Perfil epidemiológico das hepatites b e c no estado do rio grande do norte / Epidemiological profile of hepatitis Band Cin the state of Rio Grande do Norte / Perfil epidemiológico de hepatitis B y C en el estado de Rio Grande do Norte

Introdução:Considerado um grave problema de saúde pública, a Hepatite é uma doença que se destaca por ser silenciosa e nem sempre apresentar sinais e sintomas, favorecendo assim o atraso no seu diagnóstico.Objetivo:Diante de um crescimento contínuo no estado do Rio Grande do Norte (RN) de casos de Hepatite B e C, o presentetrabalho objetivouidentificar o perfil epidemiológico da população do RN diagnosticada e notificada com hepatites B e/ou C entre os anos de 2007 a 2015, segundo as regionais de saúde. Método:Trata-se de um estudo observacional, descritivo, do tipo transversal, que utilizou uma consulta ao DATASUS para a obtenção dos dados. Resultados:Verificou-se que houve predominância do sexo masculino dentre os casos de hepatite B e C, assim como a faixa etária de 20 a 39 anos, considerando-se hepatite B e 40 a 59 para a hepatite C. Ademais, a raça parda foi a predominante em ambos os tipos virais; a 7ª região de saúde foi a regional que mais possuiu notificação e houve uma maior prevalência dos casos de hepatite B e C em pessoas com menores níveis de escolaridade. Conclusões:Concluiu-se que o perfil das hepatites B e C no estado do Rio Grande do Norte tem se mostrado semelhante aos dados do Brasil, com uma alta prevalência, sugerindo assim a necessidade de se ter uma maior articulação entre os setores e departamentos responsáveis pelo registro e controle das hepatites virais do tipo B e C e a importância do gestor em saúde frente a essas situações para a realização de medidas preventivas (AU).

Introduction:Considered a serious public health problem, Hepatitis is a disease that stands out for being silent and not always showing signs and symptoms, thus favoring the delay in its diagnosis.Objective:Faced with a continuous growth in the state of Rio Grande do Norte (RN) of cases of Hepatitis B and C, the present study aimed to identify the epidemiological profile of the population of the RN diagnosed and notified with hepatitis B and / or C between the years 2007 to 2015, according to regional health.Methods:This is an observational, descriptive, cross-sectional study that used a consultation with DATASUS to obtain the data.Results:It was found that there was a male predominance among the cases of hepatitis B and C, as well as the age group of 20 to 39 years, considering hepatitis B and 40 to 59 for hepatitis C. Furthermore, the brown race was the predominant in both viral types; the 7th health region was the region with the most reports and there was a higher prevalence of cases of hepatitis B and C in people with lower levels of education.Conclusions:It was concluded that the profile of hepatitis B and C in the state of Rio Grande do Norte has shown to be similar to the data from Brazil, with a high prevalence, thus suggesting the need to have a greater articulation between the sectors and departments responsible for the registry and control of type B and C viral hepatitis and the importance of the health manager in face of these situations for carrying out preventive measures (AU).

Introducción:considerada como un grave problema de salud pública, la hepatitis es una enfermedad que destaca por ser silenciosa y no siempre muestra signos y síntomas, favoreciendo así el retraso en su diagnóstico. Objetivo:Frente aun crecimiento continuo en el estado de Rio Grande do Norte (RN) de casos de hepatitis B y C, el presente estudio tuvo como objetivo identificar el perfil epidemiológico de la población de NB diagnosticada y notificada con hepatitis B y / o C entre los años de 2007 a 2015, según la salud regional. Método:Este es un estudio observacional, descriptivo, transversal que utilizó una consulta con DATASUS para obtener los datos. Resultados:se encontró que había un predominio de hombres entre los casos de hepatitis B y C, así como el grupo de edad de 20 a 39 años, considerando la hepatitis B y 40 a 59 para la hepatitis C. Además, la raza marrón predominaba en ambos tipos virales; la séptima región de salud fue la región con más informes y hubo una mayor prevalencia de casos de hepatitis B y C en personas con niveles más bajos de educación. Conclusiones:Se concluyó que el perfil de hepatitis B y C en el estado de Rio Grande do Norte ha demostrado ser similar a los datos de Brasil, con una alta prevalencia, lo que sugiere la necesidad de una mayor articulación entre los sectores y departamentos responsables. para el registro y control de la hepatitis viral tipo B y C y la importancia del gerente de salud ante estas situaciones para llevar a cabo medidas preventivas (AU).

