Hypoadiponectinaemia in nonalcoholic fatty liver disease obese women is associated with infrequent intake of dietary sucrose and fatty foods.

BACKGROUND: The present study aimed to investigate the relationship between adiponectinaemia and food intake among obese women with nonalcoholic fatty liver disease (NAFLD). METHODS: In total, 60 obese women were examined by abdominal ultrasound for liver steatosis and subcutaneous and visceral adiposity. A standard interview (including questions about alcohol intake, medical history and physical activity), a physical examination (including height, weight, body mass index, waist and hip circumferences, waist-to-hip ratio, and body composition) and biochemical and clinical parameters (including serum glucose and insulin, homeostatic model assessment insulin resistance, lipid profile, aminotransferases, C-reactive protein, adiponectin, leptin, resistin, tumour necrosis factor-α, interleukin-6 levels and blood pressure) were performed. Food intake was evaluated by a qualitative food frequency questionnaire. RESULTS: Twenty-four NAFLD patients and thirty-six controls were analysed. The Mann-Whitney test showed lower adiponectin levels in the liver disease group compared to controls (P < 0.05). The Pearson correlation coefficient indicated that adiponectinaemia was negatively correlated with lipid profile and serum tumour necrosis factor-α (P = 0.05) and was positively associated with adiposity measures and serum leptin (P < 0.05). By simple linear regression, all of these variables predicted serum adiponectin levels. Chi-squared and Fisher's exact tests indicated that, in both groups, food intake showed no differences, although sucrose and fatty foods were associated with lower adiponectin levels in the liver disease group (P < 0.05 and P < 0.05, respectively), as well as in the control group (P = 0.05 and P < 0.05, respectively). CONCLUSIONS: Hypoadiponectinaemia in NAFLD was associated with dietary sucrose and fatty food intake, emphasising the important role of diet in the occurrence of this disease.

Liver HLA-G expression is associated with multiple clinical and histopathological forms of chronic hepatitis B virus infection.

As the mechanisms leading to the persistence of hepatitis B virus (HBV) infection are poorly understood and as the histocompatibility leucocyte antigen (HLA)-G is well described as a tolerogenic molecule, we evaluated HLA-G expression in 74 specimens of HBV liver biopsies and in 10 specimens obtained from previously healthy cadaver liver donors. HBV specimens were reviewed and classified by the METAVIR score, and HLA-G expression was assessed by immunohistochemistry. No HLA-G expression was observed in control hepatocytes. In contrast, 57 (77%) of 74 HBV specimens showed soluble and membrane-bound HLA-G expression in hepatocytes, biliary epithelial cells or both. No associations between the intensity of HLA-G expression and patient age or gender, HBeAg status, severity of liver fibrosis, and grade of histological findings were observed. Although significance was not reached (P = 0.180), patients exhibiting HLA-G expression presented a higher median HBV DNA viral load (105 copies/mL) than those who did not express HLA-G (10(3.7) copies/mL). These results indicate that HLA-G is expressed in most cases of chronic HBV infection in all stages and may play a role in the persistency of HBV infection.

Changing epidemiology of hepatitis A in Brazil: reassessing immunization policy.

Recent studies have shown that the prevalence of antibody to hepatitis A virus (HAV) is decreasing in several Latin American countries. Brazil is a very large and heterogeneous country, showing striking regional differences. With regard to sanitary facilities, 81.7% of the districts in the south-eastern region have sewage systems, compared with only 5.8% in the northern region. Results of sero-epidemiological studies and reported hepatitis A outbreaks indicate a change in the epidemiological pattern of hepatitis A in the country. Individuals, especially those under the age of 10, are mostly unprotected from HAV infection, regardless of their socioeconomic status. During 2000-2005, approximately 14 000-21 000 cases of hepatitis A were reported annually in Brazil, a rate of 7.5-11 cases per 100 000 population. Nationwide, hepatitis A mortality rates declined progressively from 1980 to 2002. As fatal cases constitute a small, but predictable, portion of all acute hepatitis A cases, which are in turn part of the total number of HAV infections, these data suggest that there has been a decline in HAV circulation in all Brazilian regions over the last two decades. Taken together these facts point out that the epidemiological pattern of hepatitis A is changing in Brazil. Besides improvements in sanitary conditions in the poorest Brazilian regions, the introduction of hepatitis A vaccination of young children could be a strategy for controlling HAV infection in the country.

Geographic distribution of hepatitis C virus genotypes in Brazil.

