Patricia Lofego Gonçalves

Detection of hepatitis C virus RNA in saliva samples from patients with seric anti-HCV antibodies

We examined the frequency of HCV-RNA in saliva samples from anti-HCV positive patients. Both plasma and saliva samples from 39 HCV patients (13 with normal liver enzymes, 19 with abnormal liver enzymes and 13 with cirrhosis) were investigated. Stimulated saliva and fresh plasma were centrifuged (900 x g,10 min) and stored at -70 degrees C, after the addition of guanidine isothiocyanate RNA extraction buffer. HCV-RNA was detected by RT-nested-PCR (amplification of HCV-cDNA for two rounds, using HCV primers 939/209 and 940/211). HCV genotyping was carried out by RFLP (using Mva I and Hinf 1 or Hae III and Rsa I restriction enzymes). Thirty-two out of 39 (82%; 95% CI=70-94%) anti-HCV-positive patients had HCV-RNA in plasma samples. Eight out of 39 (20.5%; 95% CI=6.6-34.4%) had HCV-RNA in the saliva. The HCV genotype in saliva samples from these patients matched the genotype found for plasma HCV-RNA. No significant correlation between the presence of HCV and either age, gender, HCV genotype or any risk factor for HCV infection was found. The observed prevalence (20.5% of anti HCV positive patients or 25% of the patients with HCV-RNA in plasma) was lower than that previously reported from other countries. The low frequency of HCV-RNA in saliva samples observed in our study may be due to the use of cell-free saliva. Other authors reporting higher frequencies of HCV-RNA in saliva used whole saliva, without centrifugation.

Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espfrito Santo

OBJECTIVES: To report the etiology of liver cirrhosis cases diagnosed at the University Hospital in Vitoria, Espirito Santo, Brazil. METHODS: The medical charts of patients with liver cirrhosis who presented to the University Hospital in Vitoria were reviewed. Chronic alcoholism and the presence of hepatitis B or C infections (HBV and HCV, respectively) were pursued in all cases. RESULTS: The sample consisted of 1,516 cases (male:female ratio 3.5:1, aged 53.2±12.6 years). The following main etiological factors were observed: chronic alcoholism alone (39.7%), chronic alcoholism in association with HBV or HCV (16.1%), HCV alone (14.5%) and in association with alcoholism (8.6%) (total, 23.1%), and HBV alone (13.1%) and in association with alcoholism (7.5%, total 20.6%). The remaining etiologies included cryptogenic cases (9.8%) and other causes (6.0%). The mean patient age was lower and the male-to-female ratio was higher in the cirrhosis cases that were associated with alcoholism or HBV compared with other causes. Intravenous drug abuse and a history of surgery or blood transfusion were significantly associated with HCV infection. Hepatocellular carcinoma was present at the time of diagnosis in 15.4% of cases. Chronic alcoholism associated with HCV infection was significantly associated (p<0.001) with reduced age (at the time of cirrhosis diagnosis) and increased prevalence of hepatocellular carcinoma (p = 0.052). CONCLUSION: Alcoholism, HCV and HBV are the main factors associated with liver cirrhosis in the state of Espirito Santo. Chronic alcoholism associated with HCV infection reduced the age of patients at the time of liver cirrhosis diagnosis.

Smoking habits of sixth year medical students and anti-smoking measures in Portugal

OBJECTIVES To study the smoking habits of 6th year Portuguese medical students and assess their knowledge and acceptance of anti-smoking measures and how they felt these would impact on public health. MATERIAL AND METHODS We conducted a descriptive cross-sectional study, in which a self-administered, anonymous questionnaire was made available online to the target population (6th year Portuguese medical students). The relationships between some of the variables were analysed using contingency tables and the chi2 test, with p<0.05 taken as statistically significant. RESULTS We obtained 255 answers to our questionnaire. We found an 18.04% prevalence of smokers. The majority of smokers smoked 1 - 10 cigarettes per day, with men smoking more, and most of them had begun their habit between 13 and 18 years of age, with women beginning later. 36.96% of smokers had already made an attempt to quit smoking. The great majority of the respondents agreed with the anti-smoking measures listed in the questionnaire. Furthermore, they expected these measures to have a positive impact on smoking and on smoking-related morbidity and mortality. Only 34.90% of the students judged smoking cessation to be sufficiently taught in their curricula. CONCLUSIONS The results are in accordance with the population in general in terms of the prevalence of smokers, the age of beginning smoking and a high prevalence of women smokers. There appears to be across-the-board agreement with anti-smoking measures, along with hope for a reduced general and individual consumption and morbi-mortality.