Necrolytic acral erythema in a Chinese patient with hepatitis C and hepatitis B virus coinfection

Abstract: Necrolytic acral erythema is a distinct erythema that has been described as an extrahepatic manifestation of hepatitis C virus infection. Most reported cases have been in Africa, especially Egypt. We report the first case (to the best of our knowledge) of necrolytic acral erythema in a Chinese patient with HCV and HBV coinfection. We aim to increase awareness for recognizing this condition in the Chinese population.

TeleCondutas: hepatite B / TeleGuides: Hepatitis B

As hepatite virais apresentam forma clínicas diversas, desde infecções assintomáticas até quadros de hepatopatia avançada, como cirrose e hepatocarcinoma. A equipe da atenção primária deve investigar pessoas com sinais e sintomas comuns da infecção, bem como assintomáticos que fazem parte do grupo de risco. Esta guia apresenta informação que orienta a conduta para casos de hepatite B no contexto da Atenção Primária à Saúde, incluindo: forma de transmissão, quadro clínico, suspeita ou diagnóstico de cirrose, diagnóstico de hepatite b, avaliação sorológica da hepatite b, avaliação de paciente com hepatite b aguda, avaliação de paciente com hepatite b crônica, rastreamento, vacina para hepatite b, encaminhamento para serviço especializado.

Avaliação do desempenho de testes rápidos na detecção de marcadores do vírus da hepatite B / Evaluation of the performance of rapid tests for detection of hepatitis B virus markers

O uso de testes rápidos (TR) para detecção de marcadores de infecção pelo vírus da hepatite B (HBV) pode ser uma ferramenta para aumentar o acesso ao diagnóstico em áreas de difícil acesso. O objetivo deste estudo foi avaliar o desempenho de TRs na detecção de marcadores do HBV para fins de diagnóstico e estudos epidemiológicos. Um painel de referência com amostras de soro de pacientes com infecção pelo HBV e indivíduos saudáveis foi confeccionado para avaliação dos testes rápidos na detecção do HBsAg. Após, amostras de soro, sangue total e saliva foram obtidas de indivíduos de três grupos: i) alta endemicidade, ii) Baixa prevalência, e iii) alta vulnerabilidade para aquisição do HBV, e foram empregadas para avaliação dos TRs de detecção de HBsAg, anti-HBs e anti-HBe. Cinco TR foram avaliados: Vikia HBsAg® (Biomérieux, França), HBsAg teste rápido (Doles, Brasil), e do fabricante Wama (Brasil), os testes: Imuno- Rápido HBsAg®, Imuno-rápido anti-HBsAg® e Imuno-rápido anti-HBeAg®. Amostras de soro foram avaliadas em todos os TR, saliva foi avaliada nos TR para a detecção do HBsAg e sangue total somente no TR Vikia HBsAg®. Os resultados dos TR foram comparados com os obtidos em testes imunoenzimáticos comerciais (EIE) para detecção de HBsAg e anti-HBs e teste de eletroquimioluminescencia (ECLIA) para detecção de anti-HBe. Os TR para detecção de HBsAg tiveram sua repetitividade e reprodutibilidade em amostras de soro e saliva avaliadas, assim como a determinação de reação cruzada a outras infecções. O Vikia HBsAg® apresentou melhor concordância, utilizando amostras de soro no painel de referencia (98,68 por cento) e no total dos grupos de diferentes perfis (96,08 por cento), sendo melhor no grupo i (95,81 por cento). Os diferentes TR para detecção do HBsAg utilizando amostras de soro apresentaram concordância acima de 93 por cento no painel de referência e 87 por cento nos grupos de diferentes perfis...

