Occult hepatitis B virus infection in patients with chronic liver disease of different etiology in a Brazilian referral center: comparison of two different hepatitis B virus deoxyribonucleic acid amplification protocols: a cross-sectional study

ABSTRACT BACKGROUND: Occult hepatitis B virus infection (OBI) is defined as the presence of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) in the liver of individuals with undetectable hepatitis B virus surface antigen (HBsAg) in the serum. The actual prevalence of OBI and its clinical relevance are not yet fully understood. OBJECTIVE: To evaluate the prevalence of HBV DNA in liver biopsies of HBsAg-negative patients with chronic liver disease of different etiologies in a referral center in Brazil and compare two different HBV DNA amplification protocols to detect HBV. DESIGN AND SETTING: This cross-sectional observational study was conducted at the Liver Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil, between January 2016 and December 2019. METHODS: HBV DNA was investigated in 104 liver biopsy samples from individuals with chronic liver disease of different etiologies, in whom HBsAg was undetectable in serum by nested-polymerase chain reaction (nested-PCR), using two different protocols. RESULTS: OBI, diagnosed by detecting HBV DNA using both protocols, was detected in 6.7% of the 104 individuals investigated. Both protocols showed a good reliability. CONCLUSION: In addition to the differences in the prevalence of HBV infection in different regions, variations in the polymerase chain reaction technique used for HBV DNA amplification may be responsible for the large variations in the prevalence of OBI identified in different studies. There is a need for better standardization of the diagnostic methods used to diagnose this entity.

Percepções discentes sobre as abordagens tradicional e baseada em problema na anatomia patológica / Student perceptions about tradicional and problem-based approaches in pathological anatomy

Resumo: Introdução: O ensino da patologia, ciência que estuda as doenças e um dos ramos fundamentais da medicina, atravessa um período reflexivo sobre quais estratégias metodológicas se adaptam melhor à nova matriz curricular médica. Objetivo: Para o aprofundamento dessas reflexões à luz dos estudantes, o presente estudo analisou o comportamento e a preferência discentes em aulas práticas tradicionais e baseadas em problema na disciplina Anatomia Patológica II do curso de Medicina da Universidade Federal de Minas Gerais. Método: As análises qualitativas do comportamento e da preferência foram realizadas por meio da observação das aulas e da aplicação de questionário semiaberto, on-line e baseado na escala Likert. Resultado: Os resultados demostraram a clara preferência dos alunos pela metodologia ativa, tanto no que tange ao desenvolvimento das habilidades e competências estabelecidas para um eficiente ensino da patologia quanto no que concerne à participação em sala de aula. Conclusão: Assim, o estudo fortalece a importância da escuta acadêmica no planejamento do ensino da patologia.

Abstract: Introduction: The teaching of Pathology, a science that studies diseases and one of the fundamental branches of Medicine, is going through a period of reflection, in which methodological strategies are better suited to the new medical curriculum matrix. Objective: In order to expand these reflections in accordance with the students, the present study analyzed the students' behavior and preferences in traditional and problem-based practical classes in the discipline of Pathological Anatomy II of the Medical course at Universidade Federal de Minas Gerais. Method: The qualitative analyses of behavior and preferences were carried out through the observation of classes and the application of a semi-open online questionnaire, based on the Likert scale. Result: The results showed the students' obvious preference for the active methodology, both regarding the development of established skills and competences for an efficient teaching of Pathology, as well as participation in class. Conclusion: Therefore, the study reinforces the importance of academic listening when planning the teaching of Pathology.

Hepatitis Relapse after Yellow Fever Infection: Is There Another Wave?

Abstract During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.

Anti-serum validation for use in immunohistochemistry for Trypanosoma cruzi detection

Abstract INTRODUCTION: The detection of Trypanosoma cruzi in tissue samples is important in many situations, such as testing of the reactivation of the infection. The detection of T. cruzi nests in endomyocardial biopsies (EMB) may be useful to evaluate graft rejection. Given their scarcity, such nests are not routinely identified. To increase the diagnosis sensitivity, immunohistochemistry (IHC) may serve as a promising strategy. Here, we validate an antiserum for the detection of T. cruzi infection by IHC. METHODS: We used 1) positive controls (PCs) - 13 EMB, 12 skin biopsies, and 1 heart with T. cruzi nests as sections stained with hematoxylin and eosin (HE); 2) negative controls - a) 10 explant hearts and 10 EMB with no amastigote nests or clinical/laboratory signs of chagasic infection; and b) eight samples with leishmaniasis, toxoplasmosis, or histoplasmosis; and 3) Cases - 31 EMB of chagasic patients with no parasite nests in HE sections but detected positive for T. cruzi DNA by polymerase chain reaction. As a primary antibody, a hyperimmune serum from T. cruzi-infected rabbits was used. RESULTS: IHC results were positive for 21 of 26 PCs (80.8%) and one case of cutaneous leishmaniasis. In 4 of 31 cases, IHC revealed nests (12.9%), which were undetected by conventional histological examination. CONCLUSIONS: This study shows that IHC with the tested antiserum increases the sensitivity of the diagnosis and may be recommended for routine use in EMB analyses of cardiac transplant patients with Chagas disease.

