The IL6-174G/C Polymorphism Associated with High Levels of IL-6 Contributes to HCV Infection, but Is Not Related to HBV Infection, in the Amazon Region of Brazil.

The dysregulation of cytokine production can lead to an inefficient immune response, promoting viral persistence that induces the progression of chronic viral hepatitis. The study investigated the association of the IL6-174G/C polymorphism with changes in cytokine levels and its influence on the persistence and progression of chronic hepatitis caused by HBV and HCV in 72 patients with chronic hepatitis B (HBV), 100 patients with hepatitis C (HCV), and a control group of 300 individuals. The genotyping of the IL6-174G/C polymorphism was performed by real-time PCR, and cytokine levels were measured by enzyme-linked immunosorbent assay (ELISA). HCV patients with the wild-type genotype (GG) had a higher viral load (p = 0.0230). The plasma levels of IL-6 were higher among patients infected with HBV and HCV than among the control group (p < 0.0001). Patients with HCV were associated with increased inflammatory activity (A2−A3; p < 0.0001). In hepatitis C, carriers of the GG genotype had higher levels of IL-6 (p = 0.0286), which were associated with A2−A3 inflammatory activity (p = 0.0097). Patients with A2−A3 inflammatory activity and GG genotype had higher levels of IL-6 than those with the GC/CC genotype (p = 0.0127). In conclusion, the wild-type genotype for the IL6-174G/C polymorphism was associated with high levels of IL-6 and HCV viral load and inflammatory activity, suggesting that this genotype may be a contributing factor to virus-induced chronic infection.

The Genetic Profile and Serum Level of IL-8 Are Associated with Chronic Hepatitis B and C Virus Infection.

The present study evaluated the IL8-251 A/T polymorphism in samples from 74 patients with chronic hepatitis B (HBV), 100 patients with chronic hepatitis C (HCV), and 300 healthy donors (CG). The correlations of this polymorphism with plasma IL-8 and disease stage were calculated. Polymorphisms were identified by real-time PCR. IL-8 was measured by enzyme-linked immunosorbent assay. The IL8-251 A/T genotype was not associated with susceptibility to infection by HBV or HCV. The wild-type allele (A) was associated with higher levels of inflammation (p = 0.0464) and fibrosis scores (p = 0.0016) in the HBV group, representing an increased risk for increased inflammatory activity (OR = 1.84; p = 0.0464) and for high fibrosis scores (OR = 2.63; p = 0.0016). Viral load was higher in HBV patients with polymorphic genotypes (TA and TT) at the IL8-251 A/T polymorphism than in those with the wild-type genotype (p = 0.0272 and p = 0.0464, respectively). Plasma IL-8 was higher among patients infected with HBV or HCV than in the control group (p = 0.0445 and p = 0.0001, respectively). The polymorphic genotype was associated with lower IL-8 than the wild-type genotype in the HBV group (p = 0.0239) and the HCV group (p = 0.0372). The wild-type genotype for IL8-251 A/T and high IL-8 were associated with a worse prognosis for infections; therefore, they may contribute to viral persistence and the development of more severe forms of chronic viral liver diseases.

Intrahepatic TLR3 and IFNL3 Expressions Are Associated with Stages of Fibrosis in Chronic Hepatitis C.

An inefficient immune response against the hepatitis C virus (HCV), combined with viral evasion mechanisms, is responsible for the chronicity of infection. The need to evaluate the innate mechanisms of the immune response, such as TLR3 and IFN-λ3, and their relationship with the virus-host interaction is important for understanding the pathogenesis of chronic hepatitis C. The present study aimed to investigate the gene expressions of TRL3 and IFNL3 in liver tissue, seeking to evaluate whether these could be potential biomarkers of HCV infection. A total of 23 liver biopsy samples were collected from patients with chronic HCV, and 8 biopsies were collected from healthy control patients. RNA extraction, reverse transcription and qPCR were performed to quantify the relative gene expressions of TLR3 and IFNL3. Data on the viral load; AST, ALT, GGT and AFP levels; and the viral genotype were collected from the patients' medical records. The intrahepatic expression of TLR3 (p = 0.0326) was higher in chronic HCV carriers than in the control group, and the expression of IFNL3 (p = 0.0037) was lower in chronic HCV carriers than in the healthy control group. The expression levels of TLR3 (p = 0.0030) and IFNL3 (p = 0.0036) were higher in the early stages of fibrosis and of necroinflammatory activity in the liver; in contrast, TLR3 and IFNL3 expressions were lower in the more advanced stages of fibrosis and inflammation. There was no correlation between the gene expression and the serum viral load. Regarding the initial METAVIR scale scores, liver transaminase levels were lower in patients with advanced fibrosis when correlated with TLR3 and IFNL3 gene expressions. The results suggest that in the early stages of the development of hepatic fibrosis, TLR3 and IFN-λ3 play important roles in the antiviral response and in the modulation of the tolerogenic liver environment because there is a decrease in the intrahepatic expressions of TLR3 and IFNL3 in the advanced stages of fibrosis, probably due to viral evasion mechanisms.

