The infusion of Baccharis spicata (Lam. ) Baill (Asteraceae) has antiviral activity against hepatitis B virus without cytotoxic effects against several cell lines / La infusión de Baccharis spicata (Lam. ) Baill (Asteraceae) posee actividad antiviral contra el virus de la hepatitis B sin efectos citotóxicos contra varias líneas celulares

Medicinal plants are used to cure diseases, and their replacement is frequent and affects public health. The genus Baccharis has representatives within the medicinal flora of Argentina, although the replacement of the species of this genus known under the vulgar name of "carqueja" by Baccharis spicata has been detected i n herbalists or markets of herbal products. The genotoxic safety of this species has been established in previous work of our group. The aim of this study was to evaluate the antiviral activity of an infusion made from B. spicata leaves against hepatitis B virus with the HepG2.2.15 cellular system and to determine cytotoxicity in HepG2.2,15, A549 and Vero cell lines. Infusion of B. spicata was active to inhibit HBV replication with an EC 50 of 22.54 µg/mL and a CC 50 of 190 µg/mL.

Las plantas medicinales son empleadas para la cura de enfermedades, y su sustituc ión es frecuente y afecta a la salud pública. El género Baccharis posee representantes dentro de la flora medicinal de Argentina, aunque se ha detectado la sustitución de las especies de dicho género conocidas bajo el nombre vulgar de "carqueja" por Baccha ris spicata en herboristerías o mercados de productos herb arios . Se ha establecido la seguridad genotóxica de esta especie en trabajos previos de nuestro grupo. Este estudio buscó evaluar la actividad antiviral de una infusión elaborada a partir de hojas de B. spicata frente al virus de la hepatitis B con el sistema celular HepG2.2.15 y determinar la citotoxicidad en las líneas celulares HepG2.2.15, A549 y Vero. La infusión de B. spicata fue activa para inhibir la replicación del virus con un EC 50 de 22.54 µg/mL y un CC 50 de 190 µg/mL.

Trends and spatial distribution of hepatitis B in pregnant women in Brazil / Tendência e distribuição espacial da hepatite B em gestantes no Brasil

Abstract Objectives: to analyze the trend and spatial distribution of hepatitis B in pregnant women in Brazil. Methods: ecological study based on all notified cases of hepatitis B in pregnant women through the Information System for Notifiable Diseases - Sinan between 2009 and 2018. Hepatitis B virus (HBV) detection rates were calculated in all municipalities. Spatial analysis was performed using the Global Moran Index for global data and local indicators of spatial association (Lisa) for the 5,570 municipalities. For trend analysis by State, the Prais-Winsten generalized linear regression model was used. Results: 15,253 pregnant women with HBV were reported. High detection rates were observed in the municipalities of São Miguel da Boa Vista-SC (68.96/1000 live births (LB)), Araguaiana-MT (68.18/1000 LB), Reserva do Cabaçal-MT (80, 00/1,000 LB), São Geraldo da Piedade-MG (75/1000 LB), Porto Mauá-RS (111, 11/1000 LB), in the respective bienniums. Moran (I) (I=0.056) showed a positive spatial association. In Lisa, 78 municipalities were included in the high-high cluster, 51.28% in the South region and 48 in the low-low cluster with 72.91% in the Southeast. There was an increasing trend in Maranhão (p=0.004) and Pernambuco (p=0.007) and a decrease in Mato Grosso (p=0.012), Paraná (p=0.031) and Santa Catarina (p=0.008). Conclusion: the detection of hepatitis B in pregnant women was observed in most Brazilian municipalities, with an increasing trend in two states and a decrease in three others.

Resumo Objetivos: analisar a tendência e distribuição espacial da hepatite B em gestantes no Brasil. Métodos: estudo ecológico a partir de todos os casos notificados de hepatite B em gestantes pelo Sistema de Informação de Agravos de Notificação - Sinan entre 2009 e 2018. Foram calculadas as taxas de detecção do vírus da hepatite B (HBV) em todos os municípios. A análise espacial foi realizada por meio do Índice Global de Moran para os dados globais e os indicadores locais de associação espacial (Lisa) para os 5.570 municípios. Para análise de tendências por Estado, utilizou-se o modelo de regressão linear generalizada de Prais-Winsten. Resultados: foram notificadas 15.253 gestantes com HBV. Observou-se altas taxas de detecção nos municípios de São Miguel da Boa Vista-SC (68,96/1000 Nascidos vivos (NV)), Araguaiana-MT (68,18/1000 NV), Reserva do Cabaçal-MT(80,00/1.000 NV), São Geraldo da Piedade-MG (75/1000 NV), Porto Mauá-RS (111,11/1000 NV), nos respectivos biênios. Moran (I) (I=0,056) apresentou associação espacial positiva. No Lisa observou-se 78 municípios inserido no cluster alto-alto, sendo 51,28%na região Sul e 48 no cluster baixo-baixo com 72,91% no Sudeste. Verificou-se tendência crescente no Maranhão (p=0,004) e Pernambuco (p=0,007) e diminuição no Mato Grosso (p=0,012), Paraná (p=0,031) e Santa Catarina (p=0,008). Conclusão: Observou-se a detecção de hepatite B em gestantes na maioria dos municípios brasileiros, com tendência crescente em dois estados e diminuição em outros três.

