Recent trends in hepatitis A incidence in Brazil.

Hepatitis A incidence has been decreasing in Brazil since child vaccination was implemented in 2014. This trend was interrupted by an outbreak among adult male in São Paulo in 2017. This study was outlined to estimate whether the increase of hepatitis A cases among adult men in Brazil was restricted to São Paulo. Cases reported to the national surveillance system from 14 large cities of all Brazilian regions were analyzed. Trends in time series from 2012 to 2018 were estimated by Prais-Winsten regression. The outbreak in São Paulo extended to 2018. In Rio de Janeiro, the number of cases rose again, achieving the same levels reported before the vaccination era. Three of six cities from South and Southeast regions showed an upward trend in the number of cases among adult men (P < .005). The large cities in the other three Brazilian macroregions showed a decrease or stabilization of cases without an increase among male adults. The increase of hepatitis A virus (HAV) cases in Brazil has happened not only in São Paulo, but also in other cities of South and Southeast regions. The northernmost cities were not affected. A change in the epidemiological pattern of HAV infection is emerging in Southern Brazil.

Brazilian society of hepatology recommendations for the diagnosis and treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB). All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.

RESUMO O carcinoma hepatocelular é uma neoplasia de importância global e associada a altos índices de mortalidade. Recentes avanços no diagnóstico e tratamento da doença tornaram necessárias que se atualizassem as recomendações sobre o manejo da doença. Para definir as recomendações sobre o diagnóstico e tratamento do carcinoma hepatocelular, a Sociedade Brasileira de Hepatologia organizou uma reunião monotemática em João Pessoa (PB). Todos expositores foram solicitados a fazer uma revisão sistemática da literatura e apresentar os temas relacionados a fatores de risco para o desenvolvimento de carcinoma hepatocelular, métodos para rastreamento, diagnóstico radiológico e sistemas de estadiamento da doença, tratamentos curativos e paliativos e carcinoma hepatocelular em fígado não cirrótico. Após o encontro, todos os expositores se reuniram para discussão dos tópico e elaboração dessas recomendações. O texto resultante foi ainda submetido a avaliação e aprovação por todos membros da Sociedade através de sua homepage. O documento atual é a versão final que contêm as recomendações da Sociedade Brasileira de Hepatologia.

Detection of hepatitis B activity in HBeAg-negative carriers with normal aminotransferase levels in central Brazil.

UNLABELLED: BACKGROUND AND RATIONALE FOR THE STUDY: Hepatitis B virus (HBV) chronic infection may follow a benign course with low risk of cirrhosis or liver cancer. As differentiation of inactive status from HBeAg-negative chronic hepatitis B is often challenging, monitoring of inactive HBV carriers is important to detect viral relapse or formerly undetected activity. The incidence of hepatitis activity in HBeAg-negative carriers with normal aminotransferases was examined by retrospective analysis of a cohort of carriers who had been followed-up at a hospital in Central Brazil. All patients had remained free of evidence of liver disease and maintained normal aminotransferase levels throughout the first year of follow-up. The incidence density of chronic HBV activity was determined and an incidence curve was constructed using the Kaplan-Meier method. Cox regression models were developed to identify for surrogate markers of activity. RESULTS: Among the 224 patients who comprised the cohort, chronic HBV activity was detected in 30 during followup. The incidence density of activity was 11.8 per 100 person-years (95% confidence interval: 8.3-16.9). The results of Cox regression analysis indicated that chronic HBV activity was associated with entrance in the latter years of the period examined (p = 0.001) and initial normal aspartate aminotransferase (AST) levels close to the upper-normal value (p = 0.022). CONCLUSION: Normal AST levels near the upper-normal value may be an indicator of relapse or previously undetected activity, and should thus be monitored closely in HBeAg-negative HBV carriers, in whom risk of relapse should remain an important managing consideration.

Brazilian society of hepatology recommendations for the diagnosis and treatment of hepatocellular carcinoma.

Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB). All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.