Hepatitis C virus genotypes and associated risk factors in the state of Pará, Northern Brazil.

BACKGROUND: Despite the emergence of more effective therapies, hepatitis C virus (HCV) infection remains a serious public health problem at the global level. Currently, this virus is classified into seven genotypes and 67 subgenotypes, which in turn are distributed heterogeneously in Brazil and worldwide. Studies have shown that this genetic divergence results in differences in the progression of chronic disease associated with HCV infection and its treatment. OBJECTIVE: The aim of this study was to report the frequency of HCV genotypes in the state of Pará, Northern Brazil, and to assess the association between genotype and different clinical and laboratory characteristics, as well as risk factors for infection. METHOD: Data from 85 medical records of untreated patients who had chronic hepatitis C infection were analyzed; the patients were evaluated at two hospitals in Belem, Pará, Brazil. RESULTS: Circulation of genotypes 1 and 3 was detected, with a higher prevalence of genotype 1 (75.3%) than genotype 3 (24.7%). In addition, there was a predominance of subgenotype 1b (60.34%) compared to 1a (20.69%) and 3a (18.97%). Reuse of needles and/or glass syringes was significantly associated with infection by HCV genotype 1 than genotype 3; however, the small number of patients infected with genotype 3 may have biased the results. No associations between genotype and the evaluated clinical and laboratory characteristics were observed. CONCLUSION: This study reinforces the differences in the distribution of HCV genotypes in Brazil and showed no association between HCV genotype and progression of chronic hepatitis C in the studied group.

Association of serum levels of C-reactive protein with CRP-717 T/C polymorphism and viremia in HCV and HBV carriers.

INTRODUCTION: The present study investigated the association of the rs2794521 polymorphism in the CRP gene in individuals with chronic hepatitis B and C, correlating it with markers of hepatic inflammation, fibrosis scores, viral load, and plasma protein levels. METHODS: The study analyzed 185 blood samples obtained from patients with hepatitis B (n=74) and hepatitis C (n=111) and 300 samples from healthy donors. Genotyping was performed by real-time polymerase chain reaction, and protein levels were quantified using the automated immunoturbidimetric method. RESULTS: The TT genotype was the most frequent in all studied groups and was associated with higher plasma levels of the protein but not with the progression of liver disease. Low levels of C-reactive protein were associated with increased viremia and scores indicative of severe fibrosis and cirrhosis. CONCLUSIONS: The present results demonstrated a close relationship between the ability of the virus to replicate and cause liver damage and low serum concentrations of C-reactive protein. Future research may determine if these results can be interpreted as a possible form of escape for the virus by decreasing its action as an opsonin and decreasing phagocytosis, which are functions of C-reactive protein in the immune response.

Association of serum levels of C-reactive protein with CRP-717 T/C polymorphism and viremia in HCV and HBV carriers

Abstract INTRODUCTION: The present study investigated the association of the rs2794521 polymorphism in the CRP gene in individuals with chronic hepatitis B and C, correlating it with markers of hepatic inflammation, fibrosis scores, viral load, and plasma protein levels. METHODS: The study analyzed 185 blood samples obtained from patients with hepatitis B (n=74) and hepatitis C (n=111) and 300 samples from healthy donors. Genotyping was performed by real-time polymerase chain reaction, and protein levels were quantified using the automated immunoturbidimetric method. RESULTS: The TT genotype was the most frequent in all studied groups and was associated with higher plasma levels of the protein but not with the progression of liver disease. Low levels of C-reactive protein were associated with increased viremia and scores indicative of severe fibrosis and cirrhosis. CONCLUSIONS: The present results demonstrated a close relationship between the ability of the virus to replicate and cause liver damage and low serum concentrations of C-reactive protein. Future research may determine if these results can be interpreted as a possible form of escape for the virus by decreasing its action as an opsonin and decreasing phagocytosis, which are functions of C-reactive protein in the immune response.

