José Fernando de Castro Figueiredo

Are Haemochromatosis Mutations Related to the Severity of Liver Disease in Hepatitis C Virus Infection

It has been proposed that iron overload may adversely affect liver disease outcome. The recent identification of 2 mutations in the HFE gene related to hereditary haemochromatosis (Cys282Tyr and His63Asp) provided an opportunity to test whether they are associated with hepatic iron accumulation and the activity and severity of liver disease in hepatitis C virus (HCV) infection. We investigated the prevalence of HFE mutations in 135 male patients with chronic HCV hepatitis, and correlated genotype distribution with different parameters of iron status and the activity and severity of liver disease. Of these 135 patients, 6 (4.4%) carried Cys282Tyr and 32 (23.7%) carried His63Asp, frequencies which were similar to those observed in healthy controls. Serum iron levels and transferrin saturation (but not ferritin levels or liver iron content) were significantly higher in carriers than in non-carriers of HFE mutations. No difference was observed in serum ALT, AST and GGT levels between carriers and non-carriers. Finally, scores for necroinflammatory activity and fibrosis in the liver were significantly higher in HFE carriers than in non-carriers. Patients with chronic HCV infection carrying HFE mutations tend to present more evident body iron accumulation and a higher degree of necroinflammatory activity and fibrosis in the liver. HFE gene mutations might be an additional factor to be considered among those implicated in the determination of a worse prognosis of the liver disease in chronic HCV infection.

Co-infecção HIV e vírus da hepatite B: prevalência e fatores de risco

The objective of this study was to assess the prevalence of hepatitis B virus and possible risk factors for this disease in 401 patients infected with the human immunodeficiency virus, followed at the University Hospital of the Ribeirao Preto Medical School, Sao Paulo State University. Each participant was submitted to a specific questionnaire and had a blood sample tested for the serologic markers HBsAg, total anti-HBcAg, anti-HBsAg and anti-HCV, using ELISA technique. The overall prevalence of hepatitis B markers was 40.9%, with 8.5% for HBsAg, 39.7% for total anti-HBcAg and 5.5% for anti-HBsAg. The variables that showed association with HBV were: age, higher education level, history of jaundice, time spent in prison, having a homosexual partner and positive markers for anti-HCV. Co-infection HBV/HCV was present in 20.4% of the participants.

Risco de infecção pelo vírus da imunodeficiência humana (HIV) em profissionais da saúde

A fim de investigar o risco ocupacional de infeccao pelo virus da imunodeficiencia humana (HIV) em profissionais da saude, foram estudados 35 casos de acidentes com material potencialmente contaminado pelo HIV, ocorridos em funcionarios do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (HCFMRP-USP). Dos 36 profissionais de saude estudados, 52,8% (19/36) eram auxiliares de enfermagem, 19,4% (7/36) enfermeiras, 13,9% (5/36) atendentes de enfermagem, e 5,5% (2/36) tecnicos de enfermagem. Em 47,2% (17/36) dos casos houve exposicao parenteral a sangue (acidente com agulha). As maos e os dedos foram as areas do corpo mais atingida. Foi empregado o teste imunoenzimatico (ELISA) para deteccao de anticorpos anti-HIV, sendo realizado em todos os profissionais por ocasiao do acidente e com 1,2, 6 e 12 meses apos a exposicao. Os resultados foram negativos nao sendo registrada nenhuma soroconversao. Recomenda-se que a educacao continuada para o trabalhador de saude deve reforcar o uso das precaucoes universais, especialmente os cuidados com agulhas e outros instrumentos perfurantes.

Fatores de risco para doenças sexualmente transmissíveis entre prostitutas e travestis de Ribeirão Preto (SP), Brasil

