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Advances in science have made many contributions to human development. Vaccines are one of the best examples of this, working as a tool capable of preventing infectious diseases. Objective: to analyze the principles of bioethics regarding the offer of vaccination to the population. Method: This is an integrative literature review, carried out through a survey of studies published in databases of the Electronic Science Library Online (ScIELO), Virtual Health Library (BVS), Brazilian Journal of Nursing (REBEn), in the period from 2016 to 2022. Results. The different authors discussed the relationship between the offer of mass vaccination and bioethics, showing that this practice can lead to non-observance of bioethical principles, since the common good that is the fact of offering immunization to all, can be understood as respect for the principle of justice, more than it can directly interfere with the principle of individual autonomy, since compulsory vaccination is defended based on the principle that, in the scope of collective health, the protection of the population must prevail over the autonomy of the individual. However, for this, the vaccine needs to have its effectiveness proven, in order to respect the principle of beneficence and non-maleficence in the act of its application. Conclusion: One of the ways to ensure respect for bioethical principles regarding vaccination is to choose the path of health education for the population so that they can understand the importance and make their own choices, thus respecting the bioethical principle of autonomy. Los avances en la ciencia han hecho muchas contribuciones al desarrollo humano. Las vacunas son uno de los mejores ejemplos de ello, funcionando como una herramienta capaz de prevenir enfermedades infecciosas. Objetivo: analizar los principios de la bioética en cuanto a la oferta de vacunación a la población. Método: Se trata de una revisión integrativa de la literatura, realizada a través de un levantamiento de estudios publicados en bases de datos de la Biblioteca Electrónica de Ciencias en Línea (ScIELO), Biblioteca Virtual en Salud (BVS), Revista Brasileña de Enfermería (REBEn), en el período de 2016 a 2022. Resultados. Los diferentes autores discutieron la relación entre la oferta de vacunación masiva y la bioética, mostrando que esta práctica puede conducir a la inobservancia de los principios bioéticos, ya que el bien común que es el hecho de ofrecer la inmunización a todos, puede entenderse como el respeto a la principio de justicia, más que puede interferir directamente con el principio de autonomía individual, ya que la vacunación obligatoria se defiende con base en el principio de que, en el ámbito de la salud colectiva, la protección de la población debe prevalecer sobre la autonomía del individuo. Sin embargo, para ello, la vacuna necesita tener probada su eficacia, a fin de respetar el principio de beneficencia y no maleficencia en el acto de su aplicación. Conclusión: Una de las formas de garantizar el respeto de los principios bioéticos en relación con la vacunación es elegir el camino de la educación en salud de la población para que pueda comprender la importancia y tomar sus propias decisiones, respetando así el principio bioético de autonomía. Os avanços da ciência trouxeram muitas contribuições para o desenvolvimento humano. As vacinas são um dos melhores exemplos disso, funcionando como uma ferramenta capaz de prevenir doenças infecciosas. Objetivo: analisar os princípios da bioética frente a oferta de vacinação para a população. Método: Trata-se de uma revisão integrativa da literatura, realizada por meio de levantamento de estudos publicados em bases de dados da Biblioteca Eletrônica de Ciências Online (ScIELO), Biblioteca Virtual em Saúde (BVS), Revista Brasileira de Enfermagem (REBEn), no período de 2016 a 2022. Resultados. Os diferentes autores discorreram sobre a relação da oferta da vacinação em massa e a bioética, evidenciando-se que essa prática pode levar a não observância de princípios bioéticos, uma vez que o bem comum que é o fato da oferta de imunização para todos, pode ser entendido como respeito ao princípio da justiça, mais que pode interferir diretamente no princípio da autonomia do indivíduo uma vez que a vacinação compulsória é defendida amparada no princípio de que no âmbito da saúde coletiva a proteção da população deve prevalecer sobre a autonomia do indíviduo. No entanto, para isso a vacina precisa ter sua eficácia comprovada, afim de respeitar o princípio da beneficência e não maleficência no ato da sua aplicação. Conclusão: Uma das formas de se garantir o respeito aos principios bioéticos frente a vacinação, é optar pelo caminho da educação em saúde da população para que ela possa entender a importância e fazer suas próprias escolhas, respeitando assim o princípio bioético da autonomia.

