Immunogenicity and safety of an inactivated hepatitis A vaccine in children with Down syndrome.

OBJECTIVES: Hepatitis A vaccine has not been investigated in children with Down syndrome. The aim of this study was to evaluate immunogenicity and safety of an inactivated hepatitis A vaccine in noninstitutionalized children with Down syndrome and compare their responses to those of healthy control children. METHODS: An open, prospective, controlled trial of 127 children ages 1 to 12 years, 63 with Down syndrome and 64 healthy control subjects, was conducted at a single hospital. Inactivated hepatitis A virus (HAV) vaccine containing 720 enzyme-linked immunosorbent assay units of alum-adsorbed HAV was administered intramuscularly in a two-dose schedule at 0 and 6 months. Seroconversion and anti-HAV titers were measured at months 1 and 7. RESULTS: Seroconversion rates at month 1 were 92% and 94% and geometric mean titers (GMT) were 164.02 and 160.77 mIU/mL in the Down syndrome (DS) and control groups, respectively. At month 7, seroconversion rates were 100% in both groups, with GMT of 1,719.86 and 2,344.90 mIU/mL in the DS and control groups, respectively (P = 0.117). Both doses were well tolerated and no significant adverse events observed. Local reaction at the injection site was the most common adverse event reported in both groups (15% in DS and 11% in controls). CONCLUSIONS: The authors' data demonstrate a good response to HAV vaccination in children with DS living at home, with GMT not statistically different from that of healthy control children. HAV vaccine is well tolerated and highly immunogenic in children with DS.

Prevalence study of metastases in cirrhotic livers.

BACKGROUND/AIMS: Metastatic carcinoma is rarely seen in cirrhotic livers. The aim of this study is to verify the prevalence of metastases in cirrhotic liver comparing cirrhotic patients with a control group. METHODOLOGY: This study is based on 7,092 necropsies performed in two big Hospitals of Porto Alegre, Brazil. Two thousand seven hundred and three consecutive autopsies were analyzed to study the frequency of liver metastases in cirrhotic patients. This material included 111 cases of liver cirrhosis. A control group was obtained by matching selection to compare the prevalence of extrahepatic cancer and hepatic metastases between the two groups. RESULTS: Our analysis showed that hepatitis metastases, as well as extrahepatic cancer, are less frequently seen in the cirrhotic liver (no cases of hepatic metastases and 6 of extrahepatic cancer) compared to the control group (10 cases of hepatic metastases and 21 of extrahepatic cancer), this difference being statistical significant (p < 0.05). CONCLUSIONS: Our results show that, in our sample, hepatic metastases are less common in cirrhosis of the liver than in liver without cirrhosis, this result may be due to the fact that patients with cirrhosis present less extrahepatic cancers and cirrhotic livers may represent an unfavorable site for metastatic growth.

Immunogenicity and safety of hepatitis A vaccine in children with chronic liver disease.

BACKGROUND: Acute hepatitis A superimposed on chronic liver disease has been associated with a more severe course of disease and development of fulminant hepatitis. The aim of this study was to evaluate the immunogenicity and safety of an inactivated hepatitis A virus vaccine in children with chronic liver disease. PATIENTS AND METHODS: This was an open, prospective, and controlled trial with 89 anti-HAV negative children between 1 and 16 years of age studied at a pediatric liver disease and transplantation referral center. Inactivated HAV vaccine (Havrix), from GlaxoSmithKline Biologicals containing 720 Elisa units of alum-adsorbed hepatitis A antigen per 0.5 ml dose was used. Thirty-four pediatric patients with chronic liver disease (mean age: 7.0 +/- 4.86 years) and 55 healthy controls (mean age: 4.8 +/- 2.7 years) received two doses of Havrix vaccine in months zero and six. Seroconversion and anti-HAV titers expressed as geometric mean titers (GMT) in mIU/ml were measured at months one and seven, by a modified Hepatitis A virus antibodies (HAVAB) assay. RESULTS: Seroconversion rates at four weeks after primary immunization were 76% and 94% and the GMT 107.77 and 160.77 mIU/ml in the patient and control groups, respectively. One month after second dose the seroconversion rates were 97% and 100% in the groups with GMT of 812.40 and 2,344.90 mIU/ml. Both doses were well tolerated with no significant adverse events observed. Local injection-site symptoms were the most common reactions reported in both groups. CONCLUSION: Although GMTs were significantly lower in children with chronic liver disease compared to healthy controls, the overall seroconversion rates were not different. Hepatitis A virus vaccine was safe, well-tolerated, and immunogenic in children with chronic liver disease.

Seroprevalence of hepatitis a antibodies in a group of normal and Down syndrome children in Porto Alegre, southern Brazil.

