Jorge Areias

First-degree relatives of patients with early-onset gastric carcinoma show even at young ages a high prevalence of advanced OLGA/OLGIM stages and dysplasia

First‐degree relatives (FDRs) of early‐onset gastric carcinoma (EOGC) patients are at increased risk of cancer development. OLGA/OLGIM (Operative Link on Gastritis/Intestinal Metaplasia Assessment) classifications have been proposed for the identification of individuals at high risk of gastric cancer development.

Alcohol consumption among patients with hepatitis B infection in northern Portugal considering gender and hepatitis B virus genotype differences.

Alcohol abuse is an important public health problem. In Portugal with a population of 10 millions of inhabitants, there are around 10% of alcoholics or excessive alcohol drinkers and 1% of chronically infected patients with hepatitis B virus (HBV). To examine the characteristics of patients with higher levels of alcohol consumption and to investigate the association between alcohol consumption and liver damage a total of 298 chronically infected individuals, with HBV genotyped and submitted to liver biopsy, were classified with Childs grading and separated by habits of alcohol intake, less and greater than 20g/day. No significant differences were observed about genotype but genotypes A and D were predominant in both of them. A higher percentage of males (P<.001) were observed in the group with alcohol intake above 20g/day, as well a lower proportion of patients with HBeAg negativity (P< or =.035). In this group, biochemistry parameters, such as alanine aminotransferase (P=.006), aspartate aminotransferase (P=.001), gamma-glutamyl transferase (P<.001) were elevated in a significantly higher proportion than in the other group. The analysis of hematological parameters showed significantly lower values of platelets (P=.042) and mean corpuscular volume (P<.001) and significantly higher values of prothrombin time (P<.001) in the group with higher levels of alcohol consumption. The characteristics of biopsy (P<.001) and Child-Phugs classification (P=.002) revealed more severe results in this group. Logistic regression showed a positive association between liver damage and alcohol intake, increasing with age. In female patients, a strong positive association between alcohol intake and liver damage was also found (odds ratio: 9.379; 95% confidence interval: 0.859-468.422; P = .037); however, the most severe cases were only observed in women older than 45 years. In patients with HBV infection, alcohol is associated with a more severe liver disease. No evidence was found concerning association with HBV genotype.

Epidemiological Study of Genotypes of Hepatitis B Virus in Northern Portugal

While the overall prevalence of hepatitis B virus (HBV) infection in Portugal is around 1%, there are no published studies examining HBV genotypes in this country. This study aimed to survey HBV genotypes in the northern Portugal and to examine the possible associations between genotypes and gender, viral transmission routes, viral markers, viral load, and biochemical tests of liver function. The study sample consists of 340 patients with HBV infection of whom 42.9% were women. Tests were carried out for HBV genotypes and biochemical liver function while demographic information, including alcohol intake, was obtained from the patient files. The results indicate the predominance of genotype D (60.3%) and genotype A (31.5%). Intrafamilial transmission was predominant in female patients, while males were infected in equal proportions by perinatal, sexual, and intrafamilial transmission. Absence of HBeAg was found in a significantly smaller proportion of female patients with genotype D as compared to A (56.6% vs. 82.1%, P = 0.028). High viral load was associated significantly and independently with genotype D and HBeAg. Both alanine and aspartate aminotransferases (ALT and AST) were associated with gender and HBeAg. Thus, genotypes A and D were found to be the most prevalent in the north of Portugal. Patients infected with genotype D had higher levels of HBV DNA. HBeAg was associated with genotype D, viral load, and ALT and AST. J. Med. Virol. 81:1170–1176, 2009.

Chronic liver disease and cirrhosis among patients with hepatitis B virus infection in northern Portugal with reference to the viral genotypes