Principais motivos de descarte de córneas para transplante na Paraíba: por que o anti-HBc merece atenção?* / Main reasons for discarding corneas for transplant in Paraíba: why does anti-HBc deserve attention?*

RESUMO Objetivo: Identificar o perfil dos doadores de tecidos oculares humanos na área de atuação do Banco de Olhos da Paraíba, destacando o impacto da sorologia positiva para hepatite B no descarte dos tecidos para transplante. Métodos: O estudo é transversal e utilizou dados do Banco de Olhos da Paraíba entre janeiro de 2013 e dezembro de 2022. Dados sobre procedência, idade, sexo, causa do óbito, tempo entre óbito e enucleação, resultados sorológicos e motivo de descarte das córneas dos doadores foram coletados. Resultados: O maior motivo de descarte foi por sorologia positiva (56,5%), sendo positivadas as sorologias positivas para hepatite B e HBsAg em 11,1% e 4,75% dos pacientes, respectivamente. Conclusão: A sorologia positiva para hepatite B como um critério de descarte absoluto é responsável por grande parcela de descartes, apesar da pouca informação sobre suas repercussões e representação de infectividade nos receptores do transplante.

ABSTRACT Objective: To identify the profile of human ocular tissue donors in the area covered by the Eye Bank of Paraíba (PB), highlighting the impact of positive serology for hepatitis B (anti-HBc) in the disposal of tissues for transplantation. Methods: This is a cross-sectional that uses data from the Eye Bank of Paraíba (PB) between January 2013 and December 2022. Data on origin, age, sex, cause of death, time between death and enucleation, serological results, and reason for discarded donor corneas were collected. Results: The main reason for discarding was due to positive serology (56.5%), with positive anti-HBc and HBsAg serology in 11.1% and 4.75% of patients, respectively. Conclusion: Anti-HBc positive serology as an absolute disposal criterion is responsible for great part of disposals, despite little information about its repercussions and representation of infectivity in transplant recipients.

Knowledge and awareness of hepatitis B amongst students of Pamo University of Medical Sciences (PUMS), Port Harcourt, Rivers State, Nigeria

Background: Globally, 296 million people were infected by hepatitis B in 2019, with 1.1 million deaths. Africa is one of the endemic regions. Good knowledge and awareness of hepatitis B remain pivotal to the biosafety of medical students. This study sought to determine the levels of knowledge and awareness of hepatitis B among students of Pamo University of Medical Sciences (PUMS), Port Harcourt, Nigeria, and the predicting factors associated with this knowledge and awareness. The is with the aim of providing recommendations for improving and sustaining biosafety levels for medical and other health-related students of the University. Methodology: The study was a descriptive cross-sectional design conducted amongst 528 randomly selected medical students of PUMS, Port Harcourt, Nigeria. Structured questionnaires were interviewer-administered to collect socio-demographic information and participants' responses to questions on knowledge and awareness of hepatitis B. Data were analysed using SPSS version 26.0 and relationships of socio-demographic characteristics and predictive factors with knowledge and awareness of hepatitis B were tested using binary logistic regression analysis with p value for statistical significance set at <0.05. Results: A total of 528 students participated in the study, 202 (38.3%) males and 326 (61.7%) females. Most participants (296, 56.1%) were between 15-19 years of age with mean age of 19 ±2.43 years. The mean (±SD) of participants responses with good knowledge of hepatitis B was 249±121.5 while for good awareness, it was 181±88.3. The percentage average for good knowledge and good awareness was 47.2% and 34.2% respectively, with positive correlation between knowledge and awareness of hepatitis B (r=0.720, p<0.0001). Age was significantly associated with participants percentage average knowledge (OR=0.77, 95% CI 0.70-0.84, p<0.0001) and awareness of hepatitis B (OR=0.84, 95%CI 0.78-0.90, p=0.004). No other factor was significantly associated with knowledge and awareness of hepatitis B except Ijaw tribe (OR=0.4, 95%CI 0.24-0.66, p=0.034) and attendance of Federal Government College (OR=0.4, 95% CI 0.24-0.68, p=0.046). Conclusion: The percentage average good knowledge of 47.2% and awareness of 34.2% for hepatitis B in this study are low, although most participants in the study were between the ages of 15-19 years and in their first and second year of study. This gives room for improvement in knowledge and awareness of hepatitis B with progression in age and year of training. Good knowledge and awareness of hepatitis B are central to the biosafety of medical students. It is recommended that the National Universities Commission (NUC) and the Medical and Dental Council of Nigeria (MDCN) review the current medical school curriculum to increase the teaching of medical and health-related students that will impact more on knowledge and awareness of infectious diseases and infection prevention and control.

Effect of Hepatitis B Vaccination on HBV-infection among school children in Yaounde ten years after its introduction of the HBV vaccine into routine Immunization Program in Cameroon

Introduction: since the introduction of the anti-HBV vaccine into the Expanded Program on Immunization (EPI) in 2005 in Cameroon, vaccination coverage has reached 99.0%. This coverage would indicate an increase the number of children immune to Hepatitis B Virus (HBV) and a decrease in susceptibility to HBV-infection. This study was conducted to evaluate the effect of the HBV vaccine on pediatric HBV-infection in Yaounde, Cameroon. Methods: this school based cross-sectional study was conducted from February to May 2016 among 180 children from Nkomo public school. The study population was stratified into two groups: vaccinated (n=95) versus (vs) unvaccinated (n=85). Screening for HBV biomarkers was done using a rapid panel test for detection (HBsAg, HBeAg and anti-HBc) and anti-HBs titer using enzyme linked immunosorbent assay (ELISA). Statistical analyses were done using SPSS v. 22 with p ≥0.05 considered significant. Results: the mean age was 9.65 years. HBsAg (p=0.019) and anti-HBc (p=0.001) rates were detected in children aged ≥10 years and children aged < 10 years (95.95% [71/74]) were vaccinated vs 22.64% (24/106) for those aged ≥10 years (OR: 80.86; 95% CI: 23.36%-279.87%, p < 0.0001). According to anti-HBV vaccination status, HBsAg rate varied from [9.41% (8/85) to 1.05% (1/95), p=0.025], HBeAg rate varied from [2.35% (2/85) to 0% (0/95), p= 0.42] and anti-HBc rate ranged from [12.94% (11/85) to 2.10% (2/95), p= 0.011]. Conclusion: despite the variability of the anti-HBs titer, vaccination against HBV has a positive effect on the reduction of HBV infection in children in tropical settings such as Cameroon.