Nitric oxide levels are not changed in saliva of patients infected with hepatitis C virus

The aim of this investigation was to determine nitric oxide metabolite levels in saliva samples from hepatitis C virus-positive patients in an attempt to test the hypothesis if increased levels of nitric oxide metabolites correlates with the presence of HCV-RNA in saliva. Saliva of 39 HCV-positive patients and 13 HCV-negative patients, without clinical or laboratorial evidence of liver disease were tested for nitric oxide metabolites. HCV-RNA was detected in serum and saliva by a RT-PCR method and nitric oxide level was determined by evaluation of its stable degradation products, nitrate and nitrite. No differences were found between the concentration of nitrite in saliva from HCV patients and controls, in despite of the presence or not of HCV RNA in saliva. Patients with HCV and cirrhosis had higher concentrations of nitrite but not significantly different from the control group or the groups of anti-HCV patients without cirrhosis. Increased levels of nitrite were not detected in anti-HCV positive patients, an indirect indication that chronic sialoadenitis are infrequent in these patients or occurs with low intensity not sufficient to increase nitric oxide metabolite levels in saliva.

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo

INTRODUCTION Few studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil. METHODS We reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging. RESULTS HCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases. CONCLUSIONS These results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection.

Mortality from liver cirrhosis in Espírito Santo State, Brazil

Para estudar a mortalidade e conferir a etiologia da cirrose lancada nas Declaracoes de Obito (DO) no Espirito Santo, Brasil, foi feita a revisao das DO (2000 a 2011) e de prontuarios dos falecidos com investigacao de alcoolismo e hepatites B e C. Entre 218.410 DO foram identificados 3.554 mortes por cirrose. A mortalidade anual foi 19,8/100 mil homens e 4,31/100 mil mulheres, sem variacao anual significativa e sem alteracao significativa apos correcao por CID R98 e R99. Em 49% dos DO a causa da cirrose foi identificada: alcoolismo 85% e hepatite B ou C 15,7%. As etiologias nos 262 casos revisados foram: alcoolismo 40,5%; hepatite B ou C 26,7%; outras causas 3,8%; criptogenicas 10,6%. A media anual de anos potenciais de vida perdidos foi 5946 e 1739 anos, respectivamente, para homens e mulheres. A taxa de mortalidade por cirrose no Espirito Santo e intermediaria em relacao a outras regioes do mundo; alcoolismo e hepatites B e C sao as principais etiologias. E provavel que alcoolismo seja superestimado e hepatites B e C subestimadas como causa de cirrose nas DO.To study mortality from liver cirrhosis in Espírito Santo State, Brazil, we reviewed death certificates (DC) from 2000-2010 and medical records of deceased patients with investigation of alcoholism and hepatitis B or C. From a total of 218,410 DC, 3,554 deaths from liver cirrhosis were retrieved. The annual mortality rate was 19.8/100,000 for men and 4.31/100,000 for women, without significant changes after correction for ICD-R98 and R99 and without a significant increase in the annual percentage change. In 49% of death certificates, the aetiology of cirrhosis was defined: of these alcoholism in 81.5% of cases and viral hepatitis in 15.7%. Aetiology was confirmed in 262 reviewed records, including alcoholism (40.5%); hepatitis B or C (26.7%); other (3.8%); and cryptogenic (10.6%). The mean annual potential years of life lost were 5,946 years and 1,739 years for men and women respectively. The mortality rate from cirrhosis in Espírito Santo State is intermediate in relationship to worldwide data; alcoholism and hepatitis B or C were the main aetiologies; probably alcoholism is overestimated and hepatitis B and C viruses are underestimated as causes of cirrhosis registered on death certificates.

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil

INTRODUCTION In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

Socioeconomic disparities in access to a hepatocellular carcinoma screening program in Brazil

OBJECTIVES: Cirrhotic patients must receive an abdominal ultrasound every 6 months as part of hepatocellular carcinoma (HCC) screening. The aim of this study was to assess if HCC screening was performed as recommended by the literature and to observe the differences between the private and public services in Brazil. METHODS: We analyzed data from the HCC screenings of 253 cirrhotic patients from the University Hospital (n=177) and private sector (n=76) in Vitória, ES, Brazil. RESULTS: Ultrasound screening was performed every 13.1 months on average (SD 9.02). In 37 out of 253 patients, the screenings were performed close to the recommended frequency; 16 were performed every 6 months, and 21 were mostly performed during the follow-up period every 6 months. In the remaining 216 cases, ultrasounds were not performed according to the guidelines; for 106 patients, less than 50% of all ultrasounds were performed every 6 months and 110 patients showed an interval greater than one year. Patients from the private sector received ultrasound screenings near the ideal in 28.9% of cases, while patients from the University Hospital received ultrasounds in only 8.4% of cases (p<0.0001). HCC was diagnosed in 30 patients (11.8%). For these 30 patients, 11 screenings were properly performed within 6 months (36.6%) and only 1 out of the 11 (9%) met the criteria for transplant. In the remaining 19 patients who did not receive the screening within 6 months, 6 (31.5%) did not meet the criteria for transplant. CONCLUSION: HCC screening in our environment was irregularly performed, mainly in the public service setting, which prevented early diagnosis in a large number of patients.