Bioethics has the function of ensuring the well-being of people, guaranteeing and avoiding possible damages that may occur to their interests, providing the professional and those who are served by him, the right to respect and will, respecting their beliefs and values. Objective: to highlight the bioethical principles and their application against Hepatitis B virus infection in the light of the literature. Methods; This is a review of mixed studies, published in the bases of the National Library of Medicine (PUBMED), Latin American and Caribbean Literature on Health Sciences (LILACS) and Scientific Electronic Library Online (SCIELO), in the chronological period between 2012 to 2022. Results: It was evidenced that chronic HBV infection is the main cause of Liver Cirrhosis and hepatocellular carcinoma and that vaccination is an effective way to change this scenario. The vaccine contemplates the bioethical principle of justice and scientific evidence supports beneficence, however, adverse effects interfere with non-maleficence. However, side effects result in conflicts involving the principle of non-maleficence. These consequences are intensified when they are associated with individual and/or collective factors, which can interfere with the individual's autonomy in adhering to such a prevention measure. Conclusion: The treatment and prevention of Hepatitis B should be widely discussed in association with bioethical principles, developing health actions that can guarantee the individual the principles of autonomy, beneficence, non-maleficence and justice. La bioética tiene la función de velar por el bienestar de las personas, garantizando y evitando los posibles perjuicios que puedan ocasionarse a sus intereses, otorgando al profesional y a quienes por él sirve, el derecho al respeto y la voluntad, respetando sus creencias y valores. Objetivo: destacar los principios bioéticos y su aplicación frente a la infección por el virus de la Hepatitis B a la luz de la literatura. Métodos; Se trata de una revisión de estudios mixtos, publicados en las bases de la Biblioteca Nacional de Medicina (PUBMED), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Scientific Electronic Library Online (SCIELO), en el período cronológico comprendido entre 2012 a 2022. Resultados: Se evidenció que la infección crónica por VHB es la principal causa de Cirrosis Hepática y carcinoma hepatocelular y que la vacunación es una vía efectiva para cambiar este escenario. La vacuna contempla el principio bioético de justicia y la evidencia científica apoya la beneficencia, sin embargo, los efectos adversos interfieren con la no maleficencia, sin embargo, los efectos colaterales resultan en conflictos que involucran el principio de no maleficencia. Estas consecuencias se intensifican cuando se asocian a factores individuales y/o colectivos, que pueden interferir en la autonomía del individuo en la adhesión a tal medida de prevención. Conclusión: El tratamiento y la prevención de la Hepatitis B deben ser ampliamente discutidos en asociación con los principios bioéticos, desarrollando acciones de salud que puedan garantizar al individuo los principios de autonomía, beneficencia, no maleficencia y justicia. A bioética tem a função de assegurar o bem-estar das pessoas, garantindo e evitando possíveis danos que possam ocorrer aos seus interesses, proporcionando ao profissional e aos que são atendidos por ele, o direito ao respeito e a vontade, respeitado suas crenças e valores. Objetivo: evidenciar os princípios bioéticos e sua aplicação frente a infecção pelo vírus da Hepatite B a luz da literatura. Métodos: trata-se de uma revisão estudos mistos, publicados nas bases da National Library of Medicine (PUBMED), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletrônic Library Online (SCIELO), no período cronológico compreendido entre 2012 a 2022. Resultados: evidenciou-se que a infecção crônica pelo VHB é a principal causa de Cirrose Hepática e carcinoma hepatocelular e que a vacinação é um meio eficaz para a mudança desse cenário. A vacina, contempla o princípio bioético da justiça e, evidências cientificas embasam a beneficência, no entanto, os efeitos adversos, interferem na não-maleficência., entretanto, os efeitos colaterais, resultam em conflitos que envolvam o princípio da não-maleficência. Estas consequências intensificam-se, quando são associadas a fatores individuais e/ou coletivos, os quais podem interferir na autonomia do indivíduo em aderia tal medida de prevenção. Conclusão: a condução do tratamento e prevenção da Hepatite B deve ser amplamente discutida em associação com os princípios bioéticos, desenvolvendo ações em saúde, que possam garantir ao indivíduo, os princípios da autonomia, beneficência, não-maleficência e justiça.