HBV Viral Load and Liver Enzyme Levels May Be Associated with the Wild MBL2 AA Genotype.

The present study investigated the frequencies of rs1800450 (MBL ⁎B, G>A), rs1800451 (MBL ⁎C, G>A), and rs5030737 (MBL ⁎D, C>T) polymorphisms in exon 1 of the MBL2 gene among patients with chronic viral hepatitis. Blood samples from patients infected with hepatitis B virus (HBV; n = 65), hepatitis C virus (HCV; n = 92), and a noninfected control group (n = 300) were investigated. The presence of polymorphisms was detected using a real-time polymerase chain reaction to correlate with liver disease pathogenesis and fibrosis staging according to the Metavir classification. The genotypic and allelic frequencies showed no significant differences between the groups, but patients with active HBV and the wild AA genotype presented a positive correlation between increased transaminase and HBV DNA levels and the presence of mild to moderate fibrosis. Patients with HCV and the wild AA genotype presented mild inflammation and higher HCV RNA levels, although the same association was not observed for the fibrosis scores. The results suggest that the mutations in exon 1 of the MBL2 gene do not contribute directly to the clinical and laboratory features of HCV and HBV infections, but further studies should be performed to confirm whether the wild AA genotype has indirect effect on disease progression.

Intrahepatic mRNA Expression of FAS, FASL, and FOXP3 Genes Is Associated with the Pathophysiology of Chronic HCV Infection.

UNLABELLED: This study aimed to evaluate the relative mRNA expression of Fas receptor (FAS), Fas ligand (FASL), and forkhead box protein 3 (FOXP3) in liver biopsy specimens obtained from patients with viral and non-viral chronic hepatitis and correlate their expression with the fibrosis stage. A total of 51 liver biopsy specimens obtained from HBV (n = 6), HCV (n = 28), and non-viral hepatic disease (NVHD) (n = 9) patients and from individuals with normal liver histology (n = 8) (control-CT) were analyzed. Quantifications of the target genes were assessed using qPCR, and liver biopsies according to the METAVIR classification. The mRNA expression levels of FAS and FASL were lower in the CT group compared to the groups of patients. The increase in the mRNA expression of FAS and FASL was correlated with higher levels of inflammation and disease progression, followed by a decline in tissues with cirrhosis, and it was also associated with increased levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Higher mRNA expression of FOXP3 was observed in the HCV and NVHD groups, with the peak observed among patients with cirrhosis. The increased FOXP3 mRNA expression was positively correlated with increased FAS and FASL mRNA expression and the AST and ALT levels in all patients. CONCLUSIONS: These results suggest that regardless of the cause, the course of chronic liver disease may be modulated by the analyzed genes and correlated with an increase in regulatory T cells during the liver damage followed by hepatocyte destruction by Fas/FasL system and subsequent non specific lymphocytic infiltrate accumulation.

Absence of correlation between IL-28B gene polymorphisms and the clinical presentation of chronic hepatitis B in an Amazon Brazilian population.

OBJECTIVE: The present study investigated the prevalence of the IL-28B polymorphisms rs12979860 and rs8099917 in chronic hepatitis B patients from a case study in Eastern Amazonia. METHODS: In total, 65 chronically infected HBV patients and 97 healthy subjects who were anti-HBc and anti-HBs positive (control group) were evaluated between May 2011 and December 2012. The groups of patients were designated as inactive carriers, chronic hepatitis without cirrhosis, and chronic hepatitis with cirrhosis based on clinical, pathological, biochemical, hematological, and virological variables. The patients were genotyped using quantitative real-time PCR. RESULTS: The frequencies of the rs12979860 polymorphism were similar between the infected group (32.3% CC, 41.5% CT, and 26.2 TT) and the control population (35% CC, 47.4% CT, and 17.6% TT), and the frequencies of the rs8099917 polymorphism (7.7% GG, 35.4% GT, and 56.9% TT versus 7.2% GG, 35.1% GT, and 57.7% TT) were also similar in both groups. The associations between the rs12979860 and rs8099917 polymorphisms and the clinical manifestations were not statistically significant. CONCLUSION: In conclusion, these polymorphisms had a similar distribution between infected and control groups, indicating that they were not associated with susceptibility and the clinical evolution of hepatitis B in the examined population.