Encefalopatia hepática: relatório da 1ª reunião monotemática da Sociedade Brasileira de Hepatologia / Hepatic encephalopathy: report 1st monothematic meeting of the Brazilian Society

A encefalopatia hepática (EH) é um distúrbio funcional do sistema nervoso central (SNC) associado à insufi ciência hepática, de fisiopatologia multifatorial e complexa. Devido aos avanços no conhecimento sobre o manejo da EH na cirrose e na insuficiência hepática aguda (IHA), a diretoria da Sociedade Brasileira de Hepatologia (SBH) promoveu uma reunião monotemática acerca da fi siopatologia, diagnóstico e tratamento da EH, abordando aspectos controversos relacionados ao tema. Com a utilização de sistemática da medicina baseada em evidências, foram abordados o manejo da EH e da hipertensão intracraniana na IHA, o manejo da EH episódica na cirrose, as controvérsias no manejo da EH e a abordagem da EH mínima. O objetivo desta revisão é resumir os principais tópicos discutidos na reunião monotemática e apresentar recomendações sobre o manejo da síndrome votadas pelo painel de expertos da SBH.

Hepatic encephalopathy (HE) is a functional disorder of the central nervous system (CNS) associated with liver failure, either end-stage chronic liver disease or fulminant hepatic failure. Its pathogenesis remains complex and poorly understood. In view of recent advances in the management of HE, the Brazilian Society of Hepatology endorsed a monothematic meetingregarding HE in order to gather experts in the to discuss related data and to draw evidence-based recommendations concerning: management of HE and intracranial hypertension in FHF, treatment of episodic HE in cirrhosis, controversies in the management of EH including difficult to treat cases and diagnostic and treatment challenges for minimal HE. The purpose of this review is to summarize the lectures and recommendations made by the panel of experts of the Brazilian Society of Hepatology.

Ethnoecological knowledge of the artisan fishermen of octopi in the community of Coroa Vermelha.

Coral reefs are quite diverse ecosystems that carry out several ecological functions and plays a relevant socioeconomic role. The artisan fishing of octopi (Octopus spp.) is practiced for the survival of part of the inhabitants of Coroa Vermelha community, in the south of the state of Bahia. We intended to study the knowledge of the octopi fishermen of Coroa Vermelha using the comprehensive ethnoecological proposal of Marques. The data were collected between July, 2006 and April, 2008 through direct observation and from interviews with fishermen met by chance and through the "native specialists" criterion. Twenty semi-structured interviews were carried out following an itinerary of pre-established questions about the activity of octopi capture, and the biological and ecological aspects of the resource. The data showed that the fishermen have knowledge about biological and ecological aspects of the octopi. Two capture techniques are used: octopus fishing (polvejamento) in the reefs and through diving. Two specific folk are recognized: the "normal octopus" (Octopus insularis) and the "east octopus" (Octopus macropus (?)). The intervieews demonstrated ecological knowledge sometimes compatible with the scientific literature, mainly in which concerns the trophic ecology and behavior of the octopi.

Ethnoecological knowledge of the artisan fishermen of octopi (Octopus spp.) in the community of Coroa Vermelha (Santa Cruz Cabrália, Bahia)

Coral reefs are quite diverse ecosystems that carry out several ecological functions and plays a relevant socioeconomic role. The artisan fishing of octopi (Octopus spp.) is practiced for the survival of part of the inhabitants of Coroa Vermelha community, in the south of the state of Bahia. We intended to study the knowledge of the octopi fishermen of Coroa Vermelha using the comprehensive ethnoecological proposal of Marques. The data were collected between July, 2006 and April, 2008 through direct observation and from interviews with fishermen met by chance and through the "native specialists" criterion. Twenty semi-structured interviews were carried out following an itinerary of pre-established questions about the activity of octopi capture, and the biological and ecological aspects of the resource. The data showed that the fishermen have knowledge about biological and ecological aspects of the octopi. Two capture techniques are used: octopus fishing (polvejamento) in the reefs and through diving. Two specific folk are recognized: the "normal octopus" (Octopus insularis) and the "east octopus" (Octopus macropus (?)). The intervieews demonstrated ecological knowledge sometimes compatible with the scientific literature, mainly in which concerns the trophic ecology and behavior of the octopi.