The prevalence of infection with hepatitis B virus in Portugal is around 1% of the population; 20–30% of those infected typically develop cirrhosis. The study focuses on the epidemiological profile of patients with hepatitis B infection and liver damage, in particular, cirrhosis. Of the 358 individuals that comprised the study, a liver biopsy was performed in 249 to identify the presence of cirrhosis. Cirrhosis was observed in 59 patients (23.7%) The Child–Pugh classification was used to assess the prognosis of cirrhosis: 3 out of the 59 patients were classified as Child–Pugh grade C, the most severe, 17 (28.8%) as grade B, and 39 (66.2%) as grade A. Patients classified as grade B were older, drank more, and showed higher levels of AST and alkaline phosphatase when compared with individuals classified as grade A. Genotypes A and D were predominant, and no significant differences with respect to genotype distribution were observed. Analysis of the hematological parameters showed that patients classified as Childs grade B had lower levels of platelets and higher levels of prothrombin time than those classified as Childs grade A. The profile of the patients with cirrhosis, including an extended number of individual characteristics, provides useful information, however, only a prospective study could evaluate definitively if liver disease is influenced by these factors. Future studies would benefit from the analysis of the impact of genotypes on liver disease, particularly genotypes A and D, the most predominant genotypes in northern Portugal. J. Med. Virol. 83:71–77, 2011.

First degree relatives and familial aggregation of gastric cancer: who to choose for control in case–control studies?

Gastric carcinogenesis is a multifactorial process involving host gene and environmental interactions. Diverse case–control studies using different types of controls addressed the familial aggregation role for gastric cancer development. Our aim is to discuss the advantages and expected bias according to the different type of eligible controls. A PubMed search of papers on a query on first degree relatives of gastric cancer patients was conducted. The retrieved studies were evaluated regarding quality based on STROBE checklist. Data concerning risk of premalignant lesions and Helicobacter pylori infection was retrieved as the type of controls used on each study. Nine case–control studies were selected. A variety of controls were used ranging from general population to dyspeptic patients and spouses of the cases. We have observed that, independently of the type of control, the risk for the prevalence of premalignant lesions and H. pylori infection was higher for the cases. However, all of the evaluated case–control studies were average quality studies (mean 28 out of 45), with a small number of cases and controls (range from 39 to 300). Furthermore, concerning gene–environment interaction, each of the discussed type of control (general population, dyspeptic, spouse and neighbor) has potential advantages and disadvantages. The current data suggests that selection of any type of the aforementioned controls is feasible and seems to be mainly related to the feasibility of recruitment more than the genetic or environmental backgrounds. General population and dyspeptic patients would be equally appropriate for studies on familial aggregation of gastric cancer. Nevertheless, high-quality cohort studies are needed to validate this assumption.

Perfil epidemiológico e genotípico da infecção pelo vírus da hepatite B no Norte de Portugal

OBJECTIVE To describe the epidemiological and genotypic profile of chronic hepatitis B infection in Northern Portugal. METHODS This survey comprised 358 subjects with positive serology for hepatitis B antigen for at least six months, recruited from specialist appointments in two hospitals in Northern Portugal between 2008 and 2009. Data were obtained from patient files, laboratory tests performed at the time of viral genotyping, echograms and/or ultrasonogram results, and liver biopsies. Demographic characteristics, viral markers, viral load and genotype, and severity of liver disease were evaluated and compared between sexes. RESULTS Genotypes A and D were predominant in both sexes. Intrafamilial transmission occurred mostly among female patients. One-third of females and 58,9% of males showed alcohol intake above 20 g/day. Absence of AgHBe was similar in both sexes (p = 0.662). Elevated biochemical parameters and presence of necroinflammatory activity and steatosis in liver biopsies were more frequent among male patients (p=0.003). CONCLUSIONS Differences in terms of route of HBV infection between men and women may be a consequence of gender-associated risk behaviors. Excessive alcohol intake is more frequent among males than females, as is more severe liver disease.OBJECTIVO: Descrever o perfil epidemiologico e genotipico da infeccao cronica pelo virus da hepatite B na Regiao Norte de Portugal. METODOS: Foram incluidos 358 individuos oriundos das consultas de especialidade que apresentavam resultados positivos para o antigeno da hepatite B durante pelo menos seis meses em dois hospitais do Norte de Portugal em 2008 e 2009. Os dados foram obtidos a partir dos processos clinicos, determinacoes laboratoriais feitas quando da genotipagem do virus, ecografia e/ou ultra-sonografia e biopsia hepatica. As caracteristicas demograficas, marcadores viricos, carga viral e genotipos, e severidade da doenca hepatica foram avaliadas e comparadas entre sexos. RESULTADOS: Os genotipos A e D predominaram. A transmissao intrafamiliar ocorreu predominantemente nas mulheres. Um terco das mulheres apresentava ingestao alcoolica superior a 20 g/dia, aumentando para 58,9% nos homens. A ausencia do AgHBe foi semelhante nos dois sexos (p = 0,662). Os parâmetros bioquimicos em geral apresentaram-se com valores mais altos nos homens, assim como nos estagios necro-inflamatorio e de esteatose hepatica (p = 0,003). CONCLUSOES: As diferencas relativas as vias de transmissao da infeccao pelo virus da hepatite B entre homens e mulheres podem ser consequencia de comportamentos de risco associadas ao genero. A ingestao excessiva de alcool e predominante nos individuos do sexo masculino, assim como maior severidade da doenca hepatica em relacao as mulheres.