Nos dois cenários, houve aumento da sensibilidade dos TRs para detecção do HBsAg de acordo com a presença do HBV DNA. O TR Vikia HBsAg® apresentou concordância em amostras de sangue total de 72,72 por cento, exceto no grupo ii, onde não foi possível detectar amostras HBsAg verdadeiro positivas. Os TR para HBsAg apresentaram baixos valores de concordância em amostras de saliva (45,65 por cento), somente o Imuno-rápido HBsAg® conseguiu detectar um maior número de amostras verdadeiro positivos (n=34). Os TR para detecção de anti-HBs e anti-HBe apresentaram concordâncias iguais a 54,73 por cento e 56,89 por cento, respectivamente. O Imuno-rápido anti-HBs® apresentou melhores valores de sensibilidade em amostras com altos títulos de anti-HBs e naquelas obtidas de indivíduos com anti-HBc e anti-HBs reagente. Os TR para HBsAg apresentaram excelente repetitividade e reprodutibilidade (concordância igual à 100 por cento) em amostras de soro e saliva. Não foram observados resultados HBsAg falso positivo ou negativo em amostras reativas para Dengue, porém resultados discordantes foram observados em todos os TRs avaliados em amostras com sorologia reativa para HCV, HIV e Treponema pallidum. Conclui-se que, TR para detecção do HBsAg podem ser empregados no diagnóstico da infecção em amostras de soro, enquanto os TR para detecção de anti-HBe e anti-HBs apresentam baixo desempenho para uso diagnóstico. Palavras-chave: Teste rápido, HBsAg, anti-HBs, anti-Hbe...

Risk stratification of HBV infection in Asia-Pacific region

Hepatitis B virus (HBV) infection is the major etiology of chronic liver disease worldwide and thus a global health problem, especially in Asia-Pacific region. The long-term outcomes of Asian HBV carriers vary widely; however, a significant proportion of them will finally develop end-stage liver disease. Over the past decade, several host and HBV factors predictive of clinical outcomes in Asian HBV carriers have been identified. The community-based REVEAL-HBV study illustrated the strong association between HBV-DNA level at study entry and risk of HCC over time, and male gender, older age, high serum alanine aminotransferase (ALT) level, positive HBeAg, higher HBV-DNA level, HBV genotype C infection and core promoter mutation are independently associated with a higher hepatocellular carcinoma (HCC) risk. Another hospital-based ERADICATE-B cohort further validated the HCC risk started to increase when HBV-DNA level was higher than 2,000 IU/mL. Of particular note, in patients with low viral load (HBV-DNA level or =1,000 IU/mL was a new independent risk factor for HCC. With the results from REVEAL-HBV study, a risk calculator for predicting HCC in adult non-cirrhotic patients has been developed and validated by independent international cohorts (REACH-B). With the combination of HBV-DNA, HBsAg, and ALT levels, ERADICATE-B study proposed an algorithm to predict disease progression and categorize risk levels of HCC as well as corresponding management in Asian HBV carriers. The introduction of transient elastography may further enhance the predictive power. In conclusion, HBsAg level can complement HBV-DNA level for the risk stratification of disease progression in Asian adult patients with chronic HBV infection.

Occult hepatitis B virus infection: clearance or disguise?

No abstract available.