OBJETIVO: Caracterizar a populacao de profissionais do sexo em atividade em Ribeirao Preto, Brasil, segundo variaveis demograficas e socioeconomicas, e estudar os fatores de risco para doencas sexualmente transmissiveis nessa populacao. METODOS: Foram visitados todos os locais de pratica de prostituicao identificados na cidade. Os participantes responderam um questionario que levantava informacoes socio-demograficas e fatores de risco para doencas sexualmente transmissiveis. Foi responsavel pelas entrevistas uma assistente social que ha mais de 5 anos desenvolvia atividades educativas junto aos profissionais do sexo de Ribeirao Preto. RESULTADOS: As 449 prostitutas, 53 travestis e 13 miches estudados representam uma populacao jovem, de baixa escolaridade, reduzido nivel socioeconomico e grande mobilidade espacial. Em relacao as prostitutas, os travestis apresentaram risco significativamente mais elevado para doencas sexualmente transmissiveis, o qual se traduz por diferencas em termos do tempo de trabalho, numero medio de parceiros por dia, antecedente de doencas sexualmente transmissiveis ulcerativas, pratica de sexo anal, uso de drogas ilicitas nao-injetaveis, especialmente o crack, e antecedente de prisao. A exposicao a bebidas alcoolicas foi o unico fator de risco mais frequente entre as prostitutas. O uso de preservativo com parceiros fixos foi menos comum do que nas relacoes sexuais comerciais, tanto em prostitutas como em travestis. CONCLUSOES: Os profissionais do sexo de Ribeirao Preto, especialmente os travestis, representam uma populacao socialmente marginalizada e de alto risco para doencas sexualmente transmissiveis. E necessario que os servicos de saude publica dediquem mais atencao aos profissionais do sexo, tanto em termos de programas preventivos como de realizacao de novas investigacoes que permitam um melhor conhecimento acerca dos fatores de risco especificos desse grupo para as doencas sexualmente transmissiveis.

Biofilms, Infection, and Parenteral Nutrition Therapy

Parenteral nutrition therapy is used in patients with a contraindication to the use of the gastrointestinal tract, and infection is one of its frequent and severe complications. The objective of the present study was to detect the presence of biofilms and microorganisms adhering to the central venous catheters used for parenteral nutrition therapy by scanning electron microscopy. Thirty-nine central venous catheters belonging to patients with clinical signs of infection (G1) and asymptomatic patients (G2) and patients receiving central venous catheters for clinical monitoring (G3) were analyzed by semiquantitative culture and scanning electron microscopy. The central venous catheters of G1 presented more positive cultures than those of G2 and G3 (81% vs 50% and 0%, respectively). However, biofilms were observed in all catheters used and 55% of them showed structures that suggested central venous catheters colonization by microorganisms. Approximately 53% of the catheter infections evolved with systemic infection confirmed by blood culture. The authors conclude that the presence of a biofilm is frequent and is an indicator of predisposition to infection, which may even occur in patients who are still asymptomatic.

Hepatite C: prevalência e fatores de risco entre portadores do VIH/SIDA em Belém, Pará, na Amazônia brasileira

Este trabalho objetivou investigar a prevalencia de infeccao pelo virus da hepatite C e identificar possiveis fatores de risco para sua transmissao, em 406 individuos portadores do virus da imunodeficiencia humana, maiores de dezoito anos de idade, atendidos na rede publica de saude da cidade de Belem, Para, situada na Amazonia brasileira. Os exames referentes ao anti-VHC foram realizados pelo metodo de Elisa e a pesquisa do VHC RNA atraves da reacao de polimerase em cadeia. A prevalencia de infeccao, atual ou pregressa, pelo virus da hepatite C foi de 16% (IC: 12,4 - 19,6). A analise multivariada mostrou associacao do virus C com as variaveis idade, cujo risco significante recaiu no grupo com cinquenta ou mais anos (OR=9,75), antecedente de transfusao de sangue (OR=4,74) e uso de droga ilicita injetavel (OR=149,28). A prevalencia do virus da hepatite C entre os usuarios de drogas injetaveis foi de 83,7% e de 22,1% na populacao de transfundidos. Estes resultados indicam a efetiva transmissao do virus C atraves da exposicao percutânea e reafirmam o grande potencial de risco para hepatite C contido no uso injetavel de drogas ilicitas.

