Aspectos da vacinação contra hepatite B em idosos, no município de Salvador (BA), de 2004 a 2018: um estudo descritivo a partir do Sistema Eletrônico do Departamento de Informática do SUS (DATASUS) / Aspects of hepatitis B vaccination in the elderly of Salvador (BA) from 2004 to 2019: a descriptive study based on the Electronic System of the SUS Department of Informatics (DATASUS)

Introdução: a hepatite B é um grave problema de saúde pública no país e no mundo. Nos últimos dez anos, houve aumento significativo do número de casos notificados em idosos. Embora seja uma doença imunoprevinível, há poucos dados na literatura sobre a situação vacinal deste grupo populacional. Objetivo: este estudo visou investigar e descrever dados sobre a vacinação para hepatite B no município de Salvador, Bahia, registrados no Sistema eletrônico do Departamento de Informática do SUS (DATASUS) do Ministério da Saúde. Materiais e métodos: Trata-se de estudo descritivo, a partir de dados secundários disponíveis no Sistema de Informações do Programa Nacional de Imunizações e Sistema de Informação de Agravos de Notificação, no período 2004 a 2018, referentes ao município de Salvador, Bahia. Resultados: foram notificados 120 casos de hepatite B em idosos, no período estudado. A principal forma de contágio foi pela via sexual. Os maiores números de doses aplicadas da vacina foram observados nos anos 2017 e 2018, principalmente da primeira dose. Este aumento está, provavelmente, associado ao fato de que, em 2016, esta vacina passou a ser disponibilizada de forma universal, independentemente de idade ou condições de vulnerabilidade. Contudo, a proporção da população idosa residente no município de Salvador vacinada foi muito baixa (< 1% ao ano). Conclusão: este estudo revelou baixa cobertura vacinal da população de idosos de Salvador. Estes dados reforçam a importância de estratégias no planejamento de programas de atenção à saúde do idoso que incentivem maior adesão à vacinação completa contra hepatite B.

Introduction: hepatitis B is a worldwide public health problem. The occurrence of this disease in the elderly has increased significantly over the past 10 years. Although it is a vaccine-preventable disease, information about vaccination status in this population group is scarce. Objective: this paper aims to investigate and describe hepatitis B vaccination data in the elderly in Salvador, Bahia. Methods: it is a descriptive study, which collected data available at the Information System of the National Immunization Program, and at the Information System of Notification of Diseases websites. The years included in this research were from 2004 to 2018, and the resident population was from Salvador, Bahia, Brazil. Results: in the study period, 120 cases of hepatitis B were reported in the elderly in Salvador. The main route of infection was through sexual intercourse. The highest numbers of hepatitis B vaccine injections are observed in 2017 and 2018, especially the first shot (out of three shots). This increase may be associated with the government measure that ensured hepatitis B vaccination for every Brazilian citizen, regardless his/her age or vulnerability since 2016. However, the proportion of the vaccinated elderly population living in Salvador is still very low (<1% per year). Conclusion: this study shows low hepatitis B vaccination coverage of the elderly living in Salvador, Bahia. These data reinforce the importance of strategies that prompt elderly health care programs to encourage greater adherence to hepatitis B complete vaccination by older population.

Genetic and Oral Tests for the Diagnosis of Lactose Intolerance in Mixed-Ancestry Brazilians with Metabolic Syndrome.

BACKGROUND/AIMS: Metabolic syndrome (MetS) comprises a cluster of physiological and anthropometric abnormalities. MetS has been linked to lactose intolerance (LI). The aim of this study was to compare the sensitivity and specificity to detect LI using 2 different tests: (1) a genetic test and (2) an oral lactose tolerance test (OLTT). METHODS: Two hundred and fifty-four MetS patients, ≥20 years of age, of both genders, were recruited for this comparative study. Nine single nucleotide polymorphisms (SNPs) were selected for genetic investigation: rs182549and rs4988235(both considered "gold standard"); rs56064699; rs148142676; rs562211644; rs59533246; rs3754689; rs2278544,and rs10552864(as potential novel SNPs). Sensitivity and specificity, as well as positive and negative predictive values, were calculated for each genotype using WINPEPI version 11.65. Differences between positive and negative OLTT groups were considered statistically significant when p ≤ 0.05. RESULTS: Among the selected SNPs, only rs182549(p < 0.001) and rs4988235(p < 0.001) gave similar results compared to an OLTT. The sensitivity of both SNPs to detect LI was 87 and 86%, and specificity was 83 and 82.5%, respectively. CONCLUSION: Genetic tests using rs182549and rs4988235SNPs showed high agreement with OLTT. These genetic tests may be a good option to replace OLTT in MetS patients.

Avaliação, Ensinagem e Metodologias Ativas: uma Experiência Vivenciada no Componente Curricular Mecanismos de Agressão e de Defesa, no curso de Medicina da Universidade do Estado da Bahia, Brasil / Evaluation, Teaching and Active Methodologies: an Experience as Part of the Curricular Component Mechanisms of Aggression and Defense of the Medicine course of Universidade do Estado da Bahia, Brazil

