(c) 2013 BioFactors, 39(4):407-414, 2013″
“Background: Patients with chronic

liver disease have a higher risk of fulminant hepatitis when infected with hepatitis A virus, and vaccination of these patients against such infection is recommended. In Brazil, mainly in the South and Southeast regions, the epidemiology of hepatitis A (HA) has shifted from high to intermediate endemicity, which would have implication on policy of HA vaccination for these populations. Objective: To verify the prevalence of HA immunity in adult patients with liver cirrhosis (LC), in Uberlandia MG, a city of Southeastern Brazil. Methods: Between December 2005 and December 2006, 106 patients with LC were consecutively evaluated. In addition, 75 individuals without LC or alcoholism Sotrastaurin cost 5-Fluoracil ic50 were evaluated (control group – CG). Results: Total anti-HAV (ELISA methods) was positive in 104 (98.1%) patients with LC (82 men, 24 women; mean age, 53.3 +/- 11.9 years) and in 74 (98.7%) individuals of the CG (55 men, 20 women; mean age, 47 +/- 11.6 years), p > 0.05. Conclusions: For patients with chronic liver disease, in the geographic regions and age groups evaluated, routine vaccination against hepatitis A is not recommended. Moreover, the serum determination of total anti-HAV,

used to assess immunity, is five times cheaper than vaccination against hepatitis A and, for this reason, should precede vaccination.”
“Background: Phosphodiesterase-5 (PDE5) inhibitors, which induce relaxation of smooth muscle with some selectivity for the Pulmonary vasculature, are used ill the

treatment of pulmonary hypertension. In some patients, the use of PDE5 inhibitors does not result in the desired magnitude of pulmonary vasodilation. The use of additional vasodilators to further reduce pulmonary vascular resistance is often accompanied by unacceptable reductions in systemic arterial pressure.

Methods and Resulls: In 3 patients with heart failure, pulmonary hypertension and low systemic arterial pressures selleck chemicals llc treated with sildenafil, systemic nitrates were added to reduce Pulmonary hypertension further. Hemodynamic measurements Were made before and after addition of nitrates. Addition of systemic nitrates to sildenafil led to a reduction in mean Pulmonary arterial pressure of 11 mm Fig, from 37 mm Ha to 26 turn Hg (P – .06), whereas mean systemic arterial pressure decreased by only 4 mm Hg, from 77 mm Hg to 73 rum Hg (P = .53). The ratio of pulmonary vascular resistance to systemic vascular resistance was reduced by 45% (P = .1). Treatment with sildenafil and nitrates was Continued for two to eight months, with no episodes of marked systemic hypotension, syncope, or lightheadedness.