Introduction and objectives Direct antiviral agents (DAAs) including sofosbuvir (SOF), daclatasvir (DCV), simeprevir (SIM) and ombitasvir, paritaprevir and dasabuvir were introduced 2015 in Brazil for treatment of hepatitis C virus (HCV) infection. The aims of this study were to assess effectiveness and safety of HCV treatment with DAA in real-life world in a highly admixed population from Brazil. Materials and methods All Brazilian reference centers for HCV treatment were invited to take part in a web-based registry, prospectively conducted by the Brazilian Society of Hepatology, to assess outcomes of HCV treatment in Brazil with DAAs. Data to be collected included demographics, disease severity and comorbidities, genotype (GT), viral load, DAA regimens, treatment side effects and sustained virological response (SVR). Results 3939 patients (60% males, mean age 58 ± 10 years) throughout the country were evaluated. Most had advanced fibrosis or cirrhosis, GT1 and were treated with SOF/DCV or SOF/SIM. Overall SVR rates were higher than 95%. Subjects with decompensated cirrhosis, GT2 and GT3 have lower SVR rates of 85%, 90% and 91%, respectively. Cirrhosis and decompensated cirrhosis in GT1 and male sex and decompensated cirrhosis in GT3 were significantly associated with no SVR. Adverse events (AD) and serious AD occurred in 18% and 5% of those subjects, respectively, but less than 1% of patients required treatment discontinuation. Conclusion SOF-based DAA regimens are effective and safe in the heterogeneous highly admixed Brazilian population and could remain an option for HCV treatment at least in low-income countries.

Chronic hepatitis delta represents the most severe form of chronic viral hepatitis. The current treatment of hepatitis delta virus (HDV) infection consists of the use of interferons and is largely unsatisfactory. Several new compounds are currently in development for the treatment of HDV infection. However, surrogate markers that can be used to develop clinical endpoints in HDV infection are not well defined. In the current manuscript, we aimed to evaluate the existing data on treatment of HDV infection and to suggest treatment goals (possible "trial endpoints") that could be used across different clinical trials., NA

CONTEXT: Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. Cirrhosis due to hepatitis C infection is the leading indication for liver transplantation worldwide. However, patients who are given transplants because of viral liver diseases often present clinical coinfections, including hepatitis B together with hepatitis D. Currently, different strategies exist for patient management before and after liver transplantation, and these are based on different protocols developed by the specialized transplantation centers. CASE REPORT: We present a rare case of a 58-year-old man with chronic hepatitis B, C and D coinfection. The patient developed cirrhosis and hepatocellular carcinoma. His treatment comprised antiviral therapy for the three viruses and OLT. The patient's outcome was satisfactory. CONCLUSION: OLT, in association with antiviral therapy using entecavir, which was administered before and after transplantation, was effective for sustained clearance of the hepatitis B and D viruses. A recurrence of hepatitis C infection after transplantation responded successfully to standard treatment comprising peginterferon alfa-2A and ribavirin.

CONTEXT: Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. Cirrhosis due to hepatitis C infection is the leading indication for liver transplantation worldwide. However, patients who are given transplants because of viral liver diseases often present clinical coinfections, including hepatitis B together with hepatitis D. Currently, different strategies exist for patient management before and after liver transplantation, and these are based on different protocols developed by the specialized transplantation centers. CASE REPORT: We present a rare case of a 58-year-old man with chronic hepatitis B, C and D coinfection. The patient developed cirrhosis and hepatocellular carcinoma. His treatment comprised antiviral therapy for the three viruses and OLT. The patient's outcome was satisfactory. CONCLUSION: OLT, in association with antiviral therapy using entecavir, which was administered before and after transplantation, was effective for sustained clearance of the hepatitis B and D viruses. A recurrence of hepatitis C infection after transplantation responded successfully to standard treatment comprising peginterferon alfa-2A and ribavirin. CONTEXTO: O transplante ortotópico de fígado (TOF) é o tratamento de escolha em pacientes com doença hepática terminal. A cirrose por hepatite C é a principal indicação de transplante hepático no mundo. No entanto, pacientes transplantados por hepatopatias virais frequentemente apresentam coinfecções, como hepatite B associada a hepatite D. Atualmente, existem diferentes estratégias de manejo em pacientes pré e pós-transplantados conforme diferentes protocolos de conduta de serviços especializados em transplante. RELATO DE CASO: Apresentamos o raro caso de um homem de 58 anos diagnosticado com as hepatites crônicas B, C e D. O paciente evoluiu com cirrose e carcinoma hepatocelular. O tratamento consistiu de terapia antiviral para os três vírus e de transplante ortotópico de fígado. O desfecho do paciente foi satisfatório. CONCLUSÃO: O transplante ortotópico de fígado, associado à terapia antiviral com entecavir antes e após o procedimento, foi eficaz na depuração sustentada dos vírus B e D. A recidiva do vírus C após o transplante respondeu com sucesso ao tratamento padrão com alfapeginterferon 2A e ribavirina.