Os recifes de coral são ecossistemas muito diversos que realizam várias funções ecológicas e possuem um relevante papel socioeconômico. A pesca artesanal de polvo (Octopus spp.) é realizada para a sobrevivência de uma parte da população da comunidade de Coroa Vermelha, no Sul do Estado da Bahia. A intenção deste estudo foi avaliar o conhecimento dos pescadores de polvos de Coroa Vermelha, usando a proposta da etnoecologia abrangente de Marques. Os dados foram coletados entre julho de 2006 e abril de 2008 através da observação direta e entrevistas com pescadores encontrados oportunisticamente e com os especialistas "nativos". Vinte entrevistas semi-estruturadas foram realizadas seguindo um roteiro de perguntas pré-estabelecidas sobre a atividade de captura polvos, e os aspectos biológicos e ecológicos do recurso capturado. Os dados demonstraram que os pescadores têm conhecimento sobre alguns aspectos biológicos e ecológicos dos polvos. Duas técnicas de captura são utilizadas: pesca sobre o recife (polvejamento) e através de mergulho. Dois específicos do povos são reconhecidos: o polvo "normal" (Octopus insularis) e o polvo "de leste" (Octopus macropus (?)). Os entrevistados demonstraram conhecimento ecológico, por vezes, compatíveis com a literatura científica, principalmente no que diz respeito à ecologia trófica e comportamento dos polvos.

Clinical profile of hepatitis B virus chronic infection in patients of Brazilian liver reference units.

PURPOSE: To assess data about chronic forms of hepatitis B virus (HBV) infection in Brazilian reference units, the Brazilian Society of Hepatology (SBH) performed a survey, with its associates spread throughout the country. METHODS: SBH members were contacted by electronic mail. They were asked for data from their liver units regarding chronically infected HBV patients between January 2005 and September 2007. All subjects with HBV surface antigenemia lasting more than 6 months were eligible. Patients who died after January 2005 were also included. RESULTS: Data from 24 units of 17 cities (12 Brazilian states) were obtained. These corresponded to 3,913 patients. Mean age was 39 years, ranging from 1 to 84 years. The northern region had the lowest mean age (35 years) and the southern region the highest (43 years). Most of the sampled people were white; 1,448 of 3,614 patients had chronic hepatitis B. Most of them were HBeAg negative (1.4:1). There were 1,695 (46.9%) inactive carriers of 3,614 HBV-infected patients and other 69 (1.9%) were considered as having immune-tolerant status. Hepatitis D coinfection was common among the Amazonian sample (n = 369). CONCLUSIONS: This large sample study shows important tendencies of chronic hepatitis B infection in Brazilian reference units, such as HBeAg-negative chronic hepatitis B cases overwhelming wild-type strains infected cases. Besides, hepatitis D occurs only among the Amazonian patients.

Prevalence of hepatitis B virus and risk factors in Brazilian non-injecting drug users.

Non-injecting drug users are at high-risk for acquiring hepatitis B virus (HBV), although the factors contributing to this increased risk are not known. In the present study, the overall and occult HBV infection prevalence rates were determined in a large population of non-injecting drug users in the Central-West region of Brazil. HBV genotypes and predictors of infection were also identified. A total of 852 individuals in 34 drug treatment centers were interviewed, and their serum samples were tested for the presence of HBV markers by ELISA. HBsAg and anti-HBc-positive samples were tested for HBV DNA by PCR. Samples with HBV DNA were genotyped by restriction fragment length polymorphism (RFLP). The overall prevalence of HBV infection was 14% (95% CI: 11.7-16.5). A multivariate analysis of risk factors showed that age >30 years, non-white race/ethnicity, duration of drug use >10 years, lifetime number of sexual partners >10, non-use of condoms, and HCV and HIV status were associated significantly with HBV infection. Of the 9 (1%) HBsAg-reactive samples, HBV DNA was present in 2/2 of HBeAg-positive and in 5/7 anti-HBe-positive samples. An occult HBV infection rate of 2.7% (3/110) was found among anti-HBc-positive individuals. All HBV DNA-positive samples were genotyped: seven were genotype A, two were genotype D, and one was genotype F. Finally, few individuals (8%) had serological evidence of a previous HBV vaccination. These findings indicate that preventive interventions are needed for both sexual and drug-related high-risk behavior. Additionally, non-injecting drug users should be targeted for HBV vaccination.

Hepatitis B virus genotypes and resistance mutations in patients under long term lamivudine therapy: characterization of genotype G in Brazil.