Overview and recent trends of systematic reviews and meta-analyses in hepatology

A systematic review (SR) is a research methodology that involves a comprehensive search for and analysis of relevant studies on a specific topic. A strict and objective research process is conducted that comprises a systematic and comprehensive literature search in accordance with predetermined inclusion/exclusion criteria, and an assessment of the risk of bias of the selected literature. SRs require a multidisciplinary approach that necessitates cooperation with clinical experts, methodologists, other experts, and statisticians. A meta-analysis (MA) is a statistical method of quantitatively synthesizing data, where possible, from the primary literature selected for the SR. Review articles differ from SRs in that they lack a systematic methodology such as a literature search, selection of studies according to strict criteria, assessment of risk bias, and synthesis of the study results. The importance of evidence-based medicine (EBM) in the decision-making for public policy has recently been increasing thanks to the realization that it should be based on scientific research data. SRs and MAs are essential for EBM strategy and evidence-based clinical practice guidelines. This review addresses the current trends in SRs and MAs in the field of hepatology via a search of recently published articles in the Cochrane Library and Ovid-MEDLINE.

Histological and immunohistochemical features in fatal acute fulminant hepatitis E.

Background: Hepatitis E is being increasingly recognized as an emerging infection in developed countries. Data on histological findings and nature of inflammatory cell infiltrate in liver in this disease are quite sparse. Aims: This study was planned to study the histological features and the type of inflammatory infiltrate in liver biopsies of patients with acute fulminant hepatitis E. Materials and Methods: We retrieved postmortem liver biopsies of 11 Indian patients with fulminant hepatitis E, and compared these with biopsies from seven patients with fulminant hepatitis B. Results : Biopsies from acute fulminant hepatitis E showed varying degrees of hepatocyte necrosis, mixed portal and lobular inflammation, accompanied by bile ductular proliferation, lymphocytic cholangitis, Kupffer cell prominence, cholestasis, apoptotic bodies, pseudo-rosette formation, steatosis, and presence of plasma cells in portal tracts. Interface hepatitis was more frequent in acute hepatitis B than in acute hepatitis E (100% vs 20%; P<0.05). These findings differ from those reported in cases with autochthonous hepatitis E in Europe. On immunohistochemistry, lymphocyte infiltrate consisted predominantly of CD3 + T cells in both hepatitis E and hepatitis B; these cells contained a predominant cytotoxic (CD8 + ) cell subpopulation in 81.8% of cases with hepatitis E and in 50% of cases with hepatitis B. Conclusion: Our findings suggest that histological changes in HEV infection may vary with geographical location because of prevalent HEV genotypes, and that CD8 + lymphocytes play a role in HEV-induced liver injury.

Virus de la hepatitis B e infección por VIH/SIDA en niños / Hepatitis b and HIV/AIDS infection in children

La infección por VIH/SIDA en niños ha aumentado a nivel mundial y en nuestro medio no es la excepción, aunque desde hace muchos años se ha cambiado la historia natural de la enfermedad utilizando la terapia antirretroviral altamente efectiva (HAART). La manera más frecuente de transmisión del Virus de la Hepatitis B (VHB) son contactos con sangre o fluidos y a través de actividad sexual. La infección por VIH/SIDA es una enfermedad viral progresiva caracterizada por el desarreglo inmune. La infección concurrente de VIH con VHB y hepatitis C (VHC) se asocia con incremento en la severidad y empeora el pronóstico de la enfermedad hepática.

HIV/AIDS in children has increased worldwide and in our environment is no exception, although for many years has changed the natural history of disease using highly effective antiretroviral therapy (HAART). The most frequent way of transmission of Hepatitis B Virus (HBV) is contact with blood or body fluids and by sexual activity. HIV/AIDS is a viral disease characterized by progressive immune disorder. HIV concurrent infection with HBV and hepatitis C virus (HCV) is associated with increased severity and worsens the prognosis of liver disease.