RESUMO A contemporaneidade e a docência nas áreas de saúde e formação profissional, tem se transformado e evoluído nos últimos tempos, com a introdução das metodologias ativas no processo ensino-aprendizagem, nas instituições de ensino superior no Brasil. Essas metodologias ativas de aprendizagem, como a ABP, Aprendizagem Baseada em Problemas, são utilizadas com a finalidade de que estudantes da área da saúde adquiram o conhecimento de forma significativa, em relação ao ensino tradicional. A educação médica no Brasil tem sido assunto de muitas discussões sobre a formação profissional em saúde e vem passando por significativas mudanças nos últimos anos. O presente artigo tem por objetivo relatar uma experiência docente no ensino de graduação em Medicina, nos componentes curriculares Mecanismo de Agressão e Defesa I e II (MADs), na Universidade do Estado da Bahia - Campus I. MADs é um componente curricular atualmente presente em diferentes cursos da área de saúde do Brasil. Este componente é composto pelas disciplinas microbiologia, parasitologia, imunologia e patologia, lecionado de forma integrada. Foram aplicadas metodologias ativas de ensino, do tipo aprendizagem baseada em problemas (ABP), que abrangeram sessões tutoriais, atividades em laboratórios, apresentações científicas e o uso de filmes. Além disto, foram utilizados recursos lúdicos e a ferramenta MOODLE no campus virtual. Esta proposta teve início no ano de 2012 e vem sendo aplicada a partir desta data até os dias atuais. A experiência vivenciada nas MADs, com a utilização de variadas formas de metodologias de ensinagem, tem permitido "romper" com o tradicional, isto é, tem levado o discente a desenvolver habilidades, competências e construção dos saberes. Estas novas alternativas de ensino nos permitiu uma interação mais ampla entre a relação discente-docente e nos fez refletir e avançar no processo avaliativo, que tem sido realizado de forma ampla e processual. Além disso, um impacto positivo para sua formação pode ser observado. No que se refere ao processo de ensino, aprendizagem e avaliações, novas propostas pedagógicas devem ser inseridas priorizando o caráter formativo e de desenvolvimento dos discentes, para que haja a construção de competências necessárias ao perfil estabelecido pelas DCNs, Diretrizes Curriculares Nacionais, do curso de Graduação em Medicina e demais cursos de saúde.

ABSTRACT Changes are occurring in health teaching and professional training, due to the introduction of active methodologies to the teaching-learning process in Brazilian higher education institutions. These active learning methodologies, such as PBL (Problem-Based Learning), are used to help medical students acquire knowledge in a more relevant way, compared to traditional teaching. Medical education in Brazil has been the subject of much discussion, and has undergone significant changes in recent years. The objective of the present work is to report the teaching experience in the curricular components Mechanisms of Aggression and Defense I (MAD I) and Mechanisms of Aggression and Defense II (MAD II) of Universidade do Estado da Bahia [State University of Bahia] - Campus I in undergraduate teaching in Medicine. These subjects are composed of the disciplines microbiology, parasitology, immunology (MAD I and II) and pathology (MAD II), taught in an integrated way. Active teaching methodologies were applied, such as problem-based learning, laboratory activities, scientific presentations and the use of film. In addition, the MOODLE tool was used in the virtual campus. This proposal began in 2012 and has been applied since then. The experience of the MADs, with the use of different forms of teaching methodologies, has led to a transformation of traditional teaching, leading students to develop their skills and competencies and build knowledge. These new teaching alternatives allow for a broader interaction between the students and the teacher and led us to reflect and advance in the evaluation process, which has been carried out in a broad and procedural way. Moreover, a positive impact on the students' training was observed. As for the processes of teaching, learning and evaluation, new pedagogical proposals should be introduced, prioritizing the formative and developmental character of students so that the necessary competences can be built into the profile established by the National Curricular Guidelines (DCNs) of the Undergraduate Medicine course and other courses in the area of health.

Associação entre esclerose múltipla e alelos HLA-DRB1 em uma população miscigenada de Salvador, Ba, Brasil / Association between multiple sclerosis and HLA-DRB1 alleles in an admixed population of Salvador, Ba, Brazil

Introdução: a esclerose múltipla é uma doença que afeta preferencialmente o sistema nervoso central de mulheres jovens, causandolhes graus variáveis de incapacidades física e cognitiva. Etiologicamente associa fatores ambientais, biológicos, sócio-econômicos e genéticos, como por exemplo genes do MHC classe II, especialmente os alelos HLA-DRB1*. Objetivo: determinar a frequência dos alelos HLA DRB1* em portadores de esclerose múltipla atendidos no centro de referência do C.H.U.P.E.S, UFBA, no período de outubro de 2014 a abril de 2015 e associá-las a variáveis clínico-demográficas. Metodologia: estudo do tipo caso-controle, aprovado pelo comitê de ética da Faculdade de medicina da Universidade Federal da Bahia (CAAE: 3517134.0.0000.5577), que envolveu uma amostra de conveniência composta por 97 indivíduos, cujos dados clínico-demográficos foram coletados através de questionário desenvolvido para a pesquisa. A genotipagem dos alelos HLA-DRB1* foi realizada através da técnica HLA-DR SSO GenotypingTest. Resultados: a análise quantitativa revelou perfil genotípico do tipo HLA-DRB1*15 (20,5%), em mulheres (83,0%), das raças/etnias negra ou parda (75,0%), com faixa etária entre 30 e 39 anos (28,0%). Houve predomínio da forma clínica surtoremissiva da doença (76,0%), dentre os doentes com idade mais avançada (55,0%), sem permanência de sequela clínica (70,0%) e que usavam algum tipo de Interferon (58,0%). A análise qualitativa indicou maiores frequências, na forma progressiva de esclerose múltipla dos grupos alélicos HLA-DRB1*12 (22,0%), e dos alelos HLA-DRB1*13 (12,6%)e HLA-DRB1*15 (22,0%) naqueles indivíduos com a forma surtoremissiva. Negros e pardos demonstraram maior prevalência do alelo HLA-DRB1*15 (24,0%), enquanto que nos brancos houve maior prevalência do alelo HLA-DRB1*07 (20,0%). Conclusão: forte associação entre as frequências alélicas, esclerose múltipla e as variáveis raça/etnia e forma clínica da doença.

