Hepatitis C virus infection status and associated factors among a multi-site sample of people who used illicit drugs in the Amazon region.

BACKGROUND: Elevated rates of Hepatitis C Virus (HCV) infection have been reported in epidemiological studies with people who used illicit drugs (PWUIDs) in different Brazilian regions. In Brazil's Amazon region, studies have already identified the common use of illicit drugs among adolescents and the high prevalence of HCV infections among PWUIDs. However, all studies done with PWUIDs were conducted with small samples and within limited geographic coverage. This study determined the prevalence and risk factors for HCV infection in PWUIDs in the Amazon region, northern Brazil, as well as estimating the prevalence and factors associated with the HCV spontaneous clearance (HSC). METHODS: This cross-sectional study accessed 1666 PWUIDs from multiple municipalities of the Amazon region. Socio-demographic, economic, drug use and health-related information were collected through interviews. Blood samples collected were tested for the presence of anti-HCV antibodies and RNA-HCV. HCV genotypes were identified by real-time polymerase chain reaction (PCR). Logistic regressions were run to identify factors independently associated with HCV infection status and HSC. RESULTS: In total, 577 (34.6%) featured HCV antibodies, of which 384 (23.1%) had active HCV infection and 193 (11.6%) indicated HSC. Genotypes 1 (80.2%) and 3 (18.8%) were detected. HCV infection status was associated with the length of illicit drug use history, factors related to parenteral and sexual transmission, and factors of socio-economic marginalization leading to potential risk activities for HCV. HSC was associated with the ethnic (including indigenous) background of participants. CONCLUSIONS: High levels of HCV infection were detected in PWUIDs. Genotype 1 was predominant. Intense use of illicit drugs, unprotected sexual intercourse, high number of sexual partners and social marginalization were associated with all HCV infection. HSC was associated with origin (Amazonian-born) and non-white (e.g., Black or Indigenous) of PWUIDs. These findings emphasize the need for improve HCV prevention and control services and care for PWUIDs in the Brazilian Amazon region.

Association between the Arg72Pro Genotypes in the TP53 Gene and Ile655Val in the HER2 Gene and the Risk of Developing Breast Cancer in the Population of Amapá, Northern Brazil.

BACKGROUND: The polymorphisms Arg72Pro in the TP53 gene (rs1042522) and Ile655Val in the HER2 gene (rs1136201) have been related to susceptibility to several types of cancer. Different studies show the association of these polymorphisms with breast cancer, so our aim in this study was to investigate whether the Arg72Pro and Ile655Val polymorphisms have any influence on the risk of developing breast cancer in women from the city of Macapá, Amapá, located in the brazilian amazon region. METHODS AND RESULTS: We then analyzed 80 DNA samples from women with breast cancer and 83 DNA samples from women without the disease, by the Restriction Fragment Length Polymorphism - Polymerase Chain Reaction (PCR-RFLP) technique. The genotype frequencies for rs1042522 were Ar/Arg 23.7%, Arg/Pro 47.5% and Pro/Pro 28.5% in patients and in controls Ar/Arg 69.8%, Arg/Pro 19.2% and Pro/Pro 10.8%. For the HER-2 gene the frequency of Ile/Ile, Ile/Val and Val/Val genotypes was 82.5%, 17.5% and 0% in the patients and 75.9%, 20.4% and 3.6% in the controls. The presence of at least one altered allele in rs1042522 and rs1136201 polymorphisms was found in 91.25% of patient samples. CONCLUSION: This study found a significant association between the Arg/Pro and Pro/Pro genotypes in the TP53 gene and the Ile/Val genotype in the HER-2 gene and breast cancer risk, however, we emphasize that more studies need to be carried out in the investigated population to consolidate our results.

Syphilis and Co-Infections with HIV-1, HBV, and HCV among People Who Use Crack-Cocaine in Northern Brazil.