Estudo clínico-epidemiológico de pacientes com lupus eritematoso sistêmico, em uma população da Amazônia Oriental / Clinical and epidemiological profile of patients with systemic lupus erythematosus, in a population of eastern Amazonia

Objetivo: caracterizar clínica e epidemiologicamente os pacientes portadores de lupus eritematoso sistêmico (LES), atendidos em um hospital universitário, na cidade de Belém, Pará. Método: realizado estudo transversal dos pacientes portadores de LES internados no Hospital Universitário João de Barros Barreto, período de 1999 a 2006, incluindo indivíduos com idade superior a 12 anos e com 4 ou mais critérios propostos pelo Colégio Americano de Reumatologia, coletando os dados pela análise dos prontuários. Resultados: a maioria dos pacientes era do sexo feminino (87,5%), pardos (59,7%), solteiros (65,3%), faixa etária de 20 a 30 anos, procedentes da região metropolitana de Belém. Os critérios para LES mais freqüentes foram: FAN positivo (75%), distúrbio hematológico (66,7%) e distúrbio renal (62,5%). A evolução a óbito ocorreu em 15,3%. Conclusão: na população estudada, os casos de LES eram característicos de mulheres jovens, pardas, procedentes da região metropolitana, sendo a positividade do FAN, a presença de distúrbios hematológicos e renais, os critérios mais freqüentes, com mortalidade de 15,3 %.

Objective: to characterize the epidemiological and clinical patients with SLE treated at a university hospital in the city of Belem, Pará. Method: a retrospective study was conducted of patients with SLE interned at the University Hospital João de Barros Barreto, from 1999 to 2006, including individuals aged 12 years, with 4 or more criteria proposed by the American College of Rheumatology, making data collection through the analysis of medical records. Results: Most patients were female (87.5%), brown (59.7%), single (65.3%), aged 20 to 30 years, from the metropolitan region of Belém Criteria LES for most frequent were: ANA positive (75%), hematological disorders (66.7%) and renal disorder (62.5%). The evolution to death occurred in 15.3%. Conclusion: the population studied, cases of lupus were characteristic of young women, brown, from the metropolitan region, and the positivity of ANA, the presence of haematological and renal disorders, the most common criterias, with a mortality of 15.3%.

Complicações clínicas em pacientes portadores de lupus eritematoso sistêmico / Clinical complications in patients with systemic lupus erythematosus

Objetivo: descrever as principais complicações clínicas e causas de mortalidade nos pacientes lúpicos, internados no Hospital Universitário Barros Barreto. Método: estudo transversal, de 240 prontuários de pacientes portadores de lupus sistêmico (LES), internados em hospital universitário entre 1997 e 2006. Incluíram-se pacientes com idade superior a 12 anos e que apresentassem quatro ou mais critérios para LES propostos pelo Colégio Americano de Reumatologia. Resultados: dentre os 240 prontuários analisados, 72 foram incluídos no estudo. O sexo feminino foi o prevalente com 87,5%* dos casos (*p < 0,01); a faixa etária mais acometida compreendeu pacientes entre 12 e 30 anos (59,7%); as maiores complicações foram a síndrome infecciosa (76,4%), seguida da insuficiência renal (33,8%). A infecção se assestou sobretudo nos sítios pulmonar (45,4%), urinário (29,9%) e cutâneo (17,5%). Onze pacientes (15,3%) evoluíram ao óbito, tendo como causa primária: insuficiência respiratória aguda (27,3%), choque séptico (18,2%) e falência de múltiplos órgãos e sistemas (18,2%). Conclusão: na população estudada, o LES foi mais incidente em mulheres jovens, suas maiores complicações clínicas foram as infecções, em especial, pulmonares e o óbito ocorreu, com maior freqüência, por insuficiência respiratória aguda, choque séptico e insuficiência de múltiplos órgão e sistemas.