Epidemiological and genotypic profile of hepatitis B virus infection in Northern Portugal

OBJECTIVE To describe the epidemiological and genotypic profile of chronic hepatitis B infection in Northern Portugal. METHODS This survey comprised 358 subjects with positive serology for hepatitis B antigen for at least six months, recruited from specialist appointments in two hospitals in Northern Portugal between 2008 and 2009. Data were obtained from patient files, laboratory tests performed at the time of viral genotyping, echograms and/or ultrasonogram results, and liver biopsies. Demographic characteristics, viral markers, viral load and genotype, and severity of liver disease were evaluated and compared between sexes. RESULTS Genotypes A and D were predominant in both sexes. Intrafamilial transmission occurred mostly among female patients. One-third of females and 58,9% of males showed alcohol intake above 20 g/day. Absence of AgHBe was similar in both sexes (p = 0.662). Elevated biochemical parameters and presence of necroinflammatory activity and steatosis in liver biopsies were more frequent among male patients (p=0.003). CONCLUSIONS Differences in terms of route of HBV infection between men and women may be a consequence of gender-associated risk behaviors. Excessive alcohol intake is more frequent among males than females, as is more severe liver disease.OBJECTIVO: Descrever o perfil epidemiologico e genotipico da infeccao cronica pelo virus da hepatite B na Regiao Norte de Portugal. METODOS: Foram incluidos 358 individuos oriundos das consultas de especialidade que apresentavam resultados positivos para o antigeno da hepatite B durante pelo menos seis meses em dois hospitais do Norte de Portugal em 2008 e 2009. Os dados foram obtidos a partir dos processos clinicos, determinacoes laboratoriais feitas quando da genotipagem do virus, ecografia e/ou ultra-sonografia e biopsia hepatica. As caracteristicas demograficas, marcadores viricos, carga viral e genotipos, e severidade da doenca hepatica foram avaliadas e comparadas entre sexos. RESULTADOS: Os genotipos A e D predominaram. A transmissao intrafamiliar ocorreu predominantemente nas mulheres. Um terco das mulheres apresentava ingestao alcoolica superior a 20 g/dia, aumentando para 58,9% nos homens. A ausencia do AgHBe foi semelhante nos dois sexos (p = 0,662). Os parâmetros bioquimicos em geral apresentaram-se com valores mais altos nos homens, assim como nos estagios necro-inflamatorio e de esteatose hepatica (p = 0,003). CONCLUSOES: As diferencas relativas as vias de transmissao da infeccao pelo virus da hepatite B entre homens e mulheres podem ser consequencia de comportamentos de risco associadas ao genero. A ingestao excessiva de alcool e predominante nos individuos do sexo masculino, assim como maior severidade da doenca hepatica em relacao as mulheres.

Mo1556 High-Risk Host Genotype and H. pylori Strains in First Degree Relatives of Patients With Early-Onset Gastric Cancer

determined by a wound healing assay. In xenografted model (NCI-N87), mice were injected (SC; 200 ug/head, 10 mg/kg or IV; 300 ug/head, 15 mg/kg) with CP-RUNX (HM85R) for 3 weeks. This experiment showed that local or systemic delivery of CP-RUNX3 could significantly reduce tumor growth (p<0.05). p21Cip1/Waf1 and VEGF expression in lung and tumor were also significantly increased and decreased, respectively. Conclusion: These results suggest that In Vivo protein replacement therapy with cell-permeable and tissuedistributable recombinant proteins containing MTD can intervene in an abnormally active or dysfunctional intracellular process. Therefore, we conclude that intracellular delivery of RUNX3 with MTD could be useful for treating gastric cancer.