Scientific evidence on hepatitis B and SARS-CoV-2 infection: An integrative review / Evidências científicas sobre hepatite B e infecção por SARS-CoV-2: revisão integrativa / Evidencias científicas sobre la hepatitis B y la infección por SARS-CoV-2: revisión integradora

Background and Objective: Hepatitis B is an infectious disease caused by a virus from the hepadnaviridae family, with worldwide distribution, and represents a serious global health problem. The pathology may have been affected by the COVID-19 pandemic, caused by the SARS-CoV-2 virus, making it possible for serious outcomes to occur when overlapping viral types. This study sought to describe the levels of scientific evidence of research carried out on the topic, establishing a relationship between hepatitis B virus infection and SARS-CoV-2 infection. Content: integrative literature review, with searches performed in the databases of the Medical Literature Analysis and Retrieval System Online, and Scientific Electronic Library Online, with analysis centered on the description of the methodological design, and on the classification of the level of evidence. Conclusion: the scientific production on hepatitis B associated with SARS-CoV-2 infection corresponds mostly to studies with a low level of evidence. The selected publications presented limitations such as the occurrence of studies with a small number of samples, lack of subsidiary data of patients in treatment, and occurrence of non-randomized selection. The results suggest the need for further investigations for the purpose of technological improvement, identification of risk factors, therapeutic intervention, and advanced clinical investigation, in order to encourage evidence-based healthcare practices.(AU)

Justificativa e Objetivos: a hepatite B é uma doença infectocontagiosa provocada por um vírus da família hepadnaviridae, com distribuição mundial, e representa um grave problema de saúde global. A patologia pode ter sido afetada pela pandemia de COVID-19, provocada pelo vírus SARS-CoV-2, sendo possível a ocorrência de desfechos graves na sobreposição entre os dos tipos virais. Este estudo buscou descrever os níveis de evidências científicas de pesquisas realizadas sobre o tema, estabelecendo relação entre a infecção por vírus da hepatite B e a infecção por SARS-CoV-2. Conteúdo: revisão integrativa da literatura, com buscas realizadas nas bases de dados do Medical Literature Analysis and Retrieval System Online e Scientific Electronic Library Online, com análise centrada na descrição do delineamento metodológico e na classificação do nível de evidência. Conclusão: a produção científica sobre hepatite B associada a infecção por SARS-CoV-2 corresponde majoritariamente a pesquisas com baixo nível de evidência. As publicações selecionadas apresentaram limitações, como a ocorrência de estudos com número reduzido de amostras, falta de dados subsidiários de pacientes em tratamento e ocorrência de seleção não randomizada. Os resultados sugerem a necessidade de novas investigações para fins de incrementos tecnológicos, identificação de fatores de risco, intervenção terapêutica e investigação clínica avançada, de forma a fomentar práticas assistenciais em saúde baseadas em evidências.(AU)

Justificación y Objetivo: la hepatitis B es una enfermedad infecciosa contagiosa causada por un virus de la familia hepadnaviridae, de distribución mundial, y representa un grave problema de salud mundial. Su patología puede haberse visto afectada por la pandemia de COVID-19, provocada por el virus SARS-CoV-2, y son posibles desenlaces graves cuando se superponen tipos virales. Este estudio buscó describir los niveles de evidencia científica de las investigaciones realizadas sobre el tema, estableciendo una relación entre la infección por el virus de la hepatitis B y la infección por el SARS-CoV-2. Contenido: revisión integradora de la literatura, con búsquedas realizadas en las bases de datos Medical Literature Analysis and Retrieval System Online y Scientific Electronic Library Online, con un análisis centrado en la descripción del diseño metodológico y en la clasificación del nivel de evidencia. Conclusión: la producción científica sobre la hepatitis B asociada a la infección por SARS-CoV-2 corresponde, en su mayoría, a investigaciones con bajo nivel de evidencia. Las publicaciones seleccionadas presentaron limitaciones como la ocurrencia de estudios con un número reducido de muestras, la falta de datos subsidiarios de los pacientes en tratamiento y la ocurrencia de selección no aleatoria. Los resultados sugieren la necesidad de seguir investigando para mejorar la tecnología, identificar los factores de riesgo, intervenir terapéuticamente y realizar investigación clínica avanzada, con el fin de promover prácticas sanitarias basadas en la evidencia.(AU)

Epidemiología de infección por hepatitis B y C en personas con VIH/SIDA. Villa Clara 1986-2021 / Epidemiology of hepatitis B and C infection in people with HIV/AIDS. Villa Clara 1986-2021

Se realizó un estudio observacional descriptivo retrospectivo con el objetivo de caracterizar la infección por hepatitis B y C en pacientes seropositivos al VIH de la provincia Villa Clara, durante el período del 1 de enero de 1986 al 31 de diciembre de 2021. Esta coinfección se presentó con mayor frecuencia en pacientes adultos del sexo masculino de 60 años en adelante (22 casos, 18,48 %), seguido de pacientes con las edades 50-54 años (21, 17,64 %). Santa Clara fue el municipio de mayor prevalencia (25, 21%). Los factores de riesgo asociados fueron: la conducta sexual de riesgo (81 casos, 68,06%) y estado civil soltero (65, 54,62 %); predominó el nivel de escolaridad secundaria básica (53, 44,53 %); en la ocupación, amas de casa (42, 35,29 %) y desocupados (34, 28,57 %). En el 70,58 % de los casos, les fue diagnosticada la coinfección en el mismo año.