The rates of syphilis and viral co-infections among people who use crack-cocaine (PWUCC) were assessed in this study. This cross-sectional study relied on biological and self-reported socio-behavioral data from a convenience sample of 990 PWUCC from twenty-six municipalities in the states of Amapá and Pará, northern Brazil. Blood samples were collected to assess the presence of Treponema pallidum using the Rapid Qualitative Test (RQT) and the Venereal Disease Research Laboratory (VDRL). Reactive samples by RQT were used to assess the presence of HBV, HCV, and HIV-1 using Enzyme Immunoassay (EIA) and Polymerase Chain Reaction (PCR). Logistic regression models were used to determine the association of variables assessed with syphilis. In total, 287 (29.0%) of the PWUCC sample had reactive results for syphilis. HBV (15.7%), HCV (5.9%), and HIV-1 (9.8%) were detected among PWUCC with syphilis. Young age, low monthly income and education level, long duration of crack-cocaine use, condomless sex, multiple sex partners, and exchange of sex for money/drugs were associated with syphilis. The present study provides unique insights on the epidemiological status of syphilis among PWUCC in northern Brazil, with multiple implications for improving urgent interventions for diagnosis, prevention, and treatment.

Detection and Genetic Characterization of Hepatitis B and D Viruses: A Multi-Site Cross-Sectional Study of People Who Use Illicit Drugs in the Amazon Region.

Hepatitis B (HBV) and delta (HDV) viruses are endemic in the Amazon region, but vaccine coverage against HBV is still limited. People who use illicit drugs (PWUDs) represent a high-risk group due to common risk behavior and socioeconomic factors that facilitate the acquisition and transmission of pathogens. The present study assessed the presence of HBV and HBV-HDV co-infection, identified viral sub-genotypes, and verified the occurrence of mutations in coding regions for HBsAg and part of the polymerase in HBV-infected PWUDs in municipalities of the Brazilian states of Amapá and Pará, in the Amazon region. In total, 1074 PWUDs provided blood samples and personal data in 30 municipalities of the Brazilian Amazon. HBV and HDV were detected by enzyme-linked immunosorbent assay and polymerase chain reaction. Viral genotypes were identified by nucleotide sequencing followed by phylogenetic analysis, whereas viral mutations were analyzed by specialized software. High rates of serological (32.2%) and molecular (7.2%) markers for HBV were detected, including cases of occult HBV infection (2.5%). Sub-genotypes A1, A2, D4, and F2a were most frequently found. Escape mutations due to vaccine and antiviral resistance were identified. Among PWUDs with HBV DNA, serological (19.5%) and molecular (11.7%) HDV markers were detected, such as HDV genotypes 1 and 3. These are worrying findings, presenting clear implications for urgent prevention and treatment needs for the carriers of these viruses.

Estimates of interethnic admixture in the Brazilian population using a panel of 24 X-linked insertion/deletion markers.

OBJECTIVES: In this study, we aimed to identify ancestry informative haplotypes and make interethnic admixture estimates using X-chromosome markers. METHODS: A significant sample (461 individuals) of European, African, and Native American populations was analyzed, and four linkage groups were identified. The data obtained were used to describe the ancestral contribution of populations from four different geographical regions of Brazil (745 individuals). RESULTS: The global interethnic admixture estimates of the four mixed populations under investigation were calculated applying all the 24 insertion/deletion (INDEL) markers. In the North region, a larger Native Americans ancestry was observed (42%). The Northeast and Southeast regions had smaller Native American contribution (27% in both of them). In the South region, there was a large European contribution (46%). CONCLUSIONS: The estimates obtained are compatible with expectations for a colonization model with biased admixture between European men (one X chromosome) and Native American and African women (two X chromosomes), so the 24 X-INDEL panel described here can be a useful to make admixture interethnic estimates in Brazilian populations.

Prevalence and risk factors for HIV-1 infection in people who use illicit drugs in northern Brazil.