Objective: to describe the main clinical complications and causes of death in lupus patients, boarding at the University Hospital Barros Barreto. Method: cross-sectional study from medical records of 240 patients with systemic lupus erythematosus (SLE), in an university hospital between 1997 and 2006. It included patients aged over 12 years and to provide four or more criteria for SLE proposed by the American College of Rheumatology. Results: of the 240 charts reviewed, 72 were included in the study. Women were the most prevalent with 87.5% of cases * (* p <0.01), the most affected age group comprised patients between 12 and 30 years (59.7%), the major complications were infectious syndrome ( 76.4%), followed by renal (33.8%).The infection was laid above the pulmonary sites (45.4%), urinary (29.9%) and skin (17.5%). Eleven patients (15.3%) progressed to death, with the primary cause respiratory failure(27.3%), septic shock (18.2%) and failure of multiple organs and systems (18.2%). Conclusion: the study population, SLE was more common in young women, their more clinical complications were infections, especially lung and the death occurred more frequently for acute respiratory failure, septic shock and multiple organ failure and systems.

Soroprevalência de anticorpos anti-HAV total em pacientes com hepatite crônica C em um hospital de referência da Amazônia Brasileira / Seropevalence of total anti HAV antibodies among patients with chronic hepatitis C at a reference hospital in Brazilian Amazonia

Objetivo: determinar a soroprevalência de anticorpos anti-HAV total em pacientes com hepatite crônica C,correlacionando-a aos aspectos clínico-epidemiológicos e à necessidade de vacina contra a hepatite A. Método.: no período de janeiro a julho de 2004, selecionaram-se pacientes portadores de anti-HCV e RNA-HCV positivos com diagnóstico de hepatite crônica, cirrose e carcinoma hepatocelular do Programa de Hepatopatias Crônicas da Fundação Santa Casa de Misericórdia do Pará para a realização de sorologia anti-HAV total. Resultados: testados 243 pacientes dos quais 177 (72,8%) eram do sexo masculino e 200 (84,4%) procediam de zona urbana. Deste total, 220 (90,5%) eram anti-HAV positivos. Comparando-se os grupos anti-HAV positivo e negativo, obteve-se média de idade de 46,9 anos (DP=13,86) e 22,2 anos (DP=12,67; p<0,0001), respectivamente. Dentre aqueles com mais de 35 anos, cinco (2,7%) eram anti-HAV negativos (p<0,0001). Não houve diferença quanto à distribuição por sexo nem quanto aos diagnósticos entre os dois grupos. Conclusão: foi alta a prevalência de anti-HAV total (90,5%) em pacientes cronicamente infectados pelo vírus da hepatite C, com menor média de idade no grupo anti-HAV negativo em relação ao positivo (22,2 versus 46,9), sugerindo que a vacinação contra a hepatite A na população estudada, deveria ser feita com base na triagem sorológica prévia, principalmente após os 35 anos de idade.

Background: there are evidences that hepatitis A virus (HAV) infection in patients with pre-existing liver disease (CLD) exhibits more serious outcomes, including fulminant hepatitis and the risk is greater in those with chronic hepatitis C (CHC). Aim: to access seroprevalence of total anti-HAV antibodies in patients with CHC correlating it to clinical-epidemiological features and need of vaccination against HAV Methods: From January to July 2004, anti-HCV (Elisa 3th generation) and HCV-RNA (Ampticor Roche) positive carriers who had chronic hepatitis, liver cirrhosis and hepatocellular carcinoma were selected to be tested to total anti-HAV (Elisa) from the CLD Program of Santa Casa de Misericórdia do Pará Hospital. Results: Two hundred forty-three patients were tested being 177 (72.8%) male and 200 (84.4%) from urban zone. At all, 220 (90.5%) were" anti-HAV positives. The mean age was 46.9 (SD=13.8) and 22.2 years (SD=12.7) to positive and negative anti-HAV groups, each one (p<0,0001). Among those patients older than 35 years, 5 (2.7%) were HAV negative (p<0.0001). There was no difference statistically significant between sexes and diagnostics. Conclusion: the total anti-HAV prevalence was high (90.5%) among patients chronically infected by hepatitis C virus and the anti-HAV negative group showed a lower mean age than positive one (22.2 vs. 46.9). These data suggest that hepatitis A vaccination in Brazilian Amazonia should be considered with a previous serological screening mainly in patients older than 35 years.