A retrospective, descriptive and observational study was carried out with the aim of characterizing hepatitis B and C infection in HIV seropositive patients in Villa Clara province from January 1, 1986 to December 31, 2021. This coinfection occurred more frequently in adult male patients, between 60 years and older (22 cases, 18.48%), followed by patients aged 50-54 years (21, 17.64%). Santa Clara was the municipality with the highest prevalence (25 cases, 21%). The associated risk factors were risky sexual behaviour (81 cases, 68.06%) and single marital status (65, 54.62%); secondary school level predominated (53, 44.53%); as well as, housewives (42, 35.29%) and unemployed people (34, 28.57%). The coinfection was diagnosed in 70.58% of the cases in the same year.

Serological and vaccine evaluation for hepatitis B among Community Health Workers / Avaliação sorológica e vacinal para hepatite B entre Agentes Comunitários de Saúde / Evaluación serológica y vacuna para la hepatitis B entre Agentes Comunitarios de Salud

Abstract Objective: to identify the vaccination and serological status against hepatitis B among community health workers; to vaccinate against hepatitis B virus and to evaluate the immune response of susceptible workers. Method: phase I, cross-sectional and descriptive study, among community health workers in a capital city of the Midwest region, through a self-administered questionnaire, checking of vaccination cards, and blood collection for testing of serological markers for hepatitis B. Phase II, cohort study carried out in vaccinated non-immune workers identified in phase I. They received one dose of vaccine (challenge dose) and serological testing. Results: a total of 109 workers participated in the study. Most had vaccination record (97; 89.0%) and vaccination completeness (75; 77.3%), while the isolated anti-HBs (Antibodies against hepatitis B virus) marker was detected in 78 (71.6%) workers. The prevalence of hepatitis B virus exposure was 8.2%. Of the ten non-immune vaccinated workers, after challenge dose, one remained susceptible. Conclusion: although most workers are vaccinated and show immunological response to hepatitis B, susceptibility after challenge dose was identified. Therefore, it is necessary to have a surveillance program of the vaccination situation and serological status for this virus, to promote these workers' safety.

Resumo Objetivo: identificar a situação vacinal e sorológica contra hepatite B entre agentes comunitários de saúde; vacinar contra o vírus da hepatite B e avaliar a resposta imunológica dos agentes susceptíveis. Método: fase I, estudo transversal e descritivo, entre agentes comunitários de saúde de uma capital da região Centro-oeste, por meio de questionário autoaplicável, conferência do cartão vacinal e coleta de sangue para testagem dos marcadores sorológicos para hepatite B. Fase II, estudo de coorte realizado em trabalhadores vacinados não imunes e identificados na fase I. Estes receberam uma dose da vacina (dose desafio) e teste sorológico. Resultados: participaram do estudo 109 agentes. A maioria tinha registro de vacinação (97; 89,0%) e completude vacinal (75; 77,3%), já o marcador anti-HBs (anticorpos contra o vírus da hepatite B) isolado foi detectado em 78 (71,6%) agentes. A prevalência de exposição ao vírus da hepatite B foi de 8,2%. Dos dez agentes vacinados não imunes, após a dose desafio, um permaneceu susceptível. Conclusão: apesar da maioria dos trabalhadores estarem vacinados e apresentarem resposta imunológica para hepatite B, a suscetibilidade após a dose desafio foi identificada. Portanto, é necessário que haja um programa de vigilância da situação vacinal e estado sorológico para este vírus, para promover a segurança destes trabalhadores.

Resumen Objetivo: identificar la situación de la vacunación y serología contra la hepatitis B entre agentes comunitarios de la salud, vacunar contra el virus de la hepatitis B y evaluar la respuesta inmunológica de los agentes susceptibles. Método: fase I, estudio transversal y descriptivo, entre agentes comunitarios de la salud de una capital de la región centro oeste, por medio de cuestionario autoadministrado, verificación del carné de vacunación y extracción de sangre para comprobar los marcadores serológicos para la hepatitis B. Fase II, estudio de cohorte realizado en trabajadores vacunados no inmunes e identificados en la Fase I; estos recibieron una dosis de la vacuna (dosis de desafío) y realizaron el test serológico. Resultados: participaron del estudio 109 agentes. La mayoría tenía registro de vacunación (97; 89,0%) y de cobertura de vacunación (75; 77,3%); el marcador anti-HBs (Anticuerpos contra el virus de la hepatitis B) aislado fue detectado en 78 (71,6%) de los agentes. La prevalencia de exposición al virus de la hepatitis B fue de 8,2%. De los diez agentes vacunados no inmunes, después de la dosis desafío, uno permaneció susceptible. Conclusión: a pesar de que la mayoría de los trabajadores estaban vacunados y presentaron respuesta inmunológica para la hepatitis B, la susceptibilidad, después de la dosis desafío, fue identificada. Por tanto, es necesario que exista un programa de vigilancia de la situación de vacunación y estado serológico para este virus, para promover la seguridad de estos trabajadores.