Assessment of noninvasive liver stiffness in inactive HBsAg carriers by transient elastography

Chronic viral hepatitis can be evaluated using invasive or noninvasive methods. The aim of this study was to evaluate liver stiffness in inactive HBsAg carriers compared with normal subjects and determine if it is influenced by viral load in these patients. We prospectively evaluated 140 inactive HBsAg carriers and 152 normal subjects [without any signs or history of liver disease]. In all subjects, liver stiffness was measured by 3 experienced physicians using a FibroScan [Registered sign] device [EchoSens, France] per standard procedures. We excluded patients for whom the SR of liver stiffness measurements was < 60% and those who had measurements with an IQR>30%. The mean liver stiffness in inactive HBsAg carriers was 5.6 +/- 2.1 kPa, significantly higher than in normal subjects [4.8 +/- 1.2 kPa, p=0.0002]. In 16.4% [23] of inactive carriers, liver stiffness exceeded 7 kPa [the cutoff for significant fibrosis F >/= 2]. In patients with undetectable viral loads, the mean liver stiffness was 4.9 +/- 1.2 kPa, significantly lower than in those with detectable DNA [<2000 IU/ml] [6.7 +/- 2.7 kPa, p <0.001]. Inactive HBsAg carriers have higher liver stiffness values compared with healthy individuals. Liver stiffness in inactive HBsAg carriers with detectable viral loads is higher than in those who are aviremic, suggesting that low viral loads promote fibrosis

Seroprotección contra el virus de hepatitis B en pacientes pediátricos con cáncer / Seroprotection against hepatitis B virus in pediatric patients with cancer

Los pacientes con cáncer son población de riesgo para adquirir infección por virus de hepatitis B por estar expuestos a métodos que favorecen la inoculación parenteral del virus. Cuantificar los anticuerpos contra el antígeno de superficie para el virus de hepatitis B en pacientes sin títulos protectores al momento de su ingreso en el servicio de hematooncología pediátrica que recibieron un esquema corto de vacunación (0, 1 y 2 meses). Entre marzo de 2008 y 2009, se recibieron 40 pacientes, excluyéndose 17 posteriormente del estudio, 8 por presentar marcadores positivos de infección para hepatitis B y 9 con títulos mayores de 100UI/L. Dieciséis pacientes sin títulos protectores recibieron vacuna recombinante. Se determinaron serologías para hepatitis B: Antígeno de superficie, Anticuerpo contra el antígeno de superficie y anticore, cada 3 meses, por 1 año, considerándose como títulos protectores anticuerpo contra el antígeno de superficie mayor de 100UI/L De los 16 (100%) pacientes que recibieron vacunación, 15 (94%) alcanzaron títulos protectores, los cuales presentaron descenso del anticuerpo contra el antígeno de superficie durante el tiempo de estudio. Los pacientes vacunados alcanzaron seroprotección con posterior disminución progresiva de sus títulos protectores lo que justifica su revacunación...

Patients with cancer are a population in risk of being infected by Hepatitis B virus as a consequence of being exposed to methods favoring the parenteral inoculation of the virus. Quantifying the antibodies against the surface antigen for Hepatitis B virus in patients without protection titers when admitted to the pediatric hematology-oncology service and who received a short vaccination schedule (0, 1, and 2 months). Between March 2008 and 2009, 40 patients were received, from which later on 17 were excluded from the study since 8 showed infection positive markers for Hepatitis B, and 9 with values higher than 100IU/L. 16 patients without protection titers were recombinant- vaccinated. Serologies for Hepatitis B were determined: Surface Antigen, Antibody against surface antigen, and anticore every 3 months during 1 year, being considered as the antibody protectors against the surface antigen higher than 100IU/L. Out of the 16 patients (100%) who were vaccinated: 15 (94%) reached protection titers, showing antibody decrease against surface antigen in the study term. Vaccinated patients reached seroprotection with later progressive diminishing of protection titers, thus justifying revaccination...

Actualización sobre hepatitis B / Upgrade in hepatitis B

El virus de la hepatitis B (VHB), es un virus DNA, el cual tiene varios antígenos, como el antígeno de superficie, y antígeno core. Colombia, es un país de baja endemicidad, sin embargo, en la Sierra Nevada de Santa Marta, está endemicidad es alta. El VHB tiene como una de sus complicaciones la hipertensión porta. En general, el VHB no atraviesa la placenta, por lo que la infección es rara in utero. Son pocos los pacientes que se presentan con HB y falla hepática fulminante y por lo tanto, son pocos los antivirales que han sido utilizados, con muy poca experiencia.