Serological markers of hepatitis B in people submitted to blood testing in health care clinics

OBJECTIVE To study some of the epidemiological aspects of hepatitis B in a non-representative sample of patients seen in health care clinics. METHODS The study population comprised 632 patients who were seen at health care clinics in the city of Ribeirão Preto, Brazil, for the purpose of blood testing, regardless the reason. After signing a written consent, an additional amount of blood was drawn from the same venous puncture site used to collect the original sample for the testing assigned to the patient at the health care clinic. A questionnaire was applied to each participant, looking for the presence of risk factors for hepatitis B. The blood samples were tested for HBV markers, using immunoenzimatic techniques. RESULTS The prevalences of HBsAg and anti-HBcAg were 0.3% and 13.9%, respectively. By a logistic regression model, the following variables were significantly associated with the infection: age, time of residency in the city (higher risk among those living for a period less than one year), past history of hepatitis, incarceration and sexual behavior (higher risk among homosexual and bisexual males). CONCLUSIONS The growing difficulties in obtaining blood samples from a representative group of patients, as done in classic surveys, make it necessary to look for alternative methodologies which can provide information concerning the presence of infectious agents in a community. Though the results cannot be generalized to the population as a whole, the methodology used conveyed some knowledge regarding the circulation of hepatitis B virus. In addition, it makes much easier to obtain agreement from the participants, since it does not add any invasive procedure. Despite the limitations, this methodology may be helpful in epidemiological surveillance of infectious agents known as producing asymptomatic infections in much of the population.

Hepatitis B viral markers in banked human milk before and after Holder pasteurization

BACKGROUND Blood screening for hepatitis B virus (HBV) is not universally performed for donor selection in human milk banks. OBJECTIVES To evaluate the frequency of detection of HBV surface antigen (HBsAg) and HBV-DNA in colostrum of HBV-infected nursing mothers before and after Holder pasteurization. STUDY DESIGN Forty-two concentrated breast milk samples were obtained within two postnatal weeks from 24 HBsAg-positive women (4 HBeAg-positive and 20 HBeAg-negative, anti-HBe-positive) were tested for the presence of HBsAg and HBV-DNA before and after Holder pasteurization (30min at 62.5 degrees C). RESULTS Before pasteurization, HBsAg and HBV-DNA were found in 14/24 (58%), and 20/24 (75%) first milk samples, respectively, obtained by 4 days after delivery. At least one marker was detected in 20/24 (83%) milk samples. Both markers were identified in milk of HBeAg-positive mothers, and most mothers with anti-HBe in blood had at least one HBV marker. Once detected, viral markers were frequently found in milk samples subsequently obtained from the same woman. Holder pasteurization did not affect the probability of detecting HBsAg (8/18, 44%), HBV-DNA (12/18, 67%), or at least one of them (15/18, 83%). CONCLUSIONS Although the biological implications of these findings remain to be determined, considering that HBV is highly contagious and most recipients of banked human milk are preterm infants, these findings should be taken into account when donors are enlisted for human milk banks without serological screening.

Histoplasmosis in individuals with acquired immunodeficiency syndrome (AIDS): Report of six cases with cutaneous-mucosal involvement

The authors report the first six cases of disseminated histoplasmosis and acquired immunodeficiency syndrome (AIDS) seen at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, from 1987 to 1989, with emphasis on dermatological clinical manifestations, nasal mucosa lesions and treatment. The mycosis was the first manifestation of AIDS in four patients. It is concluded that biopsies of the lesions for histopathologic study and fungal culture are important for diagnosis.

Estudo soroepidemiológico da infecção pelo vírus da hepatite B entre portadores do vírus da imunodeficiência humana/sida na cidade de Belém, Pará - Brasil

The objective of this investigation was to study the prevalence of hepatitis B virus infection in a sample of 406 adult patients with human immunodeficiency virus infection who attended at the public health care in the city of Belem, Para, Brazil, as well as analyzing possible risk factors for hepatitis B virus infection. The overall prevalence of hepatitis B virus infection was 51% (CI: 46.1 - 55.8), with 7.9% (CI: 5.3 - 10.5) for HBsAg, 45.1% (CI: 40.3 - 49.9) for anti-HBc and 32.3% (CI: 27.5 - 36.8) for anti-HBs. After adjustment using logistic regression, hepatitis B serological markers were associated with the following variables: age, marital status and sexual preference. The frequency of hepatitis B markers was 28.7% in heterosexuals and 68.8% in homo/bisexuals (CI: 3.50 - 9.08; OR: 5.63; p=0.000). In married people the frequency was 31% and 58.7% in single people (CI: 1.29 - 3.63); OR: 2.16; p=0.003). Multivariate analysis showed no association between hepatitis B virus infection and illicit injectable drug use.