Reporte de caso: vasculitis leucocitoclastica como forma de presentación de hepatitis b crónica / Case report: leukocytoclastic vasculitis as presenting manifestation of chronic hepatitis b virus infection

La vasculitis leucocitoclástica, también denominada angeitis cutánea leucocitoclástica, es la forma más común de vasculitis. Si bien la mayoría de los casos son idiopáticos, entre los agentes etiológicos que podemos nombrar se encuentran los agentes infecciosos, las enfermedades del tejido conectivos, las reacciones de hipersensibilidad a medicamentos y las neoplasias solidas o hematológicas. Si bien los procesos infecciosos son una causa conocida de vasculitis leucocitoclástica, la infección por virus de Virus de hepatitis B (VHB) es muy infrecuente. Presentamos una mujer de 47 años, sin antecedentes patológicos previos, que consultó por artralgias en rodillas y tobillos, mialgias en gemelos y rash purpúrico con leve prurito en ambos miembros inferiores, de un mes de evolución. La biopsia cutánea de las lesiones de miembros inferiores fue compatible con vasculitis leucocitoclástica. La serología de hepatitis B fue positiva por lo que inició tratamiento antiviral con Tenofovir y Prednisona con buena evolución de sus lesiones cutáneas

Leukocytoclastic vasculitis, also called leukocytoclastic cutaneous angiitis, is the most common form of vasculitis. Although most cases are idiopathic, etiologic agents include infectious agents, connective tissue diseases, drug hypersensitivity reactions, and solid or hematologic malignancies. Although infectious processes are a known cause of leukocytoclastic vasculitis, hepatitis B virus (HBV) infection is very rare. We present a 47-year-old woman, with no previous pathologic history, who consulted for arthralgias in the knees and ankles, myalgia's and purpuric rash with mild pruritus in both lower limbs, of one month evolution. Skin biopsy of lower extremity lesions was compatible with leukocytoclastic vasculitis. Hepatitis B serology was positive, so she started antiviral treatment with tenofovir and prednisone with good evolution of her skin lesions

Uso profiláctico de antimicrobianos fuera de la práctica quirúrgica y de procedimientos invasivos: bases conceptuales y operativas / Prophylactic use of antimicrobials outside surgical and invasive-procedure settings: conceptual and operational basis

El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.

Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.

Sífilis, VIH y hepatitis B en el binomio madre-hijo. Caracterización de casos atendidos en centros de tercer nivel del interior de Córdoba / Syphilis, HIV and hepatitis B in the Mother-Child binomial

ntroducción: Las infecciones perinatales pueden transmi-tirse al feto y al recién nacido. Sífilis, VIH y hepatitis B deben tamizarse durante la gestación.Objetivo: Conocer la incidencia, prevalencia y manejo de sífilis, VIH y hepatitis B en el binomio madre/hijo. Comparar resultados con estadísticas oficiales.Materiales y métodos: Estudio retrospectivo, descriptivo y analítico, mediante revisión de historias clínicas del Sana-torio de la Cañada y Hospital Pasteur, Villa María, Córdoba. Período 01/12/2020 al 31/07/2021. Resultados: Se estudiaron 870 embarazos, la incidencia de sífilis materna fue 52,87/1000 embarazos, 76,1% de las gestantes eran menores de 30 años y hubo 41% de diag-nósticos tardíos. La incidencia de sífilis congénita fue de 18,3/1000 RN vivos. La incidencia de VIH materno fue de 6,89/1000 embarazos, 66,7% tenían menos de 30 años y el 77,7% tuvo carga viral indetectable al parto. El 100% de los RN expuestos fueron estudiados, todos con carga viral indetectable al nacimien-to. No hubo casos de hepatitis B.Conclusión: 6,3% de las embarazadas presentaron al me-nos una serología reactiva y el mayor porcentaje diagnós-tico se centró en menores de 30 años. La incidencia de sífilis congénita superó la provincial y nacional (18,3 vs. 1,18 vs. 1,14). El porcentaje de positividad de VIH materno superó al provincial. No hubo transmisión vertical de VIH al nacimiento. La prevalencia de hepatitis B fue menor a las oficiales

Introduction: Perinatal infections can be transmitted to the fetus and new-born. Syphilis, HIV and Hepatitis B must be monitored during pregnancy.Objective: To know incidence, prevalence and management of syphilis, HIV and Hepatitis B in the mother/child binomial. To compare results with official statistics.Materials and methods: Retrospective, descriptive and analytical study, through the review of medical records from Sanatorio La Cañada and Hospital Pasteur in Villa Maria, Cordoba. Period 12/01/2020 to 07/31/2021.Results 870 pregnancies were studied, the incidence of maternal syphilis was 57.87/1000 pregnancies, 76.1% of pregnant women were under 30 years old, and there were 41% late diagnoses. The incidence of congenital syphilis was 18.3/1000 live newborns. The incidence of maternal HIV was 6.89/1000 pregnancies, 66.7% were women under 30 years old and 77.7% had undetectable viral load at birth. 100% of the exposed newborns were studied, all with undetectable viral load at birth. There were no cases of Hepatitis B.Conclusion: 6.3% of pregnant women presented at least one reactive serology and the highest diagnostic percentage was focused on those under 30 years old. The incidence of congenital syphilis exceeded the provincial and national data (18.3 vs 1.18 vs 1.14). The percentage of maternal HIV positivity was superior to the provincial one. There was no vertical transmission of HIV at birth. The prevalence of Hepatitis B was less than the official ones.