The hepatitis B virus (HBV) is a DNA virus, which has several antigens such as surface antigen and core antigen. Colombia is a country of low endemicity, however, in the Sierra Nevada of Santa Marta, is endemic is high. HBVis one of the complications of portal hypertension. In general, HBV does not cross the placenta, so the infection is rare in utero. Few patients who present with HB and fulminant hepatic failure and therefore, few antiviral drugs that have been u s e d , wi t h v e r y l i t t l e e x p e r i e n c e.

Hepatitis B y C en pacientes oncológicos / Hepatitis B and C oncological patients

La mayoría de los niños que padecen enfermedades hemato-oncológicas reciben múltiples transfusiones y esto aumenta el riesgo para adquirir estas infecciones. Por otro lado, en estos niños inmunosuprimidos la infección suele ser subclínica. Suele diagnosticarse al observar elevación de aminotransferasas. Evaluar la respuesta al tratamiento de hepatitis en niños con antecedentes oncológicos. 80 pacientes con antecedentes de tratamiento hematoncológico, del año 2000 a 2008 con serologías positivas para hepatitis viral. 39 (48,75%) presentan Hepatitis B, 19 (23,75%) Hepatitis C, 22 (27,75%) coinfección Hepatitis B y C. En el grupo HBV, 7 negativizaron espontáneamente DNAHBV. 20 recibieron tratamiento con diferentes esquemas: 3 IFN, 4 lamivudina, 3 lamivudina + IFN, 10 Lamivudina + PEG; 7/20 negativizaron ADN VHB. 6/10 con tratamiento combinado negativizaron DNAHBV (60%). En el grupo con Hepatitis C, todos genotipo 1; 3 negativizaron RNAHCV espontáneamente; 10 recibieron tratamiento, 3/10 tratados con IFN + RIBAVIRINA y 7 con PEG + RIBAVIRINA. 1/3 y 4/7 (57,14%), negativizaron RNAHCV, respectivamente. En el grupo con coinfección, 14 tratados: 2 IFN; 4 IFN + RIBAVIRINA; 8 PEG + RIBAVIRINA. 11/12 con esquema combinado culminaron tratamiento; negativizaron 1/11 (9%) DNAHBV y 5/11 (45,45%) RNAHCV. 8/80 desarrollaron complicaciones, cirrosis y hepatocarcinoma. Los pacientes pediátricos presentan respuesta al tratamiento para hepatitis B y C crónicas, similar al del adulto. Hubo diferencia estadísticamente significativa en la respuesta al tratamiento relacionado con el grado de inflamación en pacientes coinfectados. Cirrosis y hepatocarcinoma también se presentan en este grupo de edad...

Most children with hemato-oncological diseases receive multiple transfusions, and this increases the risk of acquiring these infections. On the other hand, in these immunosuppressed children the infection is usually subclinical. It’s usually diagnosed by observing an elevation in aminotransferases figures. To evaluate the response to the treatment for hepatitis in children with a history of cancer. 80 patients with a history of hemato-oncological treatment, from 2000 to 2008, with positive viral hepatitis serologies/for viral hepatitis. 39 (48,75%) had Hepatitis B, 19 (23,75%) Hepatitis C, 22 (27,75%) coinfection Hepatitis B and C. In the HBV group, 7 had spontaneous HBV-DNA negative, 20 received treatment with different schemes: 3 IFN, 4 lamivudine, 3 lamivudine + IFN, 10 lamivudine + PEG; 7/20 had HBV-DNA negative. 6/10 with combined treatment had HBV-DNA negative (60%). In the group with Hepatitis C, all genotype 1; 3 had spontaneous HCV-RNA negative; 10 received treatment, of which 3/10 were treated with IFN + RIBAVIRIN and 7 with PEG + RIBAVIRIN. 1/3 and 4/7 (57.14%) had HCV-RNA negative, respectively. In the group with HBV/HCV co-infection, 14 patients treated: 2 IFN, 4 IFN + RIBAVIRIN, 8 PEG + RIBAVIRIN. 11/12 with combined scheme ended treatment; 1/11 (9%) and 5/11 (45,45%) had HBV-DNA and HCV-RNA negative, respectively. 8/80 developed complications, such as, cirrhosis and hepatocellular carcinoma. Pediatric patients presented similar response to adult patients, to the treatment for chronic hepatitis B and C. There was a statistically significant difference in treatment response related to the degree of inflammation in coinfected patients. Cirrhosis and hepatocellular carcinoma are also evidenced in this age group...