Mortalidade por cirrose hepática no Estado do Espírito Santo, Brasil

Para estudar a mortalidade e conferir a etiologia da cirrose lancada nas Declaracoes de Obito (DO) no Espirito Santo, Brasil, foi feita a revisao das DO (2000 a 2011) e de prontuarios dos falecidos com investigacao de alcoolismo e hepatites B e C. Entre 218.410 DO foram identificados 3.554 mortes por cirrose. A mortalidade anual foi 19,8/100 mil homens e 4,31/100 mil mulheres, sem variacao anual significativa e sem alteracao significativa apos correcao por CID R98 e R99. Em 49% dos DO a causa da cirrose foi identificada: alcoolismo 85% e hepatite B ou C 15,7%. As etiologias nos 262 casos revisados foram: alcoolismo 40,5%; hepatite B ou C 26,7%; outras causas 3,8%; criptogenicas 10,6%. A media anual de anos potenciais de vida perdidos foi 5946 e 1739 anos, respectivamente, para homens e mulheres. A taxa de mortalidade por cirrose no Espirito Santo e intermediaria em relacao a outras regioes do mundo; alcoolismo e hepatites B e C sao as principais etiologias. E provavel que alcoolismo seja superestimado e hepatites B e C subestimadas como causa de cirrose nas DO.To study mortality from liver cirrhosis in Espírito Santo State, Brazil, we reviewed death certificates (DC) from 2000-2010 and medical records of deceased patients with investigation of alcoholism and hepatitis B or C. From a total of 218,410 DC, 3,554 deaths from liver cirrhosis were retrieved. The annual mortality rate was 19.8/100,000 for men and 4.31/100,000 for women, without significant changes after correction for ICD-R98 and R99 and without a significant increase in the annual percentage change. In 49% of death certificates, the aetiology of cirrhosis was defined: of these alcoholism in 81.5% of cases and viral hepatitis in 15.7%. Aetiology was confirmed in 262 reviewed records, including alcoholism (40.5%); hepatitis B or C (26.7%); other (3.8%); and cryptogenic (10.6%). The mean annual potential years of life lost were 5,946 years and 1,739 years for men and women respectively. The mortality rate from cirrhosis in Espírito Santo State is intermediate in relationship to worldwide data; alcoholism and hepatitis B or C were the main aetiologies; probably alcoholism is overestimated and hepatitis B and C viruses are underestimated as causes of cirrhosis registered on death certificates.

La mortalidad por cirrosis hepática en estado de Espírito Santo, Brasil

Para estudar a mortalidade e conferir a etiologia da cirrose lancada nas Declaracoes de Obito (DO) no Espirito Santo, Brasil, foi feita a revisao das DO (2000 a 2011) e de prontuarios dos falecidos com investigacao de alcoolismo e hepatites B e C. Entre 218.410 DO foram identificados 3.554 mortes por cirrose. A mortalidade anual foi 19,8/100 mil homens e 4,31/100 mil mulheres, sem variacao anual significativa e sem alteracao significativa apos correcao por CID R98 e R99. Em 49% dos DO a causa da cirrose foi identificada: alcoolismo 85% e hepatite B ou C 15,7%. As etiologias nos 262 casos revisados foram: alcoolismo 40,5%; hepatite B ou C 26,7%; outras causas 3,8%; criptogenicas 10,6%. A media anual de anos potenciais de vida perdidos foi 5946 e 1739 anos, respectivamente, para homens e mulheres. A taxa de mortalidade por cirrose no Espirito Santo e intermediaria em relacao a outras regioes do mundo; alcoolismo e hepatites B e C sao as principais etiologias. E provavel que alcoolismo seja superestimado e hepatites B e C subestimadas como causa de cirrose nas DO.To study mortality from liver cirrhosis in Espírito Santo State, Brazil, we reviewed death certificates (DC) from 2000-2010 and medical records of deceased patients with investigation of alcoholism and hepatitis B or C. From a total of 218,410 DC, 3,554 deaths from liver cirrhosis were retrieved. The annual mortality rate was 19.8/100,000 for men and 4.31/100,000 for women, without significant changes after correction for ICD-R98 and R99 and without a significant increase in the annual percentage change. In 49% of death certificates, the aetiology of cirrhosis was defined: of these alcoholism in 81.5% of cases and viral hepatitis in 15.7%. Aetiology was confirmed in 262 reviewed records, including alcoholism (40.5%); hepatitis B or C (26.7%); other (3.8%); and cryptogenic (10.6%). The mean annual potential years of life lost were 5,946 years and 1,739 years for men and women respectively. The mortality rate from cirrhosis in Espírito Santo State is intermediate in relationship to worldwide data; alcoholism and hepatitis B or C were the main aetiologies; probably alcoholism is overestimated and hepatitis B and C viruses are underestimated as causes of cirrhosis registered on death certificates.