BACKGROUND: People who use illicit drugs (PWUDs) have a high risk of viral infections. To date, there is a paucity of information on HIV infection among PWUDs in remote Brazilian regions. This study determined the prevalence and factors associated with HIV-1 infection among PWUDs in northern Brazil. METHODS: Sociodemographic, economic, drug use and health-related information were collected through interviews from a community-recruited, multi-site sample of 1753 PWUDs. The blood samples collected were tested for the presence of HIV-1 using chemiluminescence immunoassay and PCR or western blotting. Logistic regressions identified factors independently associated with HIV-1 infection. RESULTS: In total, 266 (15.2%) PWUDs were HIV-1 positive. Hepatitis B virus and/or hepatitis C virus nucleic acid was detected in 65 (3.7%) PWUDs infected by HIV-1. The factors associated with HIV-1 infection were male gender, older age, a lower educational level and a lower income, crack cocaine use, a longer drug use history and a history of drug injection and engagement in unsafe sex, sex work and a higher number of sexual partners. CONCLUSIONS: The current study provides unique, initial insights into HIV and co-infection status and pertinent risk factors among PWUDs in northern Brazil, with clear and diverse implications for urgently improved prevention and treatment intervention needs.

Profile of blood donors and seroepidemiology of dengue in a blood center in the Brazilian Amazon / Perfil dos doadores de sangue e da soroepidemiologia da dengue em um hemocentro na Amazônia brasileira

Dengue is considered the most important clinical arbovirus. Cases of transmission by blood transfusion and contaminated donors have already been described previously. Considering this reality, this study aimed to investigate the seroepidemiological profile of dengue in blood donors at the Blood Bank of the State of Amapá (HEMOAP), as well as the socio-epidemiological and donation profiles of the participants. In the period from May to June 2017, 298 blood samples were subsequently tested for IgM and IgG antibodies against dengue using immunochromatography and PCR analysis for the detection of the virus and its serotypes. Information on donation type and donor type was acquired through the HEMOAP database. Participants also answered a socio-epidemiological questionnaire. Among the participants in the survey, the majority were male, aged 18-29 years old, completed high school, privately employed workers, with a monthly family income of one to three minimum wages. Most were repeat donors as well as replacement donations. Regarding the antibody test, three samples (1%) showed reactive results for the IgM antibody against dengue, four (1.3%) reactions for IgG and two (0.7%) reactions for both antibodies. The virus was not identified in any of the samples analyzed. No significant frequency of anti-dengue antibodies has been detected in donors, however, studies such as these help in understanding this disease, as well as enriching the debate on the risk of possible transmission of dengue by blood transfusion

A dengue é considerada a arbovirose de maior importância clínica. Casos de transmissão por transfusão sanguínea e doadores contaminados já foram descritos anteriormente. Considerando-se essa realidade, este estudo objetivou investigar o perfil soroepidemiológico da dengue em doadores de sangue no Hemocentro do Estado do Amapá (HEMOAP), assim como o perfil socioepidemiológico e de doação dos participantes. Foram coletadas, no período de maio à junho de 2017, 298 amostras de sangue posteriormente testadas para anticorpos IgM e IgG contra a dengue utilizando teste imunocromatográfico e analise por PCR para a detecção do vírus e seus sorotipos. Informações sobre tipo de doação e tipo de doador foram adquiridas por meio do banco de dados do HEMOAP. Os participantes também responderam um questionário socioepidemiológico. Entre os participantes da pesquisa a maioria foi do sexo masculino, com idade entre 18-29 anos, ensino médio completo, empregado assalariado privado, com renda familiar mensal de um a três salários mínimos. Doadores de repetição foram a maioria assim como doações de reposição. Quanto a pesquisa de anticorpos, três amostras (1%) apresentaram resultado reagente para o anticorpo IgM contra a dengue; quatro (1,3%) reagentes para IgG e duas (0,7%) reagente para ambos os anticorpos. Não foi identificado o vírus em nenhuma das amostras analisadas. Não foi detectada uma considerável frequência de anticorpos anti dengue nos doadores, no entanto, estudos como esses ajudam na compreensão dessa doença além de enriquecer o debate sobre o risco de uma possível transmissão da dengue por transfusão sanguínea

Interações medicamentosas e consequentes intervenções farmacêuticas na Unidade de Terapia Intensiva de um hospital privado em Macapá, Amapá / Interactions medicative and consequents interventions pharmaceutics in the unity of intensive therapy in a private hospital in Macapa, Amapa