Sobre la hepatitis aguda grave de etiología desconocida: la situación en México / About severe acute hepatitis of unknown etiology: the situation in Mexico

Introducción: en México, las hepatitis virales son de notificación epidemiológica obligatoria, pero no existe un sistema especial de vigilancia. La información disponible se limita a la distribución por edad y sexo. Ante la alerta de casos de hepatitis aguda grave de etiología desconocida, en la Unión Europea el Consejo Nacional de Vigilancia Epidemiológica (CONAVE) alertó al Sistema Nacional de Salud (SNS) para la atención y vigilancia de estos casos. Desarrollo: la hipótesis más convincente sobre la etiología está relacionada con una respuesta inmunitaria exacerbada que es mediada por superantígenos relacionados con la proteína espiga del SARS-CoV-2, activados por una infección por adenovirus que desencadena una respuesta de linfocitos T que provoca apoptosis de hepatocitos. Con base en la presentación clínica (niños menores de 16 años, con diarrea, dolor abdominal, ictericia, vómito e hipertransaminasemia) se han diseñado definiciones operacionales para su identificación y notificación al Sistema Nacional de Vigilancia Epidemiológica (SINAVE). Hasta junio del 2022, se han identificado 56 casos en México. Conclusiones: este brote de hepatitis representa un reto para el SINAVE. Es necesario incluir la identificación de adenovirus en el algoritmo diagnóstico de enfermedad respiratoria viral, implementar un sistema especial de vigilancia epidemiológica de hepatitis virales y sensibilizar a los profesionales sanitarios en el tema.

Introduction: In Mexico viral hepatitis requires mandatory epidemiological notification, but there is no special surveillance system. Available information is limited to distribution of cases by age and sex. Given the alert of cases of severe acute hepatitis of unknown etiology in the European Union, the National Council for Epidemiological Surveillance (Consejo Nacional de Vigilancia Epidemiológica) alerted the entire National Health System to care for and monitor these cases in Mexico. Development: The most convincing hypothesis is an exacerbated immune response mediated by superantigens related to the spike protein of SARS-CoV-2, activated by adenovirus infection that ends in a response of T lymphocytes that causes apoptosis of hepatocytes. Based on clinical presentation (children under 16 years of age, with diarrhoea, abdominal pain, jaundice, vomiting and increase in transaminases) the operational case definitions have been designed for their timely identification and notification to the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica). Until June 2022, 56 cases have been identified in Mexico. Conclusions: This hepatitis outbreak represents a challenge for the National System of Epidemiological Surveillance. It is necessary to include the identification of adenovirus in the diagnostic algorithm for viral respiratory disease, to implement a special epidemiological surveillance system for viral hepatitis, and to sensitize health professionals on this subject.

Distribuição e autocorrelação espacial das hepatites virais B e C no Paraná: estudo ecológico, 2011-2019 / Distribution and spatial autocorrelation of viral hepatitis B and C in Paraná, Brazil: an ecological study, 2011-2019 / Distribución y autocorrelación espacial de las hepatitis virales B y C en Paraná, Brasil: estudio ecológico, 2011-2019

Objetivo: analisar a distribuição e a autocorrelação espacial das taxas de detecção das hepatites B e C no estado do Paraná, Brasil. Métodos: estudo ecológico das notificações de hepatites B e C no Sistema de Informação de Agravos de Notificação, 2011-2019; estimou-se a variação percentual das taxas de detecção entre o primeiro e o último triênios do período; analisou-se a autocorrelação espacial pelo índice de Moran. Resultados: houve 16.699 notificações de hepatite B, com maior diminuição da detecção nas macrorregionais de saúde Norte (-30,0%) e Noroeste (-25,9%) paranaenses; foram observados clusters de alta ocorrência nas regionais de saúde de Foz do Iguaçu, Francisco Beltrão e Cascavel (2011-2019); para hepatite C, houve 10.920 notificações, com maior redução da detecção na macrorregional Noroeste (-18,9%) e aumento na Oeste (+51,1%); a regional de Paranaguá registrou cluster de alta detecção (2011-2016). Conclusão: as hepatites B e C apresentaram distribuição heterogênea entre regionais de saúde.

Objective: to analyze the distribution and spatial autocorrelation of hepatitis B and C detection rates in the state of Paraná, Brazil. Methods: this was an ecological study of hepatitis B and C notifications held on the Notifiable Health Conditions Information System, between 2011 and 2019. Percentage change in detection rates between the first and last three-year periods was estimated. Spatial autocorrelation was analyzed using Moran's index. Results: there were 16,699 notifications of hepatitis B, with a greater reduction in detection in the North (-30.0%) and Northwest (-25.9%) macro-regions. There were clusters of high occurrence in the Foz do Iguaçu, Francisco Beltrão and Cascavel regions between 2011 and 2019. There were 10,920 notifications of hepatitis C, with a greater reduction in detection in the Northwest macro-region (-18.9%) and an increase in the West (51.1%). The Paranaguá region recorded a high detection cluster between 2011 and 2016. Conclusion: hepatitis B and C showed heterogeneous distribution between health regions.

Objetivo: analizar la distribución y autocorrelación espacial de tasas de detección de hepatitis B y C en el estado de Paraná, Brasil. Métodos: estudio ecológico de notificaciones de hepatitis B y C en el Sistema de Información de Enfermedades de Declaración Obligatoria, entre 2011 y 2019. Se estimó la variación porcentual de las tasas de detección entre el primer y el último trienio del período. La autocorrelación espacial se analizó por el índice de Moran. Resultados: hubo 16.699 notificaciones de hepatitis B, con mayor reducción de detección en las macrorregiones Norte (-30,0%) y Noroeste (-25,9%). Hubo conglomerados de alta ocurrencia en regiones de Foz do Iguaçu, Francisco Beltrão y Cascavel entre 2011 y 2019. Para la hepatitis C, hubo 10.920 notificaciones, con una mayor reducción en la detección de la macrorregional Noroeste (-18,9%) y aumento en la Oeste (51,1%). La regional de Paranaguá registró un conglomerado de detección alto entre 2011 y 2016. Conclusión: la Hepatitis B y C mostraron distribución heterogénea entre regionales de salud.