Spontaneous esophageal hematoma: Endoscopic follow up

Intramural esophageal hematoma is a rare form of esophageal injury. It may occur spontaneously (more rare) or may be secondary to sclerosis of varicose veins, esophageal dilatation, food impaction or coagulopathy. It can present itself as a sudden pain retrosternal or dorsal, as hematemesis, dysphagia or odynophagia. Despite the exuberant presentation, most patients have resolution with conservative measures. Esophagoduodenoscopy is the diagnostic modality, and it may show a mass with a blue-red appearance. Biopsy of such lesions must be avoided because of the obvious potential risk of bleeding. The usual mode of treatment is watchful waiting, and most patients will do better without any intervention. We present the case of a female aged 51 years without past medical history and taking no medications who presented with acute dysphagia of solid foods. She denied any abdominal pain or fever, nor any previous history of dysphagia or recent use of aspirin. Examination and standard laboratory tests, including coagulation parameters and platelet counts, were within normal ranges. She subsequently had esophagoduodenoscopy, which showed in the upper esophagus a longitudinal red-blue elevation of 4 cm with no evidence of foreign body or other changes (Fig. 1). It was deemed to be an esophageal hematoma. The patient was further submitted for computed tomography of the chest, which revealed no other mediastinal or aortic lesion beyond an eccentric, welldefined intramural esophageal mass corresponding to the esophageal hematoma that was previously seen at endoscopy. The patient did well and was subsequently discharged after documented resolution on endoscopy (Fig. 2).

Perfil epidemiológico y genotípico de la infección por el virus de la hepatitis B en el Norte de Portugal

OBJECTIVE To describe the epidemiological and genotypic profile of chronic hepatitis B infection in Northern Portugal. METHODS This survey comprised 358 subjects with positive serology for hepatitis B antigen for at least six months, recruited from specialist appointments in two hospitals in Northern Portugal between 2008 and 2009. Data were obtained from patient files, laboratory tests performed at the time of viral genotyping, echograms and/or ultrasonogram results, and liver biopsies. Demographic characteristics, viral markers, viral load and genotype, and severity of liver disease were evaluated and compared between sexes. RESULTS Genotypes A and D were predominant in both sexes. Intrafamilial transmission occurred mostly among female patients. One-third of females and 58,9% of males showed alcohol intake above 20 g/day. Absence of AgHBe was similar in both sexes (p = 0.662). Elevated biochemical parameters and presence of necroinflammatory activity and steatosis in liver biopsies were more frequent among male patients (p=0.003). CONCLUSIONS Differences in terms of route of HBV infection between men and women may be a consequence of gender-associated risk behaviors. Excessive alcohol intake is more frequent among males than females, as is more severe liver disease.OBJECTIVO: Descrever o perfil epidemiologico e genotipico da infeccao cronica pelo virus da hepatite B na Regiao Norte de Portugal. METODOS: Foram incluidos 358 individuos oriundos das consultas de especialidade que apresentavam resultados positivos para o antigeno da hepatite B durante pelo menos seis meses em dois hospitais do Norte de Portugal em 2008 e 2009. Os dados foram obtidos a partir dos processos clinicos, determinacoes laboratoriais feitas quando da genotipagem do virus, ecografia e/ou ultra-sonografia e biopsia hepatica. As caracteristicas demograficas, marcadores viricos, carga viral e genotipos, e severidade da doenca hepatica foram avaliadas e comparadas entre sexos. RESULTADOS: Os genotipos A e D predominaram. A transmissao intrafamiliar ocorreu predominantemente nas mulheres. Um terco das mulheres apresentava ingestao alcoolica superior a 20 g/dia, aumentando para 58,9% nos homens. A ausencia do AgHBe foi semelhante nos dois sexos (p = 0,662). Os parâmetros bioquimicos em geral apresentaram-se com valores mais altos nos homens, assim como nos estagios necro-inflamatorio e de esteatose hepatica (p = 0,003). CONCLUSOES: As diferencas relativas as vias de transmissao da infeccao pelo virus da hepatite B entre homens e mulheres podem ser consequencia de comportamentos de risco associadas ao genero. A ingestao excessiva de alcool e predominante nos individuos do sexo masculino, assim como maior severidade da doenca hepatica em relacao as mulheres.