Narrative impairment, white matter damage and CSF biomarkers in the Alzheimer's disease spectrum.

BACKGROUND: Narrative discourse (ND) refers to one's ability to verbally reproduce a sequence of temporally and logically-linked events. Impairments in ND may occur in subjects with Amnestic Mild Cognitive Impairment (aMCI) and Alzheimer's Disease (AD), but correlates across this function, neuroimaging and cerebrospinal fluid (CSF) AD biomarkers remain understudied. OBJECTIVES: We sought to measure correlates among ND, Diffusion Tensor Imaging (DTI) indexes and AD CSF biomarkers in patients within the AD spectrum. RESULTS: Groups differed in narrative production (NProd) and comprehension. aMCI and AD presented poorer inference abilities than controls. AD subjects were more impaired than controls and aMCI regarding WB (p<0.01). ROIs DTI assessment distinguished the three groups. Mean Diffusivity (MD) in the uncinate, bilateral parahippocampal cingulate and left inferior occipitofrontal fasciculi negatively correlated with NProd. Changes in specific tracts correlated with T-tau/Aß1-42 ratio in CSF. CONCLUSIONS: AD and aMCI patients presented more ND impairments than controls. Those findings were associated with changes in ventral language-associated and in the inferior parahippocampal pathways. The latest were correlated with biomarkers' levels in the CSF. METHODS: AD (N=14), aMCI (N=31) and Control (N=39) groups were compared for whole brain (WB) and regions of interest (ROI) DTI parameters, ND and AD CSF biomarkers.

Hepatitis C virus transfusion-transmitted infection in Brazilian cardiac surgery patients.

In the past two decades, major improvements in blood safety have been achieved, particularly for HIV and hepatitis C virus (HCV). A prospective study was carried out between 1996 and 1999 in Brazil to determine the incidence of post-transfusion infection in surgery patients caused by HCV. One hundred sixty-four patients who received a blood transfusion during cardiac surgery were followed for six months and blood samples collected before and after surgery were assessed to investigate HCV infection. Alanine aminotransferase levels were serially determined, as well as clinical data related to hepatitis. Prior to surgery, HCV infection was detected by anti-HCV ELISA III in 6 patients. Any post-surgical samples which were positive by a third generation ELISA test were confirmed by immunoblot and reverse-transcription polymerase chain reaction (RT-PCR), as were the pre-transfusion samples to exclude pre-transfusion HCV infection not detected by ELISA screening. Results indicated that one patient who was previously considered negative for HCV antibody in the pre-surgical sample was later found to be positive for HCV by RT-PCR in that sample. Seroconversion for HCV antibody after surgery was observed in two patients, one of them with clinical hepatitis; their genotypes were 1a and 1b. The overall prevalence of HCV infection was 4.26% (7/164) and the incidence rate of HCV infection after surgery was 1.27% (2/157). This study shows a high rate of HCV infection acquired post-transfusion in a cohort of surgery patients in Brazil and suggests that better screening methods such as viral RNA assessment may be effective in lowering this rate.

[Prevalence of hepatitis C in patients with systemic lupus erythematosus in the Hospital of Federal University of Rio de Janeiro (HUCCF)]. / Prevalência de hepatite C em pacientes com lúpus eritematoso sistêmico do HUCCF-UFRJ.