BACKGROUND: Lamivudine is an oral nucleoside analogue widely used for the treatment of chronic hepatitis B. The main limitation of lamivudine use is the selection of resistant mutations that increases with time of utilization. Hepatitis B virus (HBV) isolates have been classified into eight genotypes (A to H) with distinct geographical distributions. HBV genotypes may also influence pathogenic properties and therapeutic features. Here, we analyzed the HBV genotype distribution and the nature and frequency of lamivudine resistant mutations among 36 patients submitted to lamivudine treatment for 12 to 84 months. RESULTS: Half of the patients were homosexual men. Only 4/36 (11%) patients were HBV DNA negative. As expected for a Brazilian group, genotypes A (24/32 positive individuals, 75%), D (3/32, 9.3%) and F (1/32, 3%) were present. One sample was from genotype C, which is a genotype rarely found in Brazil. Three samples were from genotype G, which had not been previously detected in Brazil. Lamivudine resistance mutations were identified in 20/32 (62%) HBV DNA positive samples. Mean HBV loads of patients with and without lamivudine resistance mutations were not very different (2.7 x 107 and 6.9 x 107 copies/mL, respectively). Fifteen patients showed the L180M/M204V lamivudine resistant double mutation. The triple mutant rt173V/180M/204V, which acts as a vaccine escape mutant, was found in two individuals. The three isolates of genotype G were entirely sequenced. All three showed the double mutation L180M/M204V and displayed a large genetic divergence when compared with other full-length genotype G isolates. CONCLUSION: A high (55%) proportion of patients submitted to long term lamivudine therapy displayed resistant mutations, with elevated viral load. The potential of transmission of such HBV mutants should be monitored. The identification of genotypes C and G, rarely detected in South America, seems to indicate a genotype distribution different to that observed in non treated patients. Disparities in routes of transmission (genotype G seems to be linked to homosexual behavior) and in pathogenic properties (genotype C is very aggressive) among HBV genotypes may explain the presence of rare genotypes in the present work.

Hepatitis B virus genotypes circulating in Brazil: molecular characterization of genotype F isolates.

BACKGROUND: Hepatitis B virus (HBV) isolates have been classified in eight genotypes, A to H, which exhibit distinct geographical distributions. Genotypes A, D and F are predominant in Brazil, a country formed by a miscegenated population, where the proportion of individuals from Caucasian, Amerindian and African origins varies by region. Genotype F, which is the most divergent, is considered indigenous to the Americas. A systematic molecular characterization of HBV isolates from different parts of the world would be invaluable in establishing HBV evolutionary origins and dispersion patterns. A large-scale study is needed to map the region-by-region distribution of the HBV genotypes in Brazil. RESULTS: Genotyping by PCR-RFLP of 303 HBV isolates from HBsAg-positive blood donors showed that at least two of the three genotypes, A, D, and F, co-circulate in each of the five geographic regions of Brazil. No other genotypes were identified. Overall, genotype A was most prevalent (48.5%), and most of these isolates were classified as subgenotype A1 (138/153; 90.2%). Genotype D was the most common genotype in the South (84.2%) and Central (47.6%) regions. The prevalence of genotype F was low (13%) countrywide. Nucleotide sequencing of the S gene and a phylogenetic analysis of 32 HBV genotype F isolates showed that a great majority (28/32; 87.5%) belonged to subgenotype F2, cluster II. The deduced serotype of 31 of 32 F isolates was adw4. The remaining isolate showed a leucine-to-isoleucine substitution at position 127. CONCLUSION: The presence of genotypes A, D and F, and the absence of other genotypes in a large cohort of HBV infected individuals may reflect the ethnic origins of the Brazilian population. The high prevalence of isolates from subgenotype A1 (of African origin) indicates that the African influx during the colonial slavery period had a major impact on the circulation of HBV genotype A currently found in Brazil. Although most genotype F isolates belonged to cluster II, the presence of some isolates belonging to clusters I (subgroup Ib) and IV suggests the existence of two or more founder viral populations of genotype F in Brazil.

Infection by the hepatitis C virus in chronic renal failure patients undergoing hemodialysis in Mato Grosso state, central Brazil: a cohort study.

