MANIFESTAÇÕES EXTRAINTESTINAIS EM PACIENTES COM DOENÇA INFLAMATÓRIA INTESTINAL EXTRAINTESTINAL / MANIFESTATIONS IN PATIENTS WITH INFLAMATORY BOWEL DISEASE

Introdução: A doença inflamatória intestinal compreende duas formas: a retocolite ulcerativa e a doença de Crohn. As doençasinflamatórias intestinais possuem manifestações em outros órgãos e sistemas, conhecidas como manifestações extraintestinais.A relação dessas manifestações com a gravidade e estado inflamatório da doença tem grande impacto na morbimortalidadedos pacientes. Objetivo: Estimar a prevalência, tipo e fatores associados ao aparecimento das manifestações extraintestinaisem pacientes com doença inflamatória intestinal. Método: Trata-se de um estudo observacional descritivo transversal. A populaçãodo estudo foi composta por todos os pacientes com doença inflamatória intestinal assistidos em um Hospital Universitário.A coleta de dados foi realizada por meio da análise das fichas de atendimento que contêm variáveis epidemiológicas edados relacionados à doença. Grupos com e sem manifestações foram comparados quanto às variáveis identificadas. Resultados:Foram analisados 134 fichas de pacientes com todas as informações preenchidas e diagnóstico confirmado. A média deidade foi de 44,8 anos. A maioria dos pacientes era do sexo feminino (59%). A retocolite ulcerativa foi o diagnostico mais frequente(81,3%), seguido da doença de Crohn. Dentre as manifestações extraintestinais, as mais prevalentes foram as articulares,seguidas pelas dermatológicas e hepáticas. Os fatores associados à presença de manifestações extraintestinais foram osexo feminino e a retocolite ulcerativa. Conclusão: Mulheres e portadores de retocolite ulcerativa foram os grupos que apresentarammaior prevalência de manifestações extraintestinais.Palavras-chave: Prevalência. Artrite. Doença de Crohn. Colite Ulcerativa.AbstractIntroduction: Inflammatory bowel disease comprises two forms: ulcerative colitis and Crohn's disease. The inflammatory boweldiseases have manifestations in other organs and systems, known as extraintestinal manifestations. The relationship of theseevents to the severity and inflammatory condition of the disease has a significant impact on morbidity and mortality of patients.Objective: To estimate the prevalence, type and factors associated with the onset of extraintestinal manifestations in patientswith inflammatory bowel disease. Method: This is a cross-sectional observational study. The study population consisted of allpatients with inflammatory bowel disease assisted in a University Hospital. Data collection was performed by analyzing the callrecords that contain epidemiological variables and data related to the disease. Groups with and without events were comparedto the identified variables. Results: 134 patient files were analyzed with all completed and confirmed diagnosis information.The mean age was 44.8 years. Most patients were female (59%). Ulcerative colitis is the most common diagnosis (81.3%), followedby Crohn's disease. Among the extraintestinal manifestations, the most prevalent were the joint, followed by skin andliver. The factors associated with the presence of extraintestinal manifestations were females and ulcerative colitis. Conclusion:Women and patients with ulcerative colitis were the groups with the highest prevalence of intestinal manifestations.Keywords: Prevalence. Arthritis. Crohn disease. Ulcerative colitis

Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

There is increasing interest in the identification of factors associated with liver disease progression in patients infected with hepatitis C virus (HCV). We assessed host-related factors associated with a histologically advanced stage of this disease and determined the rate of liver fibrosis progression in HCV-infected patients. We included patients submitted to liver biopsy, who were anti-HCV and HCV RNA positive, who showed a parenteral risk factor (blood transfusion or intravenous drug use), and who gave information about alcohol consumption.Patients were divided into two groups for analysis: group 1 - grades 0 to 2; group 2 - grades 3 to 4. The groups were compared in terms of sex, age at the time of infection, estimated duration of infection and alcoholism. The rate of fibrosis progression (index of fibrosis) was determined based on the relationship between disease stage and duration of infection (years). Logistic regression analysis revealed that age at the time of infection (P or =40 years (median = 0.47). The main factors associated with a more rapid fibrosis progression were age at the time of infection and the estimated duration of infection. Patients who acquired HCV after 40 years of age showed a higher rate of fibrosis progression.Universidade Federal de São Paulo (UNIFESP) Department of GastroenterologyUNIFESP, Department of GastroenterologySciEL

PERCEPÇÃO SOBRE FATORES DE PROTEÇÃO CARDIOVASCULAR ENTRE ESCOLARES DO ENSINO MÉDIO / PERCEPTIONS ABOUT PROTECTIVE FACTORS FOR CARDIOVASCULAR DISEASE AMONG HIGH SCHOL STUDENTS