Carcinoma hepatocelular em portador do vírus inativo da hepatite B¹ / Hepatocellular carcinoma in carrier of hepatitis B inactive virus

Objetivo: relatar o caso clínico de uma paciente, cronicamente, infectada pelo VHB, residente na região amazônica, acometida de CHC e sua evolução após tratamento cirúrgico. Relato de Caso: paciente feminina, 46 anos, procedente de Medicilândia, interior do Pará, atendida com queixa de tumoração, não dolorosa, em hipocôndrio direito, confirmada pelo exame físico que demonstrava aumento do bolo hepático direito, há 12 cm do RCD, endurecida e irregular. As alterações laboratoriais se restringiram à anemia normocítica, normocrômicae alfafetoproteína (AFP) acima de 480 ng/dL. A sorologia das hepatites virais foi positiva para o HBsAg e anti-HBc total, além de HBeAg, anti-HD e anti-HCV negativos e DNA-VHB por PCR abaixo de 1.000 cópias/mL. A avaliação tomográfica evidenciou massa tumoral única, ocupando extensa área do lobo hepático direito (LHD). Decidido pelo tratamento cirúrgico, sendo procedida a ressecção dos segmentos V, VI e parte do VII hepáticos com margem de segurança de 5 cm, associada à colecistectomia. A histopatologia da peça cirúrgica diagnosticou carcinoma hepatocelular medindo 13,0 x 12,0 x 11,0 cm e fígado peri-neoplásico não cirrótico. A paciente recebeu alta hospitalar após 12 dias de internação, em bom estado geral. Considerações finais: os pacientes portadores inativos do VHB apresentam alto risco de desenvolvimento de CHC em relação à população geral, sendo necessário sua triagem e o seu reconhecimento precoce possibilita tratamento curativo

[Prevalence of hepatitis B virus genotypes and the occurrence of precore mutation A-1896 and to correlate them with the clinical presentation of chronic hepatitis, in a population group of the Eastern Amazon region]. / Prevalência de genótipos e de mutantes pré-core A-1896 do vírus da hepatite B e suas implicações na hepatite crônica, em uma população da Amazônia oriental.

Hepatitis B virus (HBV) infection presents itself with a variety of clinical manifestations. The present work aims to describe the prevalence of HBV genotypes and the occurrence of precore mutation A-1896 in a population group of the Eastern Amazon region of Brazil and to correlate them with the clinical presentation of chronic HBV infection. 51 HBsAg carriers (HBV-DNA positive) were selected and divided into three groups: A (14 asymptomatic subjects), B (20 HBeAg positive symptomatic patients) and C (17 HBeAg negative symptomatic patients). Using an automa ed DNA sequencer ABI model 377 by sequencing for determined of genotypes and precore mutation. The results showed that the genotype A was the most commonly found (81.1%, 89.5% and 93.7% in groups A, B and C, respectively) and precore mutation A-1896 was described in 11.5% (3/26) of group A subjects. Genotype A of HBV was the most prevalent (89.1%) and low occurrence of precore mutation A-1896, both not associate with the worst outcome of the chronic infection of HBV.

[Hepatitis B and C virus infection and the hepatocellular carcinoma in the East Amazon, Brazil]. / Infecções pelos vírus das hepatites B e C e o carcinoma hepatocelular na Amazônia oriental.

In order to contribute to a better understanding of the possible role of hepatits B and C in the etiopathogenis of HCC in the East Amazon, there were studied 36 patients in Belém/PA. Serological hepatitis markers were evaluated and polymerase chain reaction assays were used to detect HBV-DNA and HCV-RNA. Alcohol abuse was observed in 33.3% and cirrhosis in 83.3%. In 88.9% of the sample, one or more hepatitis B markers were positive. Also, 8.3% those patients had anti-HCV simultaneously positive. The HBsAg serological test was positive in 58.3%; anti-HBc in 86%; anti-HBe in 85.7%; anti-HBe in 9.5%; IgM anti-HBc in 57.1%. The HBV DNA was found in 37.7% and in 65% of the HBsAg positive. The HCV RNA was detected in 8.5% and in 100% of the patients positive to anti-HCV. The AFP was above the normal value in 88.9% of patients, with levels up to 400ng/ml in 75% of them. In conclusion, hepatitis B virus infection seems to be important in the etiology of HCC and improving measures such immunization and screening in the risk population should be emphasyzed.

[The Liver Diseases Program of the Hospital Santa Casa de Misericórdia do Pará--infrastructure and clinical epidemiology in 10 years of attendance]. / Programa de Hepatopatias do Hospital da Fundação Santa Casa de Misericórdia do Pará--infra-estrutura e epidemiologia clinica em 10 anos de atendimento.