Texto completo: acesso restrito. p. 165-169 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-03-13T12:54:37Z No. of bitstreams: 1 Raymundo Paraná.pdf: 77007 bytes, checksum: b1b440d4a57ef5b3fa1f6da2416fe6cd (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2014-09-09T15:02:45Z (GMT) No. of bitstreams: 1 Raymundo Paraná.pdf: 77007 bytes, checksum: b1b440d4a57ef5b3fa1f6da2416fe6cd (MD5) Made available in DSpace on 2014-09-09T15:02:45Z (GMT). No. of bitstreams: 1 Raymundo Paraná.pdf: 77007 bytes, checksum: b1b440d4a57ef5b3fa1f6da2416fe6cd (MD5) Previous issue date: 2007 Clinical and epidemiologic studies on the hepatitis C virus (HCV) in the western Brazilian Amazon region are scarce. However, reports of clinical cases of hepatitis or pathologies associated to the HCV infection are frequent. In the state of Acre, there have been no studies on the population with the greatest exposure to parenteral transmission of virus infection. The objective of this study was to determine the prevalence of HCV infection among health care workers (HCWs) in this region. Of 2,338 HCWs, 646 were randomly selected for this study. The presence of antibody to HCV was determined. If these persons were antibody positive, they were tested for HCV RNA and the viral genotype was determined. The seroprevalence of antibody to HCV was 4.8% (31 of 646), and 3.7% (24 of 646) of those tested had detectable HCV RNA. Among these 24 viremic cases, HCV genotype 1 was most common (n = 16), followed by genotypes 3 (n = 6), 2 (n = 1), and an unidentified genotype. Infection with HCV (identified by a polymerase chain reaction) was more frequent among those with lower educational levels and lower incomes, those who lived for a longer period in the city of Rio Branco, those who reported intravenous use of vitamin complexes, those with a history of dental treatment, those with alcoholism, and women with history of caesarian parturition. The high prevalence of patients with HCV observed among HCWs in the city of Rio Branco and risk factors indicate the need for prevention and control programs, in addition to assistance programs, because this region is also hyperendemic for hepatitis B virus and hepatitis D virus.

RESTRITO Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2012-07-31T20:03:21Z No. of bitstreams: 1 IIII.pdf: 83975 bytes, checksum: bb96a9d09d3d1c3f1d3c0a3ce09b1669 (MD5) Made available in DSpace on 2012-07-31T20:03:21Z (GMT). No. of bitstreams: 1 IIII.pdf: 83975 bytes, checksum: bb96a9d09d3d1c3f1d3c0a3ce09b1669 (MD5) Previous issue date: 2006 Background: Hepatitis B is endemic in the Amazon region. Methods: Serological markers for hepatitis B virus (HBV) were determined in 266 household members for hepatitis B surface antigen (HBsAg)-positive women (G1) and 395 household members for HBsAg-negative women (G2), randomly selected in Acre State Women’s Medical Care Program, in order to evaluate the prevalence of HBV in this population. Before blood sample collection an epidemiological questionnaire was applied. Results: The overall prevalence of HBV carriers (HBsAg) and exposed individuals (anti-HBc, IgG) was, respectively, 21.1% and 60.5% in G1 and 2.8% and 27.4% in G2 ( P < 0.0000001). The frequency of HBsAg was higher among siblings from group G1 (75%) compared to the absence of any HBsAg-positive sibling in G2 ( P < 0.00006). The HBV markers in other family members was as follows: G1 parents, 27.3% vs 4.5% ( P < 0.03), sexual partners, 21.1% vs 2.5% ( P < 0.04), and offspring, 10.4% vs 1.5% ( P < 0.04). A low prevalence of HBsAg and anti-HBc (IgG) was observed for the last offspring of G2 mothers compared to the high prevalence among children of G1 mothers (0% vs 18.2%, P < 0.01 and 2.3% vs 59.1%, P < 0.0000005, respectively), with children younger than 1 year being the most affected. The frequency of the habit of sharing toothbrushes and the presence of at least one HBsAg carrier were higher in G1 than in G2 ( P < 0.0001 and P < 0.000002), respectively. Genotypes A, D and G were found to be predominant by Innolipa test. There were cases that reacted to more than one genotype. Conclusion: Intrafamilial transmission of HBV is evident in the present study and is possibly associated with the presence of more than one HBV carrier in the family and the shared use of toothbrushes among household contacts. Genotype analysis confirms intrafamilial transmission. Salvador