Brazil is a country of continental dimension with a population of different ethnic backgrounds. Thus, a wide variation in the frequencies of hepatitis C virus (HCV) genotypes is expected to occur. To address this point, 1,688 sequential samples from chronic HCV patients were analyzed. HCV-RNA was amplified by the RT-PCR from blood samples collected from 1995 to 2000 at different laboratories located in different cities from all Brazilian States. Samples were collected in tubes containing a gel separator, centrifuged in the site of collection and sent by express mail in a refrigerated container to Laboratório Bioquímico Jardim Paulista, São Paulo, SP, Brazil. HCV-RNA was extracted from serum and submitted to RT and nested PCR using standard procedures. Nested PCR products were submitted to cycle sequencing reactions without prior purification. Sequences were analyzed for genotype determination and the following frequencies were found: 64.9% (1,095) for genotype 1, 4.6% (78) for genotype 2, 30.2% (510) for genotype 3, 0.2% (3) for genotype 4, and 0.1% (2) for genotype 5. The frequencies of HCV genotypes were statistically different among Brazilian regions (P = 0.00017). In all regions, genotype 1 was the most frequent (51.7 to 74.1%), reaching the highest value in the North; genotype 2 was more prevalent in the Center-West region (11.4%), especially in Mato Grosso State (25.8%), while genotype 3 was more common in the South (43.2%). Genotypes 4 and 5 were rarely found and only in the Southeast, in São Paulo State. The present data indicate the need for careful epidemiological surveys throughout Brazil since knowing the frequency and distribution of the genotypes would provide key information for understanding the spread of HCV.

Short report: further evidence for hepatitis E in the Brazilian Amazon.

During an investigation of a hepatitis outbreak occurring in a small village in the Brazilian Amazon, serum samples from 16 recent hepatitis cases and 66 of their asymptomatic relatives were tested for the presence of hepatitis A, B, C, and E markers. Sanitation is poor and organized disposal of sewage is absent in the village. Two of the 16 hepatitis cases were non-A, non-B and non-C hepatitis, but their sera reacted to hepatitis E antibodies of the IgG class (anti-HEV). Likewise, sera from seven of the 66 asymptomatic relatives were positive for anti-HEV. Four of the nine anti-HEV positive sera had their reactivity confirmed by a neutralization test using synthetic peptides based on the nucleotide sequences of open reading frames 2 (ORF2) and 3 (ORF3) encoded in the HEV genome. To our knowledge, this is the first report suggesting the occurrence of acute E hepatitis cases in the Brazilian Amazon.

Hepatitis B virus infection in immigrants to the southern Brazilian Amazon.

To identify epidemiological patterns and risk factors associated with hepatitis B virus (HBV) infection in the southern Brazilian Amazon, a survey was performed in the county of Terra Nova do Norte in the northern part of the state of Mato Grosso. The population consists mainly of immigrants from the southern part of Brazil, where HBV prevalence is low. A random sample (n = 783) of the population was interviewed and tested for HBV markers. The overall prevalence of HBV infection was 54.7%. There were 31 hepatitis B surface antigen (HBsAg) carriers (3.9%), with a low rate of HBV e antigen positivity, and none with anti-hepatitis D virus. Subtypes ayw3 and ayw2 of HBsAg were predominant, suggesting that the immigrants carried HBV from their original region to the Amazon. Clustering of HBV infection within families was found. The association between HBV markers and having lived in a gold-miners' camp, even after adjusting for confounders, indicated that the gold-miners may play a role in HBV spread in areas of the Amazon where gold prospecting occurs.

[Hepatitis Delta in the State of Mato Grosso, Brazil: report of 5 cases]. / Hepatite Delta no Estado de Mato Grosso: apresentação de cinco casos.

Five cases of hepatitis B and D superinfection in teenagers from the northernmost region of Mato Grosso State are reported. Hepatitis B is high prevalent there, but not hepatitis D. The proximity to the States of Acre and Amazonas and intense migration may be introducing the virus into the region. Necessity for the surveillance of hepatitis D in northern Mato Grosso is emphasized.

[Detection of hepatitis C virus antibodies in a pool of 5 sera: their use in seroepidemiologic studies]. / Pesquisa de anticorpos contra o vírus da hepatite C em pool de 5 soros: sua utilização em inquéritos soroepidemiológicos.

In order to evaluate the reduction in the cost of testing for antibodies against hepatitis C (EIA) by the pool method, we tested serum samples from a rural population and from patients in a hemodialysis program. Two thirds of the high risk groups were positive. Pooling reduced the reagent use by 80% in the rural population and by 13% in the hemodialysis patients. We conclude that pool testing reduces the cost of anti-HCV detection in low-risk groups.

[Non-coronary chest pain: esophageal evaluation in 27 patients]. / Dor torácica não-coronariana: avaliação do esôfago em 27 pacientes.

The authors analyse the clinical features of 27 patients with non-coronary chest pain. They applied specific questionnaire and used esophageal function tests. The pain features were very similar to coronary patients, but there was a strict relationship with emotional stress. Esophageal symptoms were found in about 50% of patients. Eighty-five, one percent of the patients, presented with some abnormalities; 33.3% of the total group with esophagitis and 66.6% with motor disorders; some patients presented overlapping pictures. Three patients had duodenal ulcer. The patients were classified as having pain of proved (18.5%), or suspected (66.6%) esophageal origin. Twenty of these patients were followed and those with esophagitis and/or duodenal ulcer had a good response to specific treatment. The author stress the importance of showing the patients the benign nature of this disease. In the present group of patients, the actual diagnosis was more important in obtaining good therapeutic response than classifying the pain as above.

