DASS-21 scores in RA patients. No significant associations were found between COVID-19 outcomes and post-COVID-19 disease activity, FACIT-F or DASS-21. Conclusions Post-COVID-19 IMRD patients exhibited significant fatigue, depression, anxiety, and stress, which can be mistaken for disease activity, despite having similar disease activity scores. The variability in reports on IMRD flares and the potential triggering of SARS-CoV-2 for autoimmune manifestations underscore the need for detailed clinical assessment and a comprehensive approach to managing them.
La leucemia/linfoma de células T del adulto (ATLL) es una neoplasia linfoproliferativa agresiva de linfocitos T CD4+/CD25+, asociada en más del 95 % de los casos a infección por HTLV-1, cuya seropositividad constituye un criterio diagnóstico esencial. Sin embargo, se han documentado variantes seronegativas extremadamente infrecuentes, que plantean importantes desafíos diagnósticos y terapéuticos. Presentamos el caso de una paciente femenina de 67 años con manifestaciones neurológicas atípicas como debut de ATLL: cefalea intensa, somnolencia, desorientación y signos de afectación de pares craneales (II, V, VI y VII), incluyendo hemorragias retinianas bilaterales y parestesias faciales. El líquido cefalorraquídeo evidenció hipertensión de apertura y pleocitosis linfocítica leve sin hallazgos infecciosos, y la resonancia cerebral reveló leucoencefalopatía periventricular. Durante su evolución, desarrolló leucocitosis progresiva, anemia, trombocitopenia y linfocitos atípicos “en flor” en sangre periférica. La citometría de flujo de médula ósea mostró un inmunofenotipo CD4+/CD25+/HLA-DR+ con pérdida de CD7, CD8 y CD26. Las serologías para HTLV-1 y HTLV-2 fueron repetidamente negativas. La literatura reconoce la posibilidad de ATLL seronegativo, atribuida a baja carga viral, mutaciones en epítopos o integración silenciosa del genoma viral, detectable solo por técnicas moleculares. Este caso refuerza dichas hipótesis y evidencia una forma inusual de ATLL con afectación neurológica prominente y seronegatividad persistente, lo que cuestiona los criterios diagnósticos convencionales y resalta la necesidad de enfoques moleculares avanzados para su identificación oportuna.
