HEPATITIS B: IMMUNIZATION AND RISKS OF INFECTION IN STUDENTS DURING MEDICAL SCHOOL

Introduction: hepatitis B is a disease with significant epidemiologic relevance given its high infectivity, chronicity and carcinogenic potential. Prevention is through vaccination with subsequent verification of immunological conversion, a fact that is of unique importance for medical students and health care workers. Objective: to evaluate the degree of prevention of hepatitis B among medical students and the risk of exposure of students during the internship program in urgency and emergency services. Methodology: observational and cross-sectional study, by applying a questionnaire to students of Medicine of Universidade Federal do Paraná and Faculdade Evangélica do Paraná. Results: we obtained a total of 681 responses, from which 80,76% had been vaccinated against hepatitis B. The majority of students (62,85%) did not know their serologic status, and from the students who knew, 86,5% were immune. Regarding niddlestick accidents, 33,16% of the students who did they internship in emergency care had an accident of this kind; about half of them did not perform the appropriate follow-up. Conclusion: although the total number of students had been immunized for B virus is significant, our findings revealed an expressive number of unvaccinated students. In addition, it warns about the higher risk of infection by B virus during internship period. Therefore, it is essential to emphasize the need for greater awareness of the importance of immunization among the students.Introdução: hepatite B é uma doença com significativa relevância epidemiológica dada sua infectividade, risco de cronificação e potencial carcinogênico. Apresenta a possibilidade de prevenção através da vacinação e subsequente verificação de conversão imunológica, fato de importância ímpar para os acadêmicos de Medicina e profissionais da área de saúde. Objetivo: avaliar o grau de prevenção da hepatite B entre os graduandos de Medicina e o risco de exposição dos estudantes durante a realização de estágios em serviços de urgência e emergência. Metodologia: estudo observacional e transversal, mediante aplicação de questionário aos acadêmicos de Medicina da Universidade Federal do Paraná e Faculdade Evangélica do Paraná. Resultados: foram obtidos 681 formulários completos. 80,76% afirmaram terem sido vacinados para hepatite B. Destes, 62,85% não sabiam seu status sorológico, 86,5% dos quais eram imunes. Em relação a acidentes perfurocortantes, 33,16% dos estudantes que estagiaram em unidades de urgência e emergência tiveram algum acidente e aproximadamente metade não fez o devido acompanhamento. Conclusão: embora seja significativa a porcentagem de acadêmicos imunizados para hepatite B, o estudo demonstra também uma parcela expressiva de estudantes não vacinados. Além disto, alerta para o considerável risco de contágio do vírus B no período de treinamento em serviço, enfatizando a necessidade de maior conscientização sobre a importância da vacina entre os graduando

FECAL CALPROTECTIN: levels for the ethiological diagnosis in Brazilian patients with gastrointestinal symptoms

Background Determination of fecal calprotectin can provide an important guidance for the physician, also in primary care, in the differential diagnosis of gastrointestinal disorders, meanly between inflammatory bowel diseases and irritable bowel syndrome. Objectives The aims of the present study were to prospectively investigate, in Brazilian adults with gastrointestinal complaints, the value of fecal calprotectin as a biomarker for the differential diagnosis between functional and organic disorders and to correlate the concentrations with the activity of inflammatory bowel diseases. Methods The study included consecutive patients who had gastrointestinal complaints in which the measurement levels of fecal calprotectin were recommended. Fecal calprotectin was measured using a B&#252;hlmann (Basel, Switzerland) ELISA kit Results A total of 279 patients were included in the study, with median age of 39 years (range, 18 to 78 years). After clinical and laboratorial evaluation and considering the final diagnosis, patients were allocated into the following groups: a) Irritable Bowel Syndrome: 154 patients (102 female and 52 male subjects). b) Inflammatory Bowel Diseases group: 112 patients; 73 with Crohn&#8217;s disease; 38 female and 35 male patients; 52.1% (38/73) presented active disease, and 47.9% (35/73) had disease in remission and 39 patients with ulcerative colitis;19 female and 20 male patients; 48.7% (19/39) classified with active disease and 49.3% (20/39) with disease in remission. A significant difference (P<0.001) was observed between the median value of fecal calprotectin in Irritable Bowel Syndrome group that was 50.5 &#181;g/g (IQR=16 - 294 &#181;g/g); 405 &#181;g/g (IQR=29 - 1980 &#181;g/g) in Crohn&#8217;s disease patients and 457 &#181;g/g (IQR=25 - 1430 &#181;g/g) in ulcerative colitis patients. No difference was observed between the values found in the patients with Crohn&#8217;s disease and ulcerative colitis. Levels of fecal calprotectin were significantly lower in patients with inflammatory bowel diseases in remission when compared with active disease (P<0.001). Conclusions The present study showed that the determination of fecal calprotectin assists to differentiate between active and inactive inflammatory bowel diseases and between inflammatory bowel diseases and irritable bowel syndrome