Internações por fraturas ósseas pelo SUS em idosos do município de Salvador (BA): um estudo descritivo do ano de 2015 / Elderly hospitalizations for bone fractures by Unified Health System in Salvador (BA): a descriptive study of 2015

Introdução: as fraturas ósseas são os casos mais frequentes de internações hospitalares relacionadas a lesões por causas externas, gerando alto impacto econômico ao Sistema Único de Saúde brasileiro (SUS). A população idosa apresenta grande risco de fraturas devido à pré-existência de condições clínicas de fragilidade e de osteoporose. Objetivo: este estudo visa a analisar as internações hospitalares por fraturas ósseas pelo SUS em idosos residentes de Salvador (BA), seus custos correspondentes, a média de permanência hospitalar e o número de óbitos no ano de 2015. Metodologia: foi realizado um estudo com dados do Sistema de Informação Hospitalar, disponibilizados pelo Departamento de Informática do SUS (SIH/SUS). As categorias de fraturas desse sistema são: crânio e ossos da face, pescoço, tórax e pelve, fêmur, outros ossos dos membros e fraturas envolvendo múltiplos ossos. As variáveis estudadas foram: sexo, faixa etária, autorização de internação hospitalar, valor total, média de dias de permanência e número de óbitos. Resultados: as fraturas de outros ossos dos membros foram as mais frequentes em idosos internados por fraturas ósseas (43,7%), enquanto as mais frequentes em idosas internadas foram as de fêmur (41,3%) e de outros ossos dos membros (40,4%). Em ambos os sexos, a média de custo das internações por fraturas de fêmur foram as mais altas (≈R$3.000,00), além de demandarem mais tempo de internamento (≈12 dias). Por outro lado, a média de custo das internações por fraturas de outros ossos dos membros e sua média de dias de permanência hospitalar ficaram entre as mais baixas. Independentemente do sexo, não houve correlação importante entre os dias de permanência e a média de custo hospitalar. A taxa de mortalidade por fraturas de fêmur, no grupo de indivíduos do sexo masculino, foi discretamente maior do que no feminino (5 óbitos/100.000 e 3/100.000, respectivamente). O tipo de fratura que mais levou a óbito, no sexo feminino, foram as fraturas envolvendo múltiplos ossos, com taxa de 6 óbitos/100.000 idosas. Conclusão: os resultados apresentados neste estudo reforçam a importância do planejamento de estratégias a serem implementadas nos programas de atenção à saúde do idoso. Ao reduzir fatores de risco envolvidos com a ocorrência de fraturas, haverá redução de gastos públicos com o tratamento desse tipo de lesão e, logo, consequente melhora da utilização dos recursos financeiros em outros setores da saúde em prol da população.

Introduction: bone fractures are the most frequent cause of hospitalization regarding injury by external causes, leading to high economic impact to Brazilian Unified System (SUS). Elderly population is under great risk of fracture occurrences because of the preexisting clinical conditions of frailty and osteoporosis. Objective: this study aims to analyze hospitalizations due to bone fractures by SUS in Salvador's elderly population, their respective costs, days of hospitalization and numbers of deaths in the year of 2015. Metodology: this being investigated data from the Hospital Information System provided by the IT Department of SUS. The fracture categories available in SIH/SUS are: 'skull and facial bones'; 'neck, thorax and pelvis'; 'femoral bone'; 'other bones of the limbs'; and 'fractures involving multiple bones'. The studied variables were: biological sex, age range, number of approved hospitalizations, total cost, average duration of hospital stay, and number of deaths. Results: fractures of 'other bones of the limbs' were the most frequent in male elderly patients hospitalized for bone fractures (43.7%), whereas in female elders, 'femoral fractures' (41.3%) and 'fractures of other bones of the limbs' (40, 4%) were the most frequent. In both sexes, the average cost of hospitalizations due to 'femoral fractures' was the highest (≈R$ 3,000.00), and they required longer hospitalization period (≈12 days). The average cost of hospitalizations for 'fractures of other bones of the limbs' and their average duration of hospital stay were among the lowest. Regardless of sex, there was no significant correlation between the days of hospitalization and average hospitalization cost. Mortality due to 'femoral fractures' in males was slightly higher than in females, with rates of 5 deaths per 100,000 male elders and 3 death per 100,000 female elders. The kind of fracture that most led to death in female elders was 'fractures involving multiple bones' with a rate of 6 deaths per 100,000 elderly women. Conclusion: the results presented in this study reinforce the importance of planning strategies to be implemented in elderly health care programs in order to improve the functional status of the elderly body systems, reducing the risk factors involved in the occurrence of fractures.

Tempo de trânsito intestinal de indivíduos portadores de síndrome metabólica pela escala de bristol / Intestinal transit time of individuals with metabolic syndrome by the bristol scale

Introdução: a síndrome Metabólica (SM) é um transtorno de origem multifatorial que envolve a elevação da circunferência da cintura, da glicemia, da pressão arterial e dos triglicerídeos e redução do HDL-colesterol. Na etiopatogenia deste transtorno, diversos fatores genéticos e ambientais estão envolvidos, dentre eles, a alteração da microbiota intestinal pode ser um dos agentes causais deste distúrbio. Devido aos elevados custos para analisar este ecossistema, e à sua impossibilidade na prática clínica, ferramentas podem ser utilizadas com a intenção de monitorar o funcionamento intestinal, a exemplo da Escala de Bristol. Metodologia: foram avaliados indivíduos adultos e idosos com Síndrome Metabólica atendidos entre fevereiro de 2015 e maio de 2017. A síndrome metabólica foi definida de acordo com o preconizado pela Federação Internacional de Diabetes. Foi realizada anamnese com informações a respeito da consistência das fezes e coleta de medidas clínicas e antropométricas. Foi realizada análise estatística descritiva. Resultados: foram incluídos neste estudo 186 pacientes, com predominância do sexo feminino (83,9%) e indivíduos adultos (55,1%). Dentre os critérios da SM, o mais presente foi a pressão arterial elevada (95,1%), e a maior parte dos indivíduos apresentaram ritmo intestinal normal pela Escala de Bristol (54,8%). Em relação à idade entre os grupos, o que apresentou ritmo lento, teve maior média de idade (69 anos) em relação aos grupos com ritmo normal e ritmo rápido (57 e 54 anos, respectivamente). Por sua vez, indivíduos com ritmo intestinal rápido, apresentaram maiores médias de índice de massa corporal. Conclusão: indivíduos com Síndrome Metabólica parecem possuir tempo de trânsito intestinal adequado segundo a Escala de Bristol.