BACKGROUND: Hepatitis C virus (HCV) is a significant problem for patients undergoing hemodialysis therapy. This situation has never been studied in Mato Grosso state, central Brazil. This study was conducted aiming to estimate the prevalence of the anti-HCV and the incidence of seroconversion in the main metropolitan region of the state. METHODS: 433 patients from the six hemodialysis units were interviewed and anti-HCV was tested by a third-generation enzyme immunoassay. An open cohort of patients who tested negative for anti-HCV at the entry of the study was created and seroconversions was assessed monthly. The staff responsible for the units were interviewed to assess whether the infection control measures were being followed. Logistic and Cox regression analysis were performed in order to assess risk factor to HCV. RESULTS: The entry on the study took place between January 2002 and June 2005. 73 out of 433 (16.9%, CI 95%: 13.3-20.8) was found to be anti-HCV reactive. The multivariate analysis indicated as risk factors associated to anti-HCV the duration of the hemodialysis treatment, the number of transfusions received, and the unit of treatment. An open cohort of 360 patients who tested negative for anti-HCV was created, with a following average of 24 (+/- 15) months. Forty seroconversions were recorded corresponding to an incidence density of 4.6/1000 patient-months, ranges 0 to 30 among the units. Cox regression indicated the time of hemodialysis (RR = 2.2; CI 95%: 1.1-4.6; p < 0.05) and the unit where treatment was performed (RR = 42.4; CI 95%: 9.9-180.5; p < 0.05) as risk factors for seroconversion. The three units with highest anti-HCV prevalence and incidence were identified as those that more frequently failed to apply control measures. CONCLUSION: The study demonstrated high prevalence and incidence of anti-HCV in some of the hemodialysis units. Time on hemodialysis therapy was an independent factor associated to HCV. Blood transfusion was associated with anti-HCV in initial survey but was not important in incident cases. Failure of applying control measures was more evident in units with the highest HCV prevalence and incidence. The results suggest that nosocomial transmission was the main spread factor of HCV in the studied population.

Distribution of hepatitis C virus genotypes among blood donors from mid-west region of Brazil.

In order to investigate the hepatitis C virus (HCV) genotypes in mid-west region of Brazil, 250 anti-HCV positive blood donors were studied. Among them, the anti-HCV serological status was confirmed in 205 (82%). HCV RNA was detected in 165 samples, which were genotyped. HCV types 1, 2 and 3 were found in 67.9%, 3% and 29.1% of the donors, respectively. In Goiás state, subtype 1a (50%) was the most prevalent, followed by subtypes 3a (30.9%) and 1b (16.7%). In Mato Grosso state, subtype 1a was also predominant (41%), followed by subtypes 1b (29.5%) and 3a (25%). In Mato Grosso do Sul state, subtypes 1a and 1b were detected equally (36.8%), followed by 3a (21.1%). Subtype 2b was rare (2.4%, 4.5% and 5.3%, respectively). In Distrito Federal, subtype 3a (39%) was more frequent than 1a (31.7%) and the remaining (29.3%) belonged to subtype 1b.

Distribution of hepatitis C virus genotypes among blood donors from mid-west region of Brazil

Com objetivo de determinar os genótipos do vírus da hepatite C (HCV) circulantes na Região Centro-Oeste do Brasil, 250 doadores de sangue anti-HCV positivos foram estudados. Dentre eles, a positividade para anti-HCV foi confirmada em 205 (82%). O RNA-HCV foi detectado em 165 amostras, as quais foram genotipadas. Os tipos 1, 2 e 3 do HCV foram encontrados em 67,9%, 3% e 29,1% dos doadores, respectivamente. No Estado de Goiás, o subtipo 1a (50%) foi o mais prevalente, seguido pelos subtipos 3a (30,9%) e 1b (16,7%). No Estado de Mato Grosso, o subtipo 1a (41%) foi também predominante, seguido pelos subtipos 1b (29,5%) e 3a (25%). No Estado de Mato Grosso do Sul, os subtipos 1a e 1b foram igualmente detectados (36,8%), seguidos por 3a (21,1%). O subtipo 2b foi raro (2,4%, 4,5% e 5,3%, respectivamente). No Distrito Federal, o subtipo 3a (39%) foi mais freqüente que 1a (31,7%), sendo o restante (29,3%) identificado como subtipo 1b.

Prevalência e fatores associados a marcadores do vírus da hepatite B em população rural do Brasil central / Prevalence of and factors associated with hepatitis B virus markers in a rural population in central Brazil