[Dynamic scintigraphy of the esophagus--a method for esophageal dysfunction]. / Cintilografia dinâmica do esôfago--um método para disfunção esofagiana.

The authors present their experience with radionuclide transit in the study of esophageal motility using a very simple and easy technique. They have established a normal pattern and analyse their findings in achalasia and probable diffuse esophageal spasm. They review the literature and submit the method as a very important tool for the diagnosis of esophageal motor disorders.

[Myocarditis caused by Toxoplasma gondii in a man with acquired immunodeficiency syndrome]. / Miocardite por toxoplasma gondii em homem com síndrome de imunodeficiência adquirida.

Male, 26-years old, with acquired immunodeficiency syndrome which was admitted in the hospital with focal neurologic disturbance, developed myocardial failure and echocardiographic pattern of ventricular dysfunction. Sudden death occurred 18 days after admission and the post mortem microscopic studies showed degenerative abnormalities of cardiac muscular fibers, focal lymphocytic and histiocytic infiltrate and the presence of T. gondii.

[POEMS syndrome: report of a Brazilian case with fatal course]. / Síndrome POEMS: relato de um caso brasileiro com evolução fatal.

The authors report a case of a 27 year old man with severe polyneuropathy, multiple endocrine and cutaneous disorders, ascites, edema and multiple osteosclerotic lesions. Clinical and laboratory diagnosis of POEMS syndrome was made. The patient condition worsened progressively and death followed. The literature search showed that this is the first Brazilian case report about such a syndrome.

Prevalence of hepatitis B and C virus markers among malaria-exposed gold miners in Brazilian Amazon.

Hepatitis B and C virus markers were assessed during a survey on malaria in gold mine camps in southern Brazilian Amazon in order to identify risk factors associated to these viral diseases. The study comprised 520 subjects, most of them were gold miners. Missing subjects totaled 49 (8.6%). Among these 520, 82.9% had HBV markers and 7.1% were HBsAg positive. Previous hospitalization, surgery, sexually transmitted diseases and incarceration were quite common among surveyed people, but there is no association between total HBV markers and these factors. On other hand, HBsAg was independently associated to history of sexually transmitted diseases and history of surgery after adjustment. The most frequent HBsAg subtypes identified, adw2 (59%), predominates in populations of Northeast Brazil. The most surveyed people were immigrants coming from that area suggesting that immigrants carried HBV themselves to the study area. Immunoblot (RIBA) confirmed-anti-HCV were found in 2.1%. The only variable associated to anti-HCV in multivariate analysis was illicit intravenous drug. Lack of HCV infection in subjects with such a high HBV markers prevalence reinforces the opinion that HCV is transmitted by restricted routes when compared to HBV. Furthermore, gold miners in Amazon may be considered as a risk group for HBV infection, but not for HCV.

Outbreak of hepatitis B virus in recent arrivals to the Brazilian Amazon.

An outbreak of acute hepatitis cases in a small community took place 6 months after the community's arrival to the Brazilian Amazon. An epidemiological investigation was performed and included residents aged more than two years. Study subjects were interviewed and bled to test for hepatitis markers by enzyme immunoassays. Around 80% of the village population was surveyed. The overall prevalence of hepatitis B virus (HBV) markers was 75.1% (281/374). The surface antigen of HBV (HBsAg) and the IgM class antibody against hepatitis B core antigen (IgM anti-HBc) were present in 10.4% and 9.6%, respectively. Evidence of HBV-HDV (Delta virus) coinfection or hepatitis C infection was not found. IgM class antibody against hepatitis A virus was uncommon (3.7%). Follow-up evaluation 6 and 12 months later were carried out to identify new HBV infections. An incidence rate of 7.2 new infections per 100 exposed subjects per month was found. Average individual risk for HBV infection among susceptible inhabitants of the village between June 1995 and June 1996 can be estimated at 57.6%. The predominant HB-sAg subtype found (ayw3) suggests that immigrants may have carried HBV from the original area. Time living in the study region was significantly associated with HBV markers in analysis for linear trend and logistic regression analysis. Environmentally related factors may have facilitated HBV transmission.

Epidemiological survey of infection with hepatitis B virus in the savannah and wetlands (Pantanal) of central Brazil.

An epidemiological survey of the prevalence of hepatitis B virus (HBV) was conducted in the county of Nossa Senhora do Livramento, Mato Grosso state, central Brazil. This rural county has a largely stationary population of low socio-economic status, and is divided into savannah-type vegetation and wetland. Overall, 740 subjects aged > 9 years were selected at random, interviewed and bled so that seropositivities of various HBV markers (surface antigen and antibodies to this antigen and to core antigen) could be determined. At least one marker was found in 169 (22.8%) of the subjects but only nine (1.2%) carried the surface antigen. Vegetation type (wetland v. savannah) was not associated with HBV infection but male gender, increasing age, and having had sexual experience were each associated with the infection. The prevalence of HBV markers was higher in immigrants (32.5%) than in native individuals (21.1%), many immigrants apparently having acquired the infection before settling in the study area.

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

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.