Introduction: metabolic syndrome (MS) is a multifactorial disorder that involves elevation of waist circumference, blood glucose, blood pressure and triglycerides, and reduction of HDL-cholesterol. In the etiopathogenesis of this disorder, intestinal health plays an important role, especially in the composition of the microbiota. Due to the high costs to analyze this ecosystem, and the impossibility in clinical practice, other tools can be used with the intention of monitoring the state of health of the microbiota such as the Bristol Scale. Metodology: adult and elderly individuals attended at the Núcleo de Pesquisa e Extensão em Genômica Nutricional e Disfunções Metabólicas of Universidade do Estado da Bahia between February 2015 and May 2017 were evaluated. Anamnesis was performed with information about the consistency of feces and Collection of clinical and anthropometric measurements. The metabolic syndrome was defined according to the International Diabetes Federation. Data were analyzed descriptively. Results: a total of 186 patients were analyzed during the study period, with a predominance of females (83.9%) and adults (55.1%). Among the criteria of MS, the most present was high blood pressure (95.1%), and most of the individuals presented normal bowel rhythm by the Bristol Scale (54.8%). In relation to the age between the groups, which presented a slow rhythm, the mean age (69 years) was higher in relation to the groups with normal rhythm and fast rhythm (57 and 54 years, respectively). In turn, individuals with fast bowel rhythm presented higher mean body mass index. Conclusion: individuals with Metabolic Syndrome seem to have intestinal transit time according to the Bristol Scale.

Associação entre níveis séricos de vitamina D e componentes da síndrome metabólica em pacientes atendidos no centro de estudos e atendimento dietoterápico da Universidade do Estado da Bahia / Association between serum levels of vitamin D and components of the metabolic syndrome in patients attended at the Center for Studies and Diet Therapy at the State University of Bahia

Introdução: a síndrome metabólica é um conjunto de disfunções que ocorre no metabolismo. Por sua vez, as disfunções endocrinometabólicas, incluindo componentes da síndrome, tais como obesidade, diabetes mellitus, elevação da pressão arterial e dislipidemias, têm sido associadas a baixos níveis séricos de vitamina D. A Hipovitaminose D tem atingido altas prevalências em diferentes populações mundiais, sobretudo em portadores desta síndrome. Metodologia: estudo observacional analítico, descritivo, de corte transversal. Os pacientes foram diagnosticados com síndrome metabólica a partir das recomendações da IDF, 2006. A coleta de dados foi realizada no período de agosto de 2015 a julho de 2016 e para determinação da concentração sérica de 25-hidroxivitamina D foi utilizado o método de quimioluminescência. Resultados: a hipovitaminose D foi observada em 77,6% dos pacientes. Dentre os componentes da SM a hipertensão arterial foi o mais prevalente. A análise de dados evidenciou correlação inversamente proporcional entre os níveis séricos de 25(OH)D, com as medidas de circunferência da cintura (r= ­ 0,245; pvalor= 0,013), com níveis séricos de triglicerídeos (r= ­ 1,54; pvalor= 0,030) e também com valores de Índice de Massa Corporal (r= ­ 0,225; pvalor= 0,023). Conclusão: neste estudo foi observado alta prevalência de hipovitaminose D e evidenciada correlação inversa entre os níveis séricos de vitamina D e as medidas de Circunferência da Cintura, de níveis séricos de triglicerídeos e valores de IMC.

Introduction: metabolic syndrome is a condition in which the individual manifests a set of metabolic dysfunctions. Endocrine-metabolic dysfunctions, including components of the syndrome, such as diabetes mellitus, elevated blood pressure and dyslipidemias, have been associated with low serum levels of vitamin D. Hypovitaminosis D has reached high prevalence in different world populations, Patients with this syndrome. Metodology: descriptive, cross-sectional observational study. Patients were diagnosed with metabolic syndrome from the recommendations of the IDF, 2006. Data collection was performed from August 2015 to July 2016 and for determination of the serum concentration of 25-hydroxyvitamin D was used the chemiluminescence method. Results: hypovitaminosis D was observed in 77.6% of the patients. Among the components of MS, arterial hypertension was the most prevalent. Data analysis showed an inversely proportional correlation between 25 (OH) D serum levels and waist circumference (r = ­ 0.245; pvalor = 0.013), with serum triglyceride levels (r = ­ 1.54; pvalor = 0.030) and also with values of Body Mass Index (r = ­ 0.225, pvalor = 0.023). Conclusion: in this study, a high prevalence of D-hypovitaminosis was observed and an inverse correlation was found between serum vitamin D levels and Waist Circumference, serum triglyceride levels and BMI values.

Perfil sociodemográfico, comportamental e nutricional de adultos atendidos em uma Clínica-escola de Nutrição em Salvador, Bahia / Sociodemographic, behavioral and nutritional profile of adults attending a School Clinic of Nutrition in Salvador, Bahia

Introdução: o levantamento das características da população que frequenta as clínicas-escola de Nutrição é indispensável para a organização do serviço, bem como para o planejamento e a implementação de estratégias de prevenção e controle de agravos nutricionais. Objetivo: identificar o perfil socioeconômico, demográfico, comportamental e nutricional de pacientes adultos atendidos em uma clínica-escola de Nutrição em Salvador, Bahia. Metodologia: trata-se de um estudo descritivo, transversal, realizado com dados secundários obtidos de prontuários de pacientes adultos atendidos na clínica-escola de Nutrição de uma Instituição Pública de Ensino Superior, no período de julho de 2012 a junho de 2013. Resultados: a população do estudo foi constituída por 424 indivíduos, com predominância de: sexo feminino (83,7%); faixa etária de 20 a 29 anos (34,4%); autodeclarados pretos (54,2%); solteiros (53,8%); ensino médio completo (34,6%); renda familiar entre 1 e 3 salários mínimos (54,9%), não etilistas (58%) e não tabagistas (96,2%). A prevalência de sobrepeso e obesidade foi de 37,3% e 35,6%, respectivamente. Conclusão: as características sociodemográficas e comportamentais e o estado nutricional, segundo o Índice de Massa Corporal, dos pacientes atendidos na clínica-escola foram semelhantes às descritas em estudos realizados em outros ambulatórios. O conhecimento do perfil dos usuários pode contribuir para a melhoria dos serviços prestados e planejamento de ações de educação nutricional efetivas.

