Tratamento com interferon beta-1a em mielopatia associada ao HTLV-1/paraparesia espástica tropical: relato de caso

Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved.Descreve-se caso de mielopatia associada ao HTLV-1/paraparesia espástica tropical tratada com interferon beta-1a em paciente jovem de 21 anos e com história de dermatite infecciosa na infância. Foi estabelecida clinicamente paraparesia espástica tropical (HAM/TSP), confirmada laboratorialmente pela presença de anticorpos para HTLV-1 no LCR e excluídas caxumba, citomegalovirus, Epstein-Barr, esquistossomose, herpes virus 1 e 2, rubéola, sarampo, toxoplasmose varicela-zoster, hepatite, HIV e sífilis por sorologias. Foi diagnosticada bexiga neurogênica, com quadro clínico de nictúria, urgência urinária, parestesia no membro inferior esquerdo e discreta redução de força muscular nos membros superiores, mais acentuada nos membros inferiores. Na 4a semana de tratamento com interferon beta-1a houve desaparecimento da urgência urinária e da parestesia e melhora da clínica motora

High prevalence of hepatitis B virus and low vaccine response in children and adolescents in Northeastern Brazil

Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson’s regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p &lt; 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations

CÂNCER DE COLO DO ÚTERO, GENOTIPAGEM DO PAPILOMA VÍRUS HUMANO (HPV) EM MULHERES QUILOMBOLAS DE UM MUNICÍPIO BRASILEIRO: ACEITABILIDADE DA VACINA

O câncer de colo uterino é o segundo câncer feminino mais comum no Brasil. O papilomavírus humano (HPV) é causa necessária para seu desenvolvimento. A vacina surge como uma arma contra a infecção por HPV e, consequentemente, contra o câncer. Mas existem mais de 100 genótipos diferentes de HPV, que são divididos em baixo risco e alto risco, de acordo com o potencial oncogênico. Analisam-se os aspectos epidemiológicos e biomoleculares da infecção por HPV na mucosa genital de mulheres qui-lombolas, verificando a associação os achados citológicos e biomoleculares e observando a frequência do papilomavírus nessa população e de seus tipos, para avaliar a aplicabilidade da vacina na população em estudo. A população deste estudo é de 101 mulheres pertencentes à comunidade quilombola de Ju-çatuba, no estado do Maranhão. Foram coletadas amostras de mucosa genital, submetidas à pesquisa para a presença do HPV pela técnica de PCR Nested. As amostras positivas foram sequenciadas para fins de genotipagem viral. Em uma população predominante de mulheres em idade fértil, com parceiro fixo e baixo nível de escolaridade, verificou-se que 10 amostras da cérvice uterina foram positivas paraHPV, sendo 7 positivas para os tipos de alto risco. Mediante a presença dos tipos virais de alta oncoge-nicidade, observa-se a necessidade de implementação de condutas gestoras para redução do risco de aparecimento de câncer do colo do útero.Palavras-chave: Papilomavírus humano. Câncer. Colo uterino. Reação em cadeia da polimerase.CANCER OF THE CERVIX, GENOTYPING OF HUMAN PAPILLOMAVIRUS (HPV) IN QUILOMBOLA WOMEN IN A BRAZILIAN CITY: ACCEPTABILITY OF THE VACCINE.ABSTRACT: Cervical cancer is the second most common female cancer in Brazil. The human papilloma-virus (HPV) is a need cause for its development. The vaccine appears as a weapon against HPV infection and therefore against cancer. But there are more than 100 different HPV genotypes, which are divided into low risk and high risk according to the oncogenic potential. To analyze the epidemiological and biomolecu-lar aspects of HPV infection in the genital mucosa of women Maroons, verifying the association cytological and molecular biological findings and noting the frequency of this population papillomavirus and its types, to evaluate the applicability of the vaccine in the study population. The study population was 101 women belonging to the maroon community of Juçatuba in the state of Maranhão. Genital mucosa samples were collected and submitted to search for the presence of HPV by PCR Nested. The positive samples were sequenced for the purpose of viral genotyping. In a predominant population of women of childbearing age, with a steady partner, and low level of education, it was found that 10 samples of uterine cervix were positive for HPV, with 7 positive for high-risk types. Through the presence of viral types of high tumorige-nicity, there is a need to implement management practices for reducing the risk of developing cancer of the cervix.KEYWORDS: Human Papillomavirus. Cancer. Cervix. Polymerase Chain Reaction.EL CÁNCER DEL CUELLO UTERINO, LA GENOTIPIFICACIÓN DEL VIRUS DEL PAPILOMA HUMANO (VPH) EN MUJERES QUILOMBOLAS EN UNA CIUDAD BRASILEÑA: LA ACEPTABILIDAD DE LA VACUNA.RESUMEN: El cáncer cervical es el segundo cáncer femenino más común en Brasil. El virus del papiloma humano (VPH) es la causa necesaria para su desarrollo. La vacuna se presenta como un arma contra la infección por VPH y, por tanto, contra el cáncer. Pero hay más de 100 genotipos diferentes de VPH, que se dividen en bajo riesgo y de alto riesgo de acuerdo con el potencial oncogénico. Analizar los aspectos epidemiológicos y biomoleculares de la infección por el VPH en la mucosa genital de la mujer cimarrones, la verificación de la citología asociación y hallazgos de biología molecular y tomando nota de la frecuen-cia de este virus del papiloma de la población y sus tipos, para evaluar la aplicabilidad de la vacuna en la población de estudio. La populación de estudio fue de 101 mujeres pertenecientes a la comunidad marrón de Juçatuba en el Estado de Maranhão. Se recogieron muestras de mucosa genital presentados para buscar la presencia de VPH por PCR anidada. Las muestras positivas se secuenciaron con el propósito de determinación del genotipo viral . RESULTADOS: En una población predominante de las mujeres en edad fértil, con una pareja estable, y el bajo nivel de la educación, se encontró que 10 muestras fueron positivas para el VPH cervical, 7 siendo positivo para los tipos de alto riesgo. A través de la presencia de tipos virales de alta tumorigenicidad, hay una necesidad de aplicar prácticas de gestión para reducir el riesgo de desarrollar cáncer de la cérvix.PALABRAS CLAVE: Virus del papiloma humano. Cáncer. Cérvix. Reacción en Cadena de la Polimerasa