The high incidence of Hepatitis A and B in institutionalized patients with Down Syndrome (DS) is not fully understood. Under poor hygienic conditions, immunological alterations might predispose individuals to these infections. Sixty three DS children between 1 and 12 years old living at home with their families were examined for anti-HAV and compared to age-matched controls (64 healthy children). This cross-sectional study was carried out from May 1999 to April 2000 at the Hospital de Clínicas of Porto Alegre, southern Brazil. Groups were compared in terms of age, sex, skin color, and family income (> R$ 500 and < R $ 500/month) by the chi-square test, with Yates' correction and for the prevalence of anti-HAV (Fisher's exact test). In the DS group (n=63), the mean age was 4.4 +/- 3.3 years, 94% of the patients were white and 51% were female. Family income was < or = R$ 500/month in 40 cases (63%). In the control group (n=64), the mean age was 4.8 +/- 2.7 years, 81% of the patients were white and 56% were female. Family income was < or = R$ 500 in 20 patients (31%). DS children's families had a significantly lower income (P<0.0005). In the DS group there were 6 positive (9.5%) anti-HAV cases, and all came from low-income families (less than R$ 500/ month). In the control group, 3 cases (4.7%) were positive for anti-HAV (two were from a low-income family and one was from a higher income family). These differences were not significant. Our data indicate that Hepatitis A is not a special risk for mentally retarded DS outpatients, even in a developing country like Brazil.

Seroprevalence of hepatitis A antibodies in a group of normal and Down Syndrome children in Porto Alegre, Southern Brazil

The high incidence of Hepatitis A and B in institutionalized patients with Down Syndrome (DS) is not fully understood. Under poor hygienic conditions, immunological alterations might predispose individuals to these infections. Sixty three DS children between 1 and 12 years old living at home with their families were examined for anti-HAV and compared to age-matched controls (64 healthy children). This cross-sectional study was carried out from May, 1999, to April, 2000, at the Hospital de Clínicas of Porto Alegre, southern Brazil. Groups were compared in terms of age, sex, skin color, and family income (> R$ 500 and < R$ 500/ month) by the chi-square test, with Yates' correction and for the prevalence of anti-HAV (Fisher's exact test). In the DS group (n=63), the mean age was 4.4 ± 3.3 years, 94 percent of the patients were white and 51 percent were female. Family income was <= R$ 500/month in 40 cases (63 percent). In the control group (n=64), the mean age was 4.8 ± 2.7 years, 81 percent of the patients were white and 56 percent were female. Family income was <= R$ 500 in 20 patients (31 percent). DS children's families had a significantly lower income (P<0.0005). In the DS group there were 6 positive (9.5 percent) anti-HAV cases, and all came from low-income families (less than R$ 500/ month). In the control group, 3 cases (4.7 percent) were positive for anti-HAV (two were from a low-income family and one was from a higher income family). These differences were not significant. Our data indicate that Hepatitis A is not a special risk for mentally retarded DS outpatients, even in a developing country like Brazil

Síndrome hepatopulmonar / Hepatopulmonary syndrome

A presente revisäo enfatiza os aspectos relacionados às alteraçöes pulmonares subseqüentes à hepatopatia crônica, mais recentemente chamada síndrome hepatopulmonar, que se caracteriza por presença de doença hepática, associada a aumento do gradiente alvéolo-arterial e dilataçöes vasculares intrapulmonares. Säo abordados aspectos históricos bem como relacionados à fisiopatogenia e métodos diagnósticos empregados. O emprego de gasometria arterial em repouso e com oxigênio a 100 por cento para excluir "shunt" intrapulmonar assim como o emprego do ecocardiograma com contraste para avaliar o tipo de "shunt" säo opçöes diagnósticas menos invasivas que a arteriografia pulmonar. A difusäo com monóxido de carbono pode ser...

Efeito da colchicina sobre a cirrose hepática, em ratos, induzida por tetracloreto de carbono / Effect of colchicine on hepatic cirrhosis, in rats, induced by carbon tetrachloride

Os autores avaliam o efeito da colchicina sobre a cirrose, em ratos, induzida por tetracloreto de carbono (CCI4). Ratas Wistar foram divididas em grupos controles e em grupos tratados com colchicina, 10ug/100g/dia, e CCI4, 5ug/100g/dia, de colchicina e CCI4 ou apenas CCI4. Foi verificado que os animais que receberam CCI4 isolado ou associado à colchicina mostraram aumento da atividade da TGO, TGP e FA e reduçäo nos níveis séricos de albumina. O exame anatomopatológico do fígado dos animais desses grupos mostrou a presença de infiltrado inflamatório, esteatose, necrose, fibrose, proliferaçäo dos ductos biliares e regeneraçäo nodular. Além disso, nos rins desses animais foi detectada nefrite intersticial leve. Näo houve alteraçöes, entre os diferentes grupos, em relaçäo aos eletrólitos, uréia e creatinina