Introduction: the gathering of the characteristics of the population who attends the school clinics of Nutrition is crucial for the organization of the service, as well as for the planning and implementation of strategies for prevention and control of nutritional disorders. Objective: to identify the socioeconomic, demographic, behavioral and nutritional profile of adult patients treated at a School Clinic of Nutrition in Salvador, Bahia. Methodology: this is a descriptive, cross-sectional study, performed with secondary data obtained from medical records of adults treated at the School Clinic of Nutrition of a Public Institution of Higher Education, from July 2012 to June 2013. Results: the population of the study consisted of 424 individuals, predominantly female (83.7%); age group varying from 20 to 29 years (34.4%); selfdeclared black (54.2%); single (53.8%); with complete high school level (34.6%); with family income between 1 and 3 minimum wages (54.9%), non-alcoholic (58%) and non-smokers (96.2%). The prevalence observed for overweight and obesity was 37.3% and 35.6%, respectively. Conclusion: the sociodemographic and behavioral characteristics and nutritional status, according to the Body Mass Index, of patients treated at the school clinic were similar to those described in studies performed in other outpatient clinics. The knowledge of the profile of users can contribute to the improvement of services provided and planning of effective nutrition education actions.

Factors Associated with Insulin Resistance in Patients with Chronic HCV Genotype 1 Infection without Obesity or Type 2 Diabetes.

OBJECTIVE: To investigate the prevalence of insulin resistance (IR) and its association with clinical parameters in patients with hepatitis C virus (HCV) genotype 1 without obesity or type 2 diabetes. METHODS: One hundred and twenty-seven HCV-infected patients admitted to the Nutrition and Hepatology Clinic were included. Statistical analysis was performed using the Mann-Whitney test, Fisher's exact test, and Poisson regression analysis. RESULTS: The prevalence of IR (homeostasis model assessment [HOMA]-IR ≥ 3.0) was 37.0%. The independent predictors for IR included the following: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 1.5 times the upper normal limit (odds ratio [PR] = 2.06, 95% CI, 1.16-3.66; PR = 2.32, 95% CI, 1.26-4.49, respectively); gamma glutamyl transferase (γGT) ≥ 85 U/L (PR = 2.09, 95% CI, 1.12-4.12); increased waist circumference (PR = 2.24, 95% CI, 1.25-4.17); increased waist : hip ratio (PR = 2.24, 95% CI, 1.11-5.17); increased body fat percentage (PR = 2.21, 95% CI, 1.01-5.79); overweight (PR = 2.54, 95% CI, 1.40-4.82); and metabolic syndrome (PR = 3.05, 95% CI, 1.69-5.44). High ALT levels and anthropometric parameters remained in the model of multivariate regression analysis. CONCLUSIONS: Our findings showed a significantly high prevalence of insulin resistance in nondiabetic, nonobese patients with hepatitis C genotype 1. High ALT levels and anthropometric parameters were significantly associated with IR after multivariate regression analysis. Our data show the importance of monitoring IR, weight, and body composition in patients with chronic hepatitis C. Nutritional management seems to be important in the control of comorbidities related to excess weight and the enhancement of therapeutic responses.

Myxovirus resistance, osteopontin and suppressor of cytokine signaling 3 polymorphisms predict hepatitis C virus therapy response in an admixed patient population: comparison with IL28B.

OBJECTIVES: Suppressor of cytokine signaling 3, myxovirus resistance protein and osteopontin gene polymorphisms may influence the therapeutic response in patients with chronic hepatitis C, and an association with IL28 might increase the power to predict sustained virologic response. Our aims were to evaluate the association between myxovirus resistance protein, osteopontin and suppressor of cytokine signaling 3 gene polymorphisms in combination with IL28B and to assess the therapy response in hepatitis C patients treated with pegylated-interferon plus ribavirin. METHOD: Myxovirus resistance protein, osteopontin, suppressor of cytokine signaling 3 and IL28B polymorphisms were analyzed by PCR-restriction fragment length polymorphism, direct sequencing and real-time PCR. Ancestry was determined using genetic markers. RESULTS: We analyzed 181 individuals, including 52 who were sustained virologic responders. The protective genotype frequencies among the sustained virologic response group were as follows: the G/G suppressor of cytokine signaling 3 (rs4969170) (62.2%); T/T osteopontin (rs2853744) (60%); T/T osteopontin (rs11730582) (64.3%); and the G/T myxovirus resistance protein (rs2071430) genotype (54%). The patients who had ≥3 of the protective genotypes from the myxovirus resistance protein, the suppressor of cytokine signaling 3 and osteopontin had a greater than 90% probability of achieving a sustained response (p<0.0001). The C/C IL28B genotype was present in 58.8% of the subjects in this group. The sustained virological response rates increased to 85.7% and 91.7% by analyzing C/C IL28B with the T/T osteopontin genotype at rs11730582 and the G/G suppressor of cytokine signaling 3 genotype, respectively. Genetic ancestry analysis revealed an admixed population. CONCLUSION: Hepatitis C genotype 1 patients who were responders to interferon-based therapy had a high frequency of multiple protective polymorphisms in the myxovirus resistance protein, osteopontin and suppressor of cytokine signaling 3 genes. The combined analysis of the suppressor of cytokine signaling 3 and IL28B genotypes more effectively predicted sustained virologic response than IL28B analysis alone.