Expression of the c-MET, HGF and VEGF biomarkers in intestinal and diffuse gastric cancer in the Brazilian population: a pilot study for the standardization of the quantitative PCR technique

Background: Gastric carcinoma (GC) is the third leading cause of death among malignant tumors worldwide, causing approximately 900,000 deaths/year. Changes in oncogenes that encode tyrosine kinase receptors play an important role in the pathogenesis of GC. MET gene is a proto-oncogene that encodes a tyrosine kinase receptor c-MET and it is required for embryonic development and tissue repair. The hepatocyte growth factor (HGF) is the only known ligand for c-Met receptor. The MET oncogene activation suppresses apoptosis and promotes the survival, proliferation, migration, differentiation and angiogenesis of cells. Among the angiogenic factors, VEGF is the main regulator. Its biological function includes the promotion of endothelial cells mitosis to stimulate cells proliferation. These biomarkers expression in GC is relatively recent and population-based studies are required to define the expression pattern. The aim of this study was to determine qPCR technical standardization to evaluate quantitatively, in paraffin tissue samples, the presence of gene 23 expression of the MET, HGF and VEGF in diffuse and intestinal GC types. Methods: Twenty GC patients were studied, 10 patients were intestinal-type GC (average age 72.1 years) and 10 diffuse-type (average age 50.1 years). In all patients, tissue samples were analyzed from the tumor and distant areas of the tumor tissue. The relative expressions of the tumor markers c-Met, HGF and VEGF were performed by qPCR technique by comparing tumor and non-tumoral samples and they were normalized with the GAPDH constitutive gene. Statistical analysis was performed through T-test. Results: For c-Met, 18/20 (90%) patients expressed the marker and 9/20 (45%) overexpressed this gene, in which three were intestinal-type GC and six were diffuse-type GC. For HGF, only 7/20 (35%) patients expressed this gene and it was overexpressed in 4/20 (20%), in which two were intestinal-type GC and two were diffuse-type GC. For VEGF, 20/20 (100%) patients expressed this marker and in 12/20 (60%) were observed overexpression, in which eight patients had diffuse-type GC and four had intestinal-type GC. Conclusions: qPCR technique was standardized and suitable for expression analysis of the three biomarkers using paraffin embedded tissue samples. Further studies should be carried out to characterize the expression pattern of these biomarkers in GC in the Brazilian population (AU)

Ventriculitis: a rare case of primary cerebral toxoplasmosis in AIDS patient and literature review

Cerebral toxoplasmosis remains the most important neurological opportunistic infection and the most common cause of intracerebral mass lesion in patients with acquired immunodeficiency syndrome (AIDS). We report a case of an adult AIDS patient with an atypical pattern of toxoplasma encephalitis, presenting with ventriculitis and obstructive hydrocephalus without any focal parenchymal lesion.

Localized hepatic tuberculosis presenting as fever of unknown origin

Localized hepatic tuberculosis is a rare clinical form of tuberculosis infection; it has signs and symptoms related only to hepatic injury, with minimal or no extrahepatic involvement. It frequently presents as a non-specific syndrome, with systemic manifestations, which can sometimes result in a diagnostic dilemma. A high index of suspicion is required and a definitive diagnosis can be very difficult. We report a case of localized hepatic tuberculosis that presented as fever of unknown origin.

Schistosomiasis mansoni and severe gastrointestinal cytomegalovirus disease in a patient with acquired immunodeficiency syndrome

The behavior of the Schistosoma mansoni infection in patients with AIDS has not been explored. The case of a young woman with schistosomiasis mansoni, AIDS, and cytomegalovirus disease is reported. The authors suggest that the helminth was not a bystander in this case, or rather, by interfering with the host's immune response, it set the stage for the development and/or aggravation of the viral infection.

O comportamento da infecção pelo Schistosoma mansoni não foi explorado em pacientes com AIDS. Relatamos aqui o caso de uma paciente com esquistossomose mansoni, AIDS, e doença pelo citomegalovírus. Os autores sugerem que o helminto não foi apenas um espectador neste caso, mas, que, ao interferir na resposta imune do hospedeiro, promoveu o surgimento e/ou agravamento da infecção causada pelo citomegalovírus.