Inmunopatogenia y fisiopatología de la hepatitis por virus B / Immunopathology and Physiopathology of Viral Hepatitis Type B

Virus B, familia Hepadnaviridae, no citopático directo. La lesión hepatocelular es por la respuesta inmunológica a los antígenos virales. Respuesta inmune muy agresiva da hepatitis fulminante. En los crónicos hay débil respuesta de los linfocitos T citotóxicos CD 8, predominante la respuesta humoral de sustancias Th-2 (IL4,5,10). Factores que afectan la evolución: a). mutación del virus; b) co-infección con otros virus; c) estado inmune del paciente. Fases de la evolución a cronicidad: a) fase inmunotolerante: mucho virus y Ag positivo, seroconversiόn dura años, seroconversiόn de e es de 15% en 20 años; b) fase de aclaramiento inmune: seroconversiόn de e de 10 20% por año; c) estado de portador inactivo: mayoría de pacientes crónicos, son Ag negativos, anti e positivos; d) hepatitis crónica e negativos: ADN alto con elevación de ALT, la mayoría son mutaciones core y pre core no produciendo antígeno. e) resolución de infección crónica, 0.5-2% aclaran el antígeno de superficie, pero podrían hacer carcinoma hepatocelular en el futuro, siendo anti-HBs positivos.

HBV, Hepadnaviridae family, not direct cytopathic. This hepatocellular lesion is the result of an immunological response to viral antigens. A very aggressive response causes fulminant hepatitis. In chronic cases there is a weak response from lymphocyte T cell CD 8 and predominates the humoral response of TH-2 (IL-4-5-10) substances. Factors that affect the evolution: virus mutation, co-infection with other viruses, immune status of the patient. Stages of the evolution towards chronicity: a) immunotolerant stage (abundance of virus and e positive, seroconversion lasts years; seroconversion of Ag is 15% in 20 years); b) immune clearance stage (seroconversion of Ag is 10-20% per year); c) inactive carrier stage (most patients are chronic, Antigen negative and anti e positive); d) chronic hepatitis e negative (high DNA with an increase of ALT, most of them are core and pre-core mutations and do not produce antigen); e. resolution of chronic infection (0.5-2% clear the surface antigen, but in the future they could cause liver cell carcinoma because they are anti-HB positive.

Determinação do limite mínimo de detecção da técnica de PCR “nested” para o vírus da hepatite B (HBV) / Evaluation of minimum detection limit to hepatitis B virus (HBV) PCR “nested”

Mundialmente, a hepatite pelo vírus B (HBV) é considerada um dos maiores problemas de saúde pública, apesar da vacinação. A Organização Mundial da Saúde (OMS) estima que mais de 2 bilhões de pessoas estejam infectadas pelo HBV. O Brasil é classificado como área de incidência intermediária pela OMS. No entanto, estudos de prevalência detectaram diferenças de índices de infecção nas regiões geográficas: 8% na região Amazônica, 2,5% nas regiões Centro-Oeste e Nordeste, 2% na Sudeste e 1% na região Sul. Um diagnóstico sensível e específico é de fundamental importância para os pacientes portadores do HBV. O objetivo deste estudo foi determinar o limite mínimo de detecção da técnica de PCR “nested” “in house” para o HBV. Diluições seriadas de uma amostra quantificada de HBV (1000 cópias/mL; 750 cópias/mL; 500 cópias/mL; 250 cópias/mL) foram submetidas à técnica de PCR “nested”. O alvo da amplificação por PCR foi a região do core e pré-core do vírus. Para extração dos ácidos nucléicos da amostra foi empregado o kit comercial QIAmp. O limite mínimo de detecção encontrado foi de 500 cópias/mL ou 10 cópias por reação de PCR.