Biomarcadores convencionales y emergentes en hepatitis B / Conventional and emerging biomarkers in hepatitis B

A nivel mundial, 300 millones de personas están infectadas por el virus de la hepatitis B (VHB). A pesar de que existe una vacuna que previene la infección y se dispone de tratamiento antiviral que suprime la replicación del virus, no hay cura aún. El principal problema que evita la recuperación total del paciente, incluso para aquel que recibe tratamiento, es la persistencia de dos formas del genoma viral en los hepatocitos: el ADN circular covalentemente cerrado (ADNccc), el cual se encuentra en forma de episoma y tiene la capacidad de replicarse, y las secuencias lineales subge-nómicas que se integran en el genoma humano, con potencial oncogénico. Hasta el momento se dispone de unos pocos biomarcadores para monitorear o predecir la progresión de la enfermedad y la respuesta al tratamiento. Estos biomarcadores se detectan durante la infección, y son la base para la monitorización de la enfermedad y hacer un diagnóstico de la fase clínica de la infección. Recientemente han surgido nuevos biomarcadores como el antígeno relacionado con el core del virus de la hepatitis B (HBcrAg) y la detección del ARN del VHB, que parecen correlacionarse con los niveles transcripcionales del ADNccc, además, durante el tratamiento parecen ayudar a predecir la respuesta y podrían identificar aquellos a quienes se les puede suspender la terapia sin riesgo de recaída. En esta revisión, se describe la utilidad de los principales biomarcadores convencionales en hepatitis B, y se abordan los dos biomarcadores emergentes más estudiados que prometen evaluar el curso de la infección, al igual que determinar la progresión de la enfermedad y la respuesta al tratamiento.

Globally, 300 million people are infected with hepatitis B virus (HBV). Although there is a vaccine that prevents infection and antiviral treatment that suppresses the replication of the virus, there is still no cure. The main problem that prevents the total recovery of the patient, even for those who recei-ve treatment, is the persistence of two forms of the viral genome in hepatocytes: covalently close circular DNA (cccDNA), which is in the form of an episome that has the ability to replicate, and linear subgenomic sequences that are integrated into the human genome, with oncogenic potential. Few biomarkers are currently available to monitor or predict disease progression and response to treatment. These biomarkers are detected during infection and are the basis for monitoring the di-sease and making a diagnosis of the clinical phase of the infection. New biomarkers have recently emerged, such as hepatitis B core-related antigen (HBcrAg) and HBV RNA detection, which seem to correlate with cccDNA transcriptional levels while during treatment seem to help predict response, and could identify those for whom therapy can be discontinued without risk of relapse. In this review, the usefulness of the main conventional biomarkers in hepatitis B is described, and the two most studied emerging biomarkers are mentioned, which promise to evaluate the course of the infection, as well as to determine disease progression and treatment response.

Protection level of anti­hepatitis B vaccine and immunoglobulin in a pediatric Cameroonian population

Despite the availability for nearly twenty years of an effective vaccine, hepatitis B remains one of the most frequent viral diseases throughout the world. Mother to child transmission is one of the primary routes of transmission in children. To assess the vaccine response in children born to HBV infected mothers. HBsAg positive consenting mothers registered in the antenatal care (ANC) service database of Centre Hospitalier Dominicain St Martin de Porres, Yaounde were enrolled with their children. Socio demographic char acteristics were collected using a tested questionnaire. The 5 markers of hepatitis B were tested and the quantification of anti HBsAg antibodies was done by indirect ELISA method. The data collected was analyzed using Microsoft excel and Epi info softwares. Out of 5,996 women registered, 143 were identified as HBsAg positive (2.38% prevalence) and none was HBeAg positive. Of these 143 HBsAg positive women, 50 were enrolled in the study. Of the 50 positive mothers, 78 children were included with a mean age ± standard deviation of 2.33±2.86 years. No child was infected with HBV, but all have been exposed to the virus (HBeAb positive). Overall 64 (82.05%) received at birth both anti HBs immunoglobulin (HBIG) and a dose of vaccine, while 14 (17.95%) received only the birth dose of vaccine. 72 (92.31%) children received all three recommended doses of vaccine. Vaccine responders were 62.82% (above 10 IU/ml), while 37.18% of children were non responders; representing a higher risk group if not boosted. The coverage of the anti HBV vaccine in children in this study was 92.31%. The protection level of 62.82% is below the 95% recommended rate by WHO. The factors sustaining this suboptimal protection should be investigated

Prévalence de l'infection par l'hépatite virale B et facteurs associés chez les enfants des sujets ivoiriens porteurs de l'AGHBS / Prevalence of hepatitis B infection and factors associated in children of Ivorian HBsAg carrier

Objectifs : Déterminer la prévalence de l'infection par le virus de l'hépatite B (VHB) chez les enfants (sujets contact) des sujets porteurs chroniques de l'Ag HBs (sujets index) et rechercher les facteurs associés à cette infection chez ces enfants.Patients et méthodes: il s'est agi d'étude rétrospective transversale portant sur les patients positifs pour l'Ag HBs (sujets index), dont la famille (sujets contact: conjoints et enfants) a été soumise à un dépistage systématique de l'infection par le VHB. Résultats: L'âge médian de nos 44 sujets était de 43,1 ± 7,49 ans. Le nombre moyen d'enfants par sujet index était de 2,3 ± 1,1. L'âge médian des 92 enfants était de 9,3 ± 4,55 (de 1 à 15 ans) et 43 (44,8%) étaient vaccinés contre le VHB. La fréquence de l'infection par le VHB était de 24%. Les facteurs indépendants associés à l'infection par le VHB chez les enfants étaient l'ADN du VHB pour les sujets index> 2000 UI/ml (OR = 11,5; p = 0,001), l'existence du VHB chez les deux parents (OR = 7,9; p = 0,03) et l'absence de vaccination contre le VHB chez les enfants (OR = 30,9; p = 0,003). Conclusion: La couverture vaccinale des enfants des sujets index était insuffisante. Outre la transmission verticale, le risque de transmission intrafamiliale était élevé en présence d'au moins un des trois facteurs associés