Polymorphisms of the cytokine genes TGFB1 and IL10 in a mixed-race population with Crohn's disease.

BACKGROUND: Most Crohn's disease (CD) genes discovered in recent years are associated with biological systems critical to the development of this disease. TGFB1 and IL10 are cytokines with important roles in CD. The aim of this study was to evaluate the association between CD, its clinical features and TGFB1 and IL10 gene polymorphisms. METHODS: This case-control study enrolled 91 patients and 91 controls from the state of Bahia, Brazil. Five single nucleotide polymorphisms (SNPs) were studied in the TGFB1 gene (codon 10 T > C--rs1800470; codon 25 G > C--rs1800471) and IL10 gene (-1082 A > G--rs1800896; -819 T > C--rs1800871; -592 A > C--rs1800872). An analysis of the genetic polymorphisms was performed using a commercial kit. A comparison of allele frequencies and genotypes was estimated by calculating the odds ratio (OR) with a confidence interval adjusted via the Bonferroni test for a local alpha of 1%. A stratified analysis was applied for gender, race and smoking history. Patients with CD were characterized according to the Montreal classification. RESULTS: The C allele and CC genotype of the TGFB1 gene rs1800470 were both significantly associated with CD. The stratified analysis showed no confounding factors for the co-variables of gender, race and smoking history. The IL10 gene rs1800896 G allele was significantly associated with age at diagnosis of CD, while the T allele of the IL10 gene rs1800871 was significantly associated with perianal disease. The SNPs rs1800871 and rs1800872 were in 100% linkage disequilibrium. CONCLUSIONS: TGFB1 gene polymorphisms may be associated with susceptibility to the development of CD, and IL10 gene polymorphisms appear to influence the CD phenotype in this admixed population.

Myxovirus resistance, osteopontin and suppressor of cytokine signaling 3 polymorphisms predict hepatitis C virus therapy response in an admixed patient population: comparison with IL28B

OBJECTIVES: Suppressor of cytokine signaling 3, myxovirus resistance protein and osteopontin gene polymorphisms may influence the therapeutic response in patients with chronic hepatitis C, and an association with IL28 might increase the power to predict sustained virologic response. Our aims were to evaluate the association between myxovirus resistance protein, osteopontin and suppressor of cytokine signaling 3 gene polymorphisms in combination with IL28B and to assess the therapy response in hepatitis C patients treated with pegylated-interferon plus ribavirin. METHOD: Myxovirus resistance protein, osteopontin, suppressor of cytokine signaling 3 and IL28B polymorphisms were analyzed by PCR-restriction fragment length polymorphism, direct sequencing and real-time PCR. Ancestry was determined using genetic markers. RESULTS: We analyzed 181 individuals, including 52 who were sustained virologic responders. The protective genotype frequencies among the sustained virologic response group were as follows: the G/G suppressor of cytokine signaling 3 (rs4969170) (62.2%); T/T osteopontin (rs2853744) (60%); T/T osteopontin (rs11730582) (64.3%); and the G/T myxovirus resistance protein (rs2071430) genotype (54%). The patients who had ≥3 of the protective genotypes from the myxovirus resistance protein, the suppressor of cytokine signaling 3 and osteopontin had a greater than 90% probability of achieving a sustained response (p<0.0001). The C/C IL28B genotype was present in 58.8% of the subjects in this group. The sustained virological response rates increased to 85.7% and 91.7% by analyzing C/C IL28B with the T/T osteopontin genotype at rs11730582 and the G/G suppressor of cytokine signaling 3 genotype, respectively. Genetic ancestry analysis revealed an admixed population. CONCLUSION: Hepatitis C genotype 1 patients who were responders to interferon-based therapy had a high frequency of multiple protective polymorphisms in the myxovirus ...

Coassociations between IL10 polymorphisms, IL-10 production, helminth infection, and asthma/wheeze in an urban tropical population in Brazil.

BACKGROUND: Helminth infections are associated with protection against allergies. It is postulated that IL-10 production after helminth infection suppresses skin hypersensitivity and increases IgG4 production, protecting against allergies. OBJECTIVE: We aimed to determine whether IL10 polymorphisms are associated with helminth infection and the risk of wheeze and allergy. METHODS: Twelve IL10 single nucleotide polymorphisms were genotyped in 1353 children aged 4 to 11 years living in a poor urban area in Salvador, Brazil. Wheezing status, Ascaris lumbricoides and Trichuris trichiura infection, IL-10 production by peripheral blood leukocytes stimulated with A lumbricoides extract, serum total IgE levels, specific IgE levels, skin prick test responses to common aeroallergens, and IgG4 and IgE anti-A lumbricoides antibody levels were measured in all children. Association tests were performed by using logistic or linear regression when appropriate, including sex, age, helminth infection, and principal components for ancestry informative markers as covariates by using PLINK. RESULTS: Allele G of marker rs3024496 was associated with the decreased production of IL-10 by peripheral blood leukocytes in response to A lumbricoides stimulation. Allele C of marker rs3024498 was negatively associated with helminth infection or its markers. Marker rs3024492 was positively associated with the risk of atopic wheeze, total IgE levels, and skin prick test responses to cockroach. CONCLUSIONS: Our findings suggest that IL10 polymorphisms might play a role in the production of IL-10, helminth infection, and allergy. We hypothesize that polymorphisms related to protection against helminths, which would offer an evolutionary advantage to subjects in the past, might be associated with increased risk of allergic diseases.

Effect of soy protein supplementation in patients with chronic hepatitis C: a randomized clinical trial.