Introdução: Pacientes internados em Unidades de Terapia Intensiva (UTI) são submetidos a tratamentos com múltiplos fármacos, visto a gravidade dos problemas que são tratados. A interação medicamentosa é definida como um evento causado pela modificação do efeito ou aproveitamento de um fármaco no organismo em virtude de outro. A avaliação das potenciais interações medicamentosas pode auxiliar a equipe multiprofissional a promover um tratamento de qualidade, evitando que estas interações sejam danosas ao paciente, diminuindo o tempo de internação e consequentemente auxiliando na redução de custos. Objetivo: Avaliar as principais interações medicamentosas observadas nas UTI de um hospital privado na cidade de Macapá (Amapá, AP) através da análise das prescrições e das consequentes intervenções adotadas a fim de minimizar seus riscos. Método: Foram avaliadas prescrições de pacientes internados em UTI quanto à presença de potenciais interações medicamentosas e sua respectiva classificação, segundo seu risco e mecanismo. As principais interações foram destacadas a fim de destacar seu mecanismo e medidas adotadas pela equipe multidisciplinar. Resultados: Observou-se que a maioria das interações, tanto na UTI adulto quanto na UTI neonatal, foram consideradas de risco moderado. As interações farmacocinéticas foram mais comuns na UTI adulto, enquanto as farmacodinâmicas predominaram na UTI neonatal. O manejo no horário de administração dos medicamentos foi a intervenção mais adequada para a maioria dos casos das interações medicamentosas. Conclusões: o monitoramento das potenciais interações em pacientes críticos procura garantir a segurança do paciente, buscando diminuir os riscos potenciais aos quais estes estão expostos.

Introduction: Patients admitted to Intensive Care Units (ICU) are submitted to multiple drug treatments, considering the severity of their problems. Drug interaction is defined as an event caused by the modification of the effect or use of a drug in the body. The evaluation of potential drug interactions can help the multiprofessional team to promote a quality treatment, avoiding harmful interactions, reducing the length of hospitalization and consequently reducing costs. Objective: To evaluate the main drug interactions observed in the ICUs of a private hospital in the city of Macapá, Brazil, through the analysis of the prescriptions and the consequent interventions adopted in order to minimize their risks. Method: Prescriptions of patients admitted to the ICU were evaluated for the presence of potential drug interactions and their respective classification according to their risk and mechanism. A brief bibliographic study about the main interactions was carried out in order to highlight its mechanism and the measures adopted by the multidisciplinary team. Results: We observed that the majority of the interactions, both in the adult ICU and in the neonata ICU, were considered of moderate risk. Pharmacokinetic interactions were more common in the adult ICU, while pharmacodynamics predominated in the neonatal intensive care unit. Management during the administration of medications was the most appropriate intervention for most cases of drug interactions. Conclusions: Monitoring of potential interactions in critically ill patients seeks to ensure patient safety in order to reduce the potential risks to which they are exposed.

Hypoglycemic effect of formulation containing hydroethanolic extract of Calophyllum brasiliense in diabetic rats induced by streptozotocin

ABSTRACT Diabetes mellitus is a chronic and severe metabolic dysfunction, it's slow and progressive evolution interferes directly in the metabolism of carbohydrates, fats and proteins, causing hyperglycemia, glycosuria, polydipsia, hyperlipidaemia, among others. The aim of this study was to evaluate the antidiabetic effect of hydroethanolic extract and granulated of Calophyllum brasiliense Cambess., Clusiaceae, species in diabetic rats as well as it's biochemical parameters. The results demonstrated that both the pharmaceutical forms, hydroethanolic extract and granulated, were able to reduce significantly (p < 0.001) hyperglycemia and glycosuria, in addition to improve polydipsia, polyuria, and weight loss. Treatments using hydroethanolic extract and granulated were also able to reduce significantly levels of triacylglycerides, cholesterol and low-density lipoprotein, as well as the transaminases, urea and creatinine levels. Therefore, it is concluded that these pharmaceutical forms have anti-diabetic effect and act improving the biochemical parameters, this effect is probably due to the high content of polyphenolic compounds found in the formulations.