All over the world, the hepatitis B virus (HBV) is considered one of the major problems of public health, despite vaccination. World Health Organization (WHO) estimates that more than 2 billions of persons are infected by HBV. Brazil is classified as an area of intermediary incidence by WHO. However, prevalence studies have detected differences of infection indexes in geographic regions: 8% in the Amazonian region, 2,5% in middle-west and Northeast, 2% in Southeast and 1% in South. A sensitive and specific diagnosis is very important to the HBV carrier patients. The aim of this study was to determine the minimum limit of detection of the nested PCR in house technique for HBV. Serial dilutions of one quantified sample of HBV (1000 copies/mL; 750 copies/mL; 500 copies/mL; 250 copies/mL) were submitted to a nested PCR. The target of PCR was viral core and pre-core region. Commercial kit, QiAmp, was employed to purify nucleic acids from the sample. The minimum detection limit found was 500 copies/mL or 10 copies per PCR reaction.

Spectrum of histological features in non-alcoholic fatty liver disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become an Important entity globally, including in India and other Asian countries. Morphological evaluation of a liver biopsy is necessary for the diagnosis, staging and possibly management of this disease. However, the spectrum of changes in the liver, their evolution, Interrelationships and implications are incompletely understood. We aimed to study the spectrum of histological abnormalities in NAFLD. METHODS: The study material was drawn from a pool of 80 liver biopsies diagnosed in our laboratory as NAFLD, 67 retrieved retrospectively from our records and 13 obtained prospectively with complete clinical data. After comprehensive histological assessment, a detailed analysis was done of 32 of those categorized as definitive NAFLD on the basis of a dependable history of no alcohol Intake and seronegativity for hepatitis virus B and C Infections. RESULTS: Fatty change was preferentially seen in acinar zones 2 and 3, more so in the former. Steatotic cells varied in size; some large ones were non-spherical. Steatosis alone was present in more than a quarter of the cases and steatosis along with inflammation was present in half. The magnitude of steatosis correlated with inflammation, while both these seemed to correlate with hepatocyte Injury and fibrosis. CONCLUSION: A proportion of patients with NAFLD show only hepatic steatosis. An Increasing grade of steatosis is associated with greater Inflammation, hepatocyte injury and acinar fibrosis. Preferential involvement of acinar zone 2 by steatosis, the morphology of the steatotic cells, and nature and location of inflammation are important in the diagnosis of NAFLD and its differentiation from other causes of fatty liver.

Failure of hepatitis B surface antibody to protect acute fulminating hepatitis in a renal transplant recipient.

A 58-year-old man who had a living-related kidney transplantation (KT) 13 years ago and had received a double-dosage course of hepatitis B virus (HBV) vaccination prior to KT developed acute liver failure. An exhaustive work-up for the cause of acute liver failure revealed that HBsAg was negative but anti-HBs and anti-HBcAbs were positive. HBV DNA was 535,000 copies/ml. The strongly positive staining of HBsAg and HBcAg of liver biopsy was shown by immunohistochemistry examination. HBV harboring surface mutant of hepatitis B surface gene was thought to be the cause of acute fulminant hepatitis despite the presence of protective immunity to wild-type HBV. The patient expired from acute liver failure even though an antiviral drug was started promptly. This is the first case report of liver biopsy suggestive of acute fulminating HBV that developed in a long-term kidney recipient despite the presence of high anti-HBsAb titer.