AIM: To evaluate the effects of soy supplementation on insulin resistance, fatty liver and alanine aminotransferase (ALT) levels in non-diabetic patients with chronic hepatitis C (CHC). METHODS: In a prospective, randomized and single-blinded clinical trial, we compared patients with CHC who had casein as a supplement (n = 80) (control group), with patients who consumed a soy supplement diet (n = 80) [intervention group (IG)]. Both groups received 32 g/d of protein for 12 wk. RESULTS: Patients' baseline features showed that 48.1% were overweight, 43.7% had abdominal fat accumulation, 34.7% had hepatic steatosis and 36.3% had an homeostasis model assessment index of insulin resistance (HOMA-IR) ≥ 3.0. Descriptive analysis showed that protein supplementation diet reduced hepatic steatosis in both groups; however, significant reductions in ALT levels occurred in the soy group. Multiple regression modeling indicated that in the presence of severe fibrosis (F3/F4), γ glutamyl transferase elevation and high density lipoprotein (HDL) reduction, the intervention group had 75% less chance of developing hepatic steatosis (OR= 0.25; 95% CI: 0.06-0.82) and 55% less chance of presenting with an ALT level ≥ 1.5 × the upper limit of normal (ULN) (OR = 0.45, 95% CI: 0.22-0.89). Soy treatment did not have any effect on insulin resistance (OR = 1.92; 95% CI: 0.80-4.83), which might be attributed to the fact that the HOMA-IR values at baseline in most of our patients were in the normal range. Advanced hepatic fibrosis, an ALT level > 1.5 × ULN and visceral fat were predictors of an HOMA-IR ≥ 3. The IG group had a reduced risk of an ALT level > 1.5 × ULN. An HOMA-IR ≥ 3.0 and HDL < 35 mg/dL were also risk factors for increased ALT. CONCLUSION: Soy supplementation decreased ALT levels and thus may improve liver inflammation in hepatitis C virus (HCV) patients; it also reduced hepatic steatosis in a subgroup of patients but did not change insulin resistance. It should be considered in the nutritional care of HCV patients.

IL28B polymorphisms are markers of therapy response and are influenced by genetic ancestry in chronic hepatitis C patients from an admixed population.

BACKGROUND: IL28B polymorphisms are predictors of therapy response in hepatitis C virus (HCV) patients. We do not know whether they are markers of treatment response in admixed populations or not. AIMS: To determine whether IL28B polymorphisms are predictors of therapy response in patients with HCV from an admixed population and are influenced by genetic ancestry. METHODS: rs12979860 and rs8099917 were genotyped in 222 HCV patients treated with pegylated interferon and ribavirin. Ancestry was determined using genetic markers. RESULTS: IL28B rs12979860 C/C was associated with sustained virological response (SVR), whereas C/T and T/T were associated with failure to therapy (P = 1.12 × 10(-5) ). IL28B rs8099917 T/T was associated with SVR, and G/G and G/T were associated with nonresponse/relapse (NR/R) (P = 8.00 × 10(-3) ). Among HCV genotype 1 patients with C/C genotype, genomic ancestry did not interfere with therapy response. Among patients with rs12979860 T/T genotype, African genetic contribution was greater in the NR/R group (P = 1.51 × 10(-3) ), whereas Amerindian and European genetic ancestry contribution were higher in the SVR group (P = 3.77 × 10(-3) and P = 2.16 × 10(-2) respectively). Among HCV type 1 patients with rs8099917 T/T, African genetic contribution was significantly greater in the NR/R group (P = 5.0 × 10(-3) ); Amerindian and European ancestry genetic contribution were greater in the SVR group. CONCLUSION: IL28B rs12979860 and rs8099917 polymorphisms were predictors of therapy response in HCV genotypes 1, 2 and 3 subjects from an admixed population. Genomic ancestry did not interfere with response to therapy in patients with rs12979860 C/C, whereas it interfered in patients with C/T and T/T genotypes. Among HCV genotype 1 rs8099917 T/T patients, genomic ancestry interfered with response to therapy.

The TNF-α -308 polymorphism may affect the severity of Crohn's disease.

OBJECTIVE: The goal of this project was to analyze the association between Crohn's disease, its clinical features, and the tumor necrosis factor alpha (TNF-α) -308 polymorphism. METHODS: This is a case-control and cross-sectional study that enrolled 91 patients with Crohn's disease and 91 controls. Patients with Crohn's disease were characterized according to the Montreal Classification, along with their clinical and surgical treatment history. Analysis of the TNF-α -308 polymorphism was performed using a commercial kit. A stratified analysis was applied using an OR (odds ratio) with a 95% confidence interval. The chi-square and Fisher's exact tests were utilized for analysis of the association between the polymorphism and the clinical features of Crohn's disease. RESULTS: The low producer predicted phenotype was present in 76.9% of Crohn's disease cases and 75.8% of controls (OR 0.94 [0.45-1.97]). The TNF2 allele and the high producer predicted phenotype were more frequent among patients with Crohn's disease penetrating behavior (p = 0.004). The TNF2 allele and the high producer predicted phenotype were also associated with a history of colectomy (p = 0.02), and the TNF2 allele was associated with small bowel resection (p = 0.03). CONCLUSIONS: The TNF-α -308 polymorphism appears to affect the severity of the disease. However, TNF-α -308 polymorphism does not appear to be important for the susceptibility in the development of Crohn's disease.

The TNF-α -308 polymorphism may affect the severity of Crohn's disease

OBJECTIVE: The goal of this project was to analyze the association between Crohn's disease, its clinical features, and the tumor necrosis factor alpha (TNF-α) -308 polymorphism. METHODS: This is a case-control and cross-sectional study that enrolled 91 patients with Crohn's disease and 91 controls. Patients with Crohn's disease were characterized according to the Montreal Classification, along with their clinical and surgical treatment history. Analysis of the TNF-α -308 polymorphism was performed using a commercial kit. A stratified analysis was applied using an OR (odds ratio) with a 95 percent confidence interval. The chi-square and Fisher's exact tests were utilized for analysis of the association between the polymorphism and the clinical features of Crohn's disease. RESULTS: The low producer predicted phenotype was present in 76.9 percent of Crohn's disease cases and 75.8 percent of controls (OR 0.94 [0.45-1.97]). The TNF2 allele and the high producer predicted phenotype were more frequent among patients with Crohn's disease penetrating behavior (p = 0.004). The TNF2 allele and the high producer predicted phenotype were also associated with a history of colectomy (p = 0.02), and the TNF2 allele was associated with small bowel resection (p = 0.03). CONCLUSIONS: The TNF-α -308 polymorphism appears to affect the severity of the disease. However, TNF-α -308 polymorphism does not appear to be important for the susceptibility in the development of Crohn's disease.