Objective. To carry out a survey of hepatitis B virus seroepidemiology in a municipality in central Brazil, on the border of two large ecosystems, the cerrado (savanna) and the Amazon River basin. Methods. The municipality studied, Nova Mutum, is located in the north central portion of the Brazilian state of Mato Grosso. The study sample of 754 individuals included persons from families, selected at random, who were living in the municipality's urban center as well as all the individuals living in a nearby rural village. Ages ranged from 2 to 79 years. All eligible individuals were interviewed. Blood was collected and used to assess hepatitis B virus markers by enzyme-linked immunosorbent assay. Results. Hepatitis B virus infection was found in 232 individuals, or 31% of them; 19 of them (3%) were HBsAg-positive. Of the 754 persons, 149 of them (20%) who reported having been vaccinated against hepatitis B and who presented anti-HBs positivity were classified as vaccine responders. With the multivariate analysis, the variables found to be associated with exposure to hepatitis B virus were having begun sexual relations, having been vaccinated against yellow fever with a needle-free jet injection gun (for the age group < 20 years), and being an immigrant from southern Brazil (> 20 years). Vaccine coverage was low among individuals older than 10 years. The largest share of susceptible individuals (74%) were found in the age group of 11 to 20 years. Conclusions. Our data suggest that hepatitis B virus vaccine coverage in Brazil should be extended to include teenagers in populations that have a low to moderate hepatitis B virus prevalence. It is likely that our results can be extrapolated to other areas of Latin America with a similar epidemiological pattern

Objetivo. Realizar um inquérito soro-epidemiológico sobre infecção pelo vírus da hepatite B em um município do médio-norte do Estado de Mato Grosso, que corresponde à região limítrofe entre o cerrado e a bacia amazônica. Métodos. A amostra incluiu famílias escolhidas aleatoriamente na sede do município, assim como toda a população de uma comunidade rural, totalizando 754 indivíduos. A idade variou de 2 a 79 anos. Os participantes foram entrevistados e tiveram amostras de sangue colhidas para pesquisa de marcadores do vírus da hepatite B por método imunoenzimático. Resultados. A infecção pelo vírus da hepatite B foi constatada em 31% da amostra, sendo 3% positivos para o HBsAg. Os 149 (20%) com história de vacinação e anti-HB positivo isoladamente foram considerados respondedores à vacina. As variáveis associadas à exposição ao vírus da hepatite B por análise multivariada foram: já ter iniciado atividade sexual, ter sido vacinado com pistola pressurizada contra febre amarela (entre aqueles com menos de 20 anos) e ser migrante oriundo do Sul do Brasil (indivíduos com mais de 20 anos). A cobertura vacinal foi baixa entre indivíduos com mais de 10 anos de idade. O maior número de suscetíveis (74%) foi encontrado na faixa dos 11 aos 20 anos. Conclusões. No Brasil, a vacinação contra a hepatite B deve ser estendida quanto antes aos adolescentes nas regiões de baixa a moderada prevalência. É provável que os dados obtidos no presente estudo possam ser extrapolados para outras regiões da América Latina com padrão epidemiológico semelhante

Cintilografia dinâmica do esôfago em disfagia näo orgânica / Esophageal dynamic scintigraphy in nonorganic dysphagia

Trinta e seis pacientes com queixa de disfagia foram submetidos à cintilografia dinâmica do esôfago (CDE). Em todos, esofagografia convencional e/ou endoscopia digestiva alta havia excluído lesäo orgânica obstrutiva, näo sendo incluídos pacientes com diagnóstico radiológico de acalásia. O exame mostrou-se anormal em 64% dos pacientes, havendo franco predomínio do "padräo incoordenado" (70% dos anormais). Concluímos que a CDE mostrou boa sensibilidade para diagnóstico de alteraçöes motoras esofágicas em pacientes com disfagia näo orgânica em complemento ao estudo radiológico, e, devido à sua ótima aceitaçäo e simplicidade de realizaçäo, recomendamo-la como screening test nesse grupo de pacientes

Cintilografia dinâmica do esôfago em dor toráxica näo coronariana / Esophageal dynamic scintigraphy in noncoronarian chest pain

Vinte e sete pacientes com dor torácica näo coronariana (DTNC) foram submetidos a cintilografia dinâmica do esôfago como parte de protocolo de pesquisa de alteraçöes esofagianas e seus resultados foram comparados com os obtidos pelos estudos radiológicos - radiologia convencional - (RC) e radioscopia com päo baritado (RPB). A cintilografia dinâmica mostrou-se alterada em 63% dos pacientes, havendo predominância do "padräo incoordenado", enquanto que a RC revelou alteraçöes motoras em 18,5% dos pacientes e a RPB foi anormal em 33%. Concluímos que a cintilografia dinâmica do esôfago mostrou boa sensibilidade na investigaçäo de distúrbios da motilidade esofágica em pacientes com DTNC e, devido à sua ótima aceitaçäo e simplicidade de realizaçäo, recomendamo-la como screening test na investigaçäo do esôfago em DTNC