BACKGROUND: Patients with systemic lupus erythematosus (SLE) are at risk for the acquisition of hepatitis C, owing to frequent hospitalization and hemotransfusion. Many clinical and laboratory manifestations related to auto-immunity are shared between Lupus and HCV infected patients. OBJECTIVE: To determine the prevalence of hepatitis C in the population with SLE monitored in the out-patient service of the special programs in--Collagenoses--of the University Hospital Clementino Fraga Filho (HUCFF-UFRJ). METHODS: A Cross sectional study was performed, including 91 patients with the diagnosis of probable or definitive SLE (with 3 or more of the 11 diagnostic criteria for SLE used by the American College of Rheumatology-ACR) proceeding from the mentioned center between April/97 to September/97. Patients were evaluated on clinical and laboratory basis to determine activity of lupus disease (SLEDAI). All of patients were tested with UBI HCVEIA 4.0 assay and INNO-LIAHCV AbIII confirmatory assay. PCR was performed on all EIA positive INNO-LIAHCV AbIII assay positive patients besides 32 patients negatives in both serological assays. RESULTS: A significative increase in HCV prevalence among SLE patients was observed when compared with a control group of blood donors at HUCFF-UFRJ (6.6 and 1.39%, respectively; p = 0.02 and confidence interval of 95% = 5.5-13.8). However, if confirmative assays (INNO-LIA HCV ABIII and PCR) are used, this difference can not be observed any more HCV prevalence of 2.2% with confidence interval of 95% = 0.2-7.7). CONCLUSIONS: HCV prevalence using ELISA assay for screening showed a significant difference between SLE patients and a blood donors control group (6.6 and 1.39% respectively). However, if confirmatory assays are subsequently applied, no difference in HCV prevalence among both groups can be observed. Patients with a possible diagnosis of SLE should have a cost/benefit analysis of testing for HCV.

Prevalência de hepatite C em pacientes com lúpus eritematoso sistêmico do HUCCF-UFRJ / Prevalence of Hepatitis C in patients with Systemic Erythematosus Lupus of Hospital of Federal University of Rio de Janeiro (HUCFF)

Os pacientes com lúpus eritematoso sistêmico (LES) apresentam fatores de risco para a aquisiçäo de hepatite C, como hospitalizaçöes e hemotransfusöes, e compartilham com os pacientes infectados pelo vírus da hepatite C (HCV) várias manifestaçöes clínico-laboratoriais relacionadas a auto-imunidade. OBJETIVOS: O objetivo do presente estudo é determinar a prevalência de hepatite C em uma populaçäo com LES acompanhada no ambulatório de programas especiais - Colagenoses - do Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ). MÉTODOS: Foi realizado um estudo de corte-transversal, incluindo os primeiros 91 pacientes com o diagnóstico de LES provável ou definitivo procedentes do referido ambulatório, no período de abril a setembro de 1997. Todos os doentes foram avaliados, sob o ponto de vista clínico e laboratorial, para determinaçäo de atividade de doença lúpica. Foram realizados o teste de triagem UBI HCV EIA 4.0 e o teste suplementar INNO-LIA HCV AbIII nos 91 pacientes selecionados e , em 32 pacientes escolhidos ao acaso e nos pacientes reativos aos testes imunossorológicos foi realizada a pesquisa do RNA-HCV pelo método da reaçäo de polimerizaçäo em cadeia (PCR). RESULTADOS: Observou-se um aumento significativo da prevalência de anti-HCV na amostra, quando comparada à populaçäo de doadores de sangue do HUCFF (6,6 por cento versus 1,39 por cento com o teste EIA, valor p=0,02 e intervalo de confiança 95 por cento=5,5 a 13,8), contudo , considerando-se resultados obtidos com os testes confirmatórios imunoblot e PCR aplicados em série ( prevalência de HCV de 2,2 por cento, com intervalo de confiança 95 por cento=0,2 a 7,7) , a prevalência de HCV em pacientes com LES näo parece mais alta que em doadores de sangue. CONCLUSÖES: A prevalência de hepatite C na amostra estudada utilizando-se um teste de triagem (EIA) foi significativamente maior do que a de uma populaçäo de doadores de sangue (6,6 por cento versus 1,39 por cento). Porém, aplicando-se em série os testes confirmatórios INNO-LIAâ e PCR ( prevalência de hepatite C de 2,2 por cento) parece näo haver evidências de que pacientes com LES tenham maior risco de adquirir o HCV do que a populaçäo em geral, embora a prevalência tende a ser maior que a populaçäo de doadores de sangue. Em pacientes com diagnóstico provável de LES deve-se avaliar o custo/benefício de se investigar HCV e crioglobulinemia mista essencial (CME)