The Liver Diseases Program of the Hospital Santa Casa de Misericordia do Pará was create because of the need to attend patients with liver diseases of the Amazônia area, taking as priority to attend with quality, diagnosis of aetiologies, clinical following and specific treatment. This study aim to describe dates related to epidemiology, aetiologics agents and histopathologic analysis. One thousand sixty nine patients were evaluated through medical, laboratory, endoscopic, ultrasound or computerized tomography and histopathologic examination. Nine hundred thirty five (63.6%) patients within 1469 patients were diagnose as chronic liver disease. The average age was 50 year, 666 (71.2%) were male, and the most patients lived in Belem, State of Pará. The aetiologic agents most prevail were alcoholism (53.7%) and viral hepatitis (39.1%). Hepatic biopsy were done in 403 (43.1%) within the 935 patients and the results showed chronic hepatitis (34%) and chirrosis (34%). In summary the chronic liver disease in the amazon region is more prevail in male than female, the alcoholism is the principal aetiologie, and the most of these cases were diagnose in the severe phase.

[Polycystic echinococcosis in the Eastern Brazilian Amazon: an update]. / Equinococose policística na Amazônia oriental brasileira: atualização da casuística.

By means of epidemiological and clinical-laboratorial approaches was consolidated an update of polycystic echinococcosis in the Eastern Brazilian Amazon, period from 1962 to 2003, including unpublished cases and those already published. In that way, they were identified 40 cases of the disease in referred period, understanding cases coming from the States of Pará and Amapá, Brazil. The width of the ages went from 10 to 72 years and 47.5% belonged to the masculine sex. The liver was the attacked organ (82.5% of the cases). The Echinococcus vogeli (Rausch and Bernstein, 1972), comes as the main agent involved. Starting from the recognition of the importance and of the implications of the handling of the echinococcosis for the tropical area, it is believed that should happen an improvement of the diagnosis, appropriate treatment and of a better registration of the disease.

Prevalência de genótipos e de mutantes pré-core A-1896 do vírus da hepatite B e suas implicações na hepatite crônica, em uma população da Amazônia oriental / Prevalence of hepatitis B virus genotypes and the occurrence of precore mutation A-1896 and to correlate them with the clinical presentation of chronic hepatitis, in a population group of the eastern Amazon region

A infecção pelo virus da hepatite B apresenta amplo espectro de manifestações clínicas. Objetivando conhecer os genótipos do HBV mais prevalentes e determinar a ocorrência da mutação pré-core A-1896, em uma população da Amazônia oriental, correlacionando com o diagnóstico clínico, foram selecionados 51 pacientes portadores crônicos de HBsAg e HBV-DNA positivos e divididos em três grupos: grupo A (n=14, pacientes assintomáticos); grupo B (n=20, sintomáticos HBeAg positivos) e grupo C (n=17, sintomáticos HBeAg negativos), sendo usado o sequenciador automático ABI modelo 377 para identificação de genótipos e mutantes pré-core. Os resultados evidenciaram o genótipo A como o mais prevalente, 81,8%, 89,5% e 93,7%, nos grupos A, B e C, respectivamente. A mutação pré-core A-1896 foi encontrada em 11,5% (3/26), sendo todos assintomáticos. Concluiu-se que na população estudada o genótipo A foi o mais prevalente e houve baixa ocorrência do mutante pré-core A-1896, ambos não se constituindo fatores agravantes da doença hepática.

Hepatitis B virus (HBV) infection presents itself with a variety of clinical manifestations. The present work aims to describe the prevalence of HBV genotypes and the occurrence of precore mutation A-1896 in a population group of the Eastern Amazon region of Brazil and to correlate them with the clinical presentation of chronic HBV infection. 51 HBsAg carriers (HBV-DNA positive) were selected and divided into three groups: A (14 asymptomatic subjects), B (20 HBeAg positive symptomatic patients) and C (17 HBeAg negative symptomatic patients). Using an automa ed DNA sequencer ABI model 377 by sequencing for determined of genotypes and precore mutation. The results showed that the genotype A was the most commonly found (81,1%, 89,5% and 93,7% in groups A, B and C, respectively) and precore mutation A-1896 was described in 11,5% (3/26) of group A subjects. Genotype A of HBV was the most prevalent (89,1%) and low occurrence of precore mutation A-1896, both not associate with the worst outcome of the chronic infection of HBV.