Objectives: To determine the prevalence of hepatitis B virus (HBV) infection in children (contact subjects) of chronic HBsAg (index subjects) and to investigate the factors associated with this infection in these children. Patients and methods: this was a retrospective cross-sectional study of HBsAg positive patients (index subjects), whose families (contact subjects: spouses and children) were routinely screened for HBV infection. Results: The median age of our 44 subjects was 43.1 ± 7.49 years. The average number of children per index subject was 2.3 ± 1.1. The median age of the 92 children was 9.3± 4.55 (1 to 15 years) and 43 (44.8%) were vaccinated against HBV. The prevalence of HBV infection was 24%. The independent factors associated with HBV infection in children were HBV DNA for index subjects> 2000 IU/ml (OR = 11.5; p = 0.001), the existence of HBV in both parents (OR = 7.9; p = 0.03) and no HBV vaccination in children (OR = 30.9; p = 0.003). Conclusion: Immunization coverage of children of index subjects was insufficient. In addition to vertical transmission, the risk of intrafamilial transmission was high in the presence of at least one of the three associated factors.

Managing inflammatory arthritis post-COVID-19 vaccination in a patient with hyperuricemia and previously diagnosed with hepatitis B infection presenting with Similar Joint Symptoms with a whole food plant-based diet: A case report

@#In inflammatory arthritis, there is inflammation of one or more joints brought about by immunologic events resulting from complex interactions of environmental trigger(s) in a genetically predisposed individual. The definitive cause of which remains unclear despite substantial research. The purpose of this article is to present a case with the diagnostic challenges associated with the rare coexistence and interplay of probable multiple causative mechanisms/triggers along with hyperuricemia and hepatitis B in the same patient presenting with inflammatory arthritis. It brings to greater attention the potential role of a key diet as an adjunct in the early management of undifferentiated inflammatory arthritis and thus, highlighting the choice of a whole food, plant-based diet (WFPBD) as a single, healthy, cost-effective and well-rounded diet which may be able to target all these different probable causative mechanisms leading to early symptom control and maybe, early disease remission. WFPB diet has been used in the management of differentiated arthritis from psoriatic arthritis and rheumatoid arthritis and other types of inflammatory arthropathy but to date, there is a paucity of available evidence on managing a patient with undifferentiated inflammatory arthritis probably resulting from more than one simultaneous environmental triggers with a single key diet.

Research progress of biomarkers of hepatitis B virus and clinical significance / 生物医学工程学杂志

The infection of Hepatitis B virus (HBV) can result in severe consequences, including chronic hepatitis, liver fibrosis, cirrhosis, and even liver cancer. Effective antiviral treatment has the potential to slow down the progression of the disease. HBV serum biomarkers play a crucial role in the dynamic management of chronic hepatitis B (CHB) patients. However, the conventional hepatitis B virus markers, such as hepatitis B serologic testing and HBV DNA, are insufficient to meet the clinical requirements. This review provided a comprehensive overview of the current research on the quantification of HBsAg and anti-HBc, HBV RNA and HBV core-associated antigen, which summarized the crucial role these markers play in the administration of antiviral medications, predicting the efficacy of treatment and anticipating the likelihood of virologic rebound following drug cessation, as well as assessing disease progression in CHB patients.

Ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China: a CR-HepB-based real-world study / 中华肝脏病杂志

Objective: To understand ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China. Methods: Patients with chronic HBV infection:demographic, virologic, hematologic, blood biochemistry, and antiviral treatment data were extracted from the China Registry of Hepatitis B (CR-HepB) database between 2012 and 2022 for descriptive statistics and change trend analysis. Multiple group comparisons were conducted using the Kruskal Wallis H test, while counting data was compared between groups using χ (2) test. Results: A total of 180 012 patients with chronic HBV infection were included, with a median age of 40 years old, and a male proportion accounting for 60.2%. The HBeAg positive rate was 43.3%. Over time, the median age of new patients each year increased from 39 to 47 years, while the HBeAg positive rate decreased from 51.3% to 32.8%. The initial diagnosis of patients was mainly CHB (71.4%), followed by hepatitis B cirrhosis (11.8%), inactive HBsAg carrier status (10.6%), and chronic HBV carrier status (6.2%). Among the newly registered patients every year from 2012 to 2022, the proportion of hepatitis B cirrhosis remained stable, but after 2019, the proportion of CHB increased and the proportion of other diagnoses decreased. The proportion of patients with cirrhosis increased with age in different age groups, with 3.5%, 19.3%, and 30.4% in the < 40, 40-69, and≥70 age groups, respectively. The proportion of women in patients with cirrhosis also increased with age, from 16.1% in those < 30 years old to 44.3% in those≥80 years old. From 2012 to 2022, the proportion of patients receiving first-line nucleos(t)ide analog antiviral treatment increased year by year, from 51.0% in 2012-2013 to 99.8% in 2022. Conclusion: The CR-HepB registration data reflect the changes in clinical characteristics and antiviral treatment patterns in patients with chronic HBV infection in China over the past ten years and can thus provide a reference to promote hepatitis B diagnosis and treatment practice, as well as scientific research.