HLA-Bw4-B*57 and Cw*18 alleles are associated with plasma viral load modulation in HIV-1 infected individuals in Salvador, Brazil

Host genetic factors play an important role in mediating resistance to HIV-1 infection and may modify the course of infection. HLA-B alleles (Bw4 epitope; B*27 and B*57) as well as killer cell immunoglobulin-like receptors have been associated with slow progression of HIV-1 infection. OBJECTIVE: To evaluate the association between serological epitopes HLA-Bw4 and HLA-Bw6 and prognostic markers in AIDS. METHODS: 147 HIV-infected individuals in Bahia, Northeast Brazil, were genotyped for HLA class I locus. HLA class I genotyping was performed by hybridization with sequence-specific oligonucleotide probes following amplification of the corresponding HLA-A, HLA-B and HLA-C genes. Statistical analysis was performed using Fisher's exact and ANOVA tests for categorical and continuous variables, respectively. RESULTS: We detected a significant association (χ2 = 4.856; p = 0.018) between the presence of HLA-Bw4 and low levels of viremia. Eighteen out of the 147 HIV-infected individuals presented viremia <1,800 copies/mL and 129 presented viremia > 2,000 copies/mL. Ninety and four percent (17/18) of all individuals with viremia < 1,800 copies/mL carried HLA-Bw4, compared to 67.4 percent (87/129) of individuals with viremia > 2,000 copies/mL. Additionally, we found a significantly higher frequency of B*57 (OR = 13.94; 95 percent CI = 4.19-46.38; p < 0.0001) and Cw*18 (OR = 16.15; 95 percent CI = 3.46-75.43; p < 0.0001) alleles, favoring the group with lower viremia levels, in comparison with those with higher viral load. CONCLUSION: HLA-Bw4-B*57 and Cw*18 alleles are associated with lower level of viral load in HIV-infected Brazilian patients. These findings may help us in understanding the determinants of HIV evolution in Brazilian patients, as well as in providing important information on immune response correlates of protection for such population.

Natural killer cell receptor and HLA-C gene polymorphisms among patients with hepatitis C: a comparison between sustained virological responders and non-responders.

BACKGROUND/AIMS: Killer cell immunoglobulin-like receptors (KIR) are involved in the activation/inhibition of NK cells through an interaction with HLA class I molecules on target cells. Our study aimed to evaluate the association between KIR gene polymorphisms and the response of patients with CHC to antiviral therapy. METHODS: We compared the frequency of KIR genes, as well as that of compound KIR/HLA-C genotypes, between groups of patients with CHC who presented a sustained virological response (n=66) and who were non-responders to a combination of pegylated or standard interferon and ribavirin (n=101). KIR and HLA-C genotyping were performed using commercial kits. RESULTS: We detected a greater frequency of the KIR2DL5 gene among non-responders to antiviral therapy compared with sustained virological responders (68.3 vs. 40.9%) (P<0.001). We used multiple logistic regression analysis to determine the association between therapy response and the presence of KIR2DL5, after a control for potentially confounding variables (genotype, alcohol, fibrosis, gender, age, ethnic background and route of HCV infection). The results confirmed the strong association between the presence of KIR2DL5 and the non-response to antiviral treatment (P=0.001). CONCLUSIONS: Host genetic factors may be associated with a non-response to antiviral therapy. KIR2DL5 is a candidate gene involved in immunomodulation associated with non-response to antiviral therapy.

HLA-Bw4-B*57 and Cw*18 alleles are associated with plasma viral load modulation in HIV-1 infected individuals in Salvador, Brazil.

UNLABELLED: Host genetic factors play an important role in mediating resistance to HIV-1 infection and may modify the course of infection. HLA-B alleles (Bw4 epitope; B*27 and B*57) as well as killer cell immunoglobulin-like receptors have been associated with slow progression of HIV-1 infection. OBJECTIVE: To evaluate the association between serological epitopes HLA-Bw4 and HLA-Bw6 and prognostic markers in AIDS. METHODS: 147 HIV-infected individuals in Bahia, Northeast Brazil, were genotyped for HLA class I locus. HLA class I genotyping was performed by hybridization with sequence-specific oligonucleotide probes following amplification of the corresponding HLA-A, HLA-B and HLA-C genes. Statistical analysis was performed using Fisher's exact and ANOVA tests for categorical and continuous variables, respectively. RESULTS: We detected a significant association (χ2 = 4.856; p = 0.018) between the presence of HLA-Bw4 and low levels of viremia. Eighteen out of the 147 HIV-infected individuals presented viremia <1,800 copies/mL and 129 presented viremia > 2,000 copies/mL. Ninety and four percent (17/18) of all individuals with viremia < 1,800 copies/mL carried HLA-Bw4, compared to 67.4% (87/129) of individuals with viremia > 2,000 copies/mL. Additionally, we found a significantly higher frequency of B*57 (OR = 13.94; 95% CI = 4.19-46.38; p < 0.0001) and Cw*18 (OR = 16.15; 95% CI = 3.46-75.43; p < 0.0001) alleles, favoring the group with lower viremia levels, in comparison with those with higher viral load. CONCLUSION: HLA-Bw4-B*57 and Cw*18 alleles are associated with lower level of viral load in HIV-infected Brazilian patients. These findings may help us in understanding the determinants of HIV evolution in Brazilian patients, as well as in providing important information on immune response correlates of protection for such population.