Introdução: A adoção de hábitos saudáveis para os fatores de proteção cardiovascular deve ser iniciada na infância e adolescência, a fim de prevenir os fatores de risco e reduzir morbimortalidade cardiovascular. No entanto, existem poucas informações sobre o grau de percepção a respeito dos fatores de proteção cardiovascular, nessas faixas etárias. Objetivo: Avaliar a percepção de hábitos saudáveis como fatores de proteção cardiovascular, entre escolares do ensino médio. Métodos: Estudo transversal para avaliar a percepção de hábitos saudáveis em escolares de ensino médio entre duas escolas distintas, pública e privada. Os escolares foram aleatoriamente investigados, utilizando o Questionário de Percepção de Hábitos Saudáveis (QPHAS). Foi utilizada a análise de regressão logística para detectar associações entre maiores percepções e as variáveis sexo, idade, série do ensino médio e tipo de escola. Resultados: Participaram 474 escolares e apenas 67% obtiveram índices iguais ou superiores a 75% de acertos para maior percepção de hábitos saudáveis. Escolares do ensino privado apresentaram maior percepção sobre os fatores de proteção cardiovascular do que os do ensino público (OR=2,2; IC 95% 1,3-3,7; p = 0,002). A percepção de hábitos saudáveis quase duplica entre as séries do ensino médio, à medida que aumenta o grau de escolaridade, até a terceira série (OR=1,8; IC 95% 1,2-2,5; p = 0,001). Conclusão: Percepções de hábitos saudáveis sobre os fatores de proteção cardiovascular aumentaram a proporção que o nível de escolaridade ficava maior e são significativamente menores em estudantes do ensino público, entre escolares em fase de transição para a vida adulta.Palavras-chave: Fatores de Risco. Comportamento do adolescente. Percepção. Doenças Cardiovasculares.AbstractIntroduction: Adoption of healthy habits towards cardiovascular protection must begin in childhood and adolescence, in order to prevent risk factors and reduce cardiovascular morbidity and mortality. However, there is lack of information about how these age groups notice cardiovascular protection factors. Objective: To evaluate the perception of healthy habits as protection factors for cardiovascular disease among high school students. Methods: Cross-sectional study evaluating the perception of healthy habits in high school students between two distinct schools, a public school and a private school. Students were randomly investigated using the Questionnaire of Perception of Healthy Habits (QPHAS). Logistic regression analysis was used to detect associations between higher perceptions and sex, age, high school year and type of school. Results: 474 students participated and only 67% obtained rates equal or greater than 75% of correct responses for perception of healthy habits. Private school students had higher perception of risk factors for cardiovascular protection than public school students (OR = 2.2, 95% CI 1.3 to 3.7, p = 0.002). Perception of healthy habits almost doubles among high school grades as level of education increases (OR = 1.8, 95% CI 1.2-2.5, p = 0.001). Conclusion: Perception of healthy habits concerning protection factors for cardiovascular disease increases along the education level, and is significantly lower in public school students in transition to adulthood.Keywords: Risk factors. Adolescent behavior. Perception. Cardiovascular diseases

High incidence of tuberculosis in patients treated for hepatitis C chronic infection

AbstractBrazil is one of the 22 countries that concentrates 80% of global tuberculosis cases concomitantly to a large number of hepatitis C carriers and some epidemiological risk scenarios are coincident for both diseases. We analyzed tuberculosis cases that occurred during α-interferon-based therapy for hepatitis C in reference centers in Brazil between 2001 and 2012 and reviewed their medical records. Eighteen tuberculosis cases were observed in patients submitted to hepatitis C α-interferon-based therapy. All patients were human immunodeficiency virus-negative. Nine patients (50%) had extra-pulmonary tuberculosis; 15 (83%) showed significant liver fibrosis. Hepatitis C treatment was discontinued in 12 patients (67%) due to tuberculosis reactivation and six (33%) had sustained virological response. The majority of patients had a favorable outcome but one died. Considering the evidences of α-IFN interference over the containment of Mycobacterium tuberculosis, the immune impairment of cirrhotic patients, the increase of tuberculosis case reports during hepatitis C treatment with atypical and severe presentations and the negative impact on sustained virological response, we think these are strong arguments for latent tuberculosis infection screening before starting α-interferon-based therapy for any indication and even to consider IFN-free regimens against hepatitis C when a patient tests positive for latent tuberculosis infection

PREVALÊNCIA DE MARCADORES SOROLÓGICOS DO VÍRUS DA HEPATITE B (HBV) NOS MUNICÍPIOS DE URBANO SANTOS, AXIXÁ, HUMBERTO DE CAMPOS, MORROS E ICATU: RESULTADOS PARCIAIS DE UM ESTUDO DE BASE POPULACIONAL

As hepatites virais são doenças que apresentam distribuição universal. No Brasil, há grande variação regional na prevalência de cada hepatite. A prevalência da infecção pelo vírus da hepatite B (HBV) nas capitais do Nordeste é de 0,5%. Não há informações sobre a prevalência desta infecção no estado do Maranhão. Em estudo realizado no ano de 2010 com pacientes do Maranhão observou-se que muitos portadores do HBV eram provenientes dos municípios de Urbano Santos, Axixá, Morros, Icatu e Humberto de Campos. Esta maior frequência também já vinha sendo observada pelo Programa de Hepatites Virais da Secretaria Estadual de Saúde. Essas observações sugerem que esta é uma região onde a prevalência do HBV pode ser maior que a descrita para a região Nordeste do Brasil. Este trabalho objetiva identificar os indivíduos com sorologia positiva para os marcadores do HBV (HBsAg, anti-HBc total e anti-HBs). Trata-se de um estudo de prevalência com base em uma população definida. A amos-tra é composta por 4.000 pessoas residentes nos municípios citados. Os pacientes foram entrevistados mediante um questionário epidemiológico, demográfico e clínico. Posteriormente foram coletadas amos-tras de sangue para realização dos exames sorológicos e moleculares. Das 871 amostras testadas até o momento, a prevalência do HBsAg foi de 2.99%. As prevalências de anti-HBc total e anti-HBs foram 32.53% e 40.34%, respectivamente. Anti-HBs isoladamente positivo esteve presente em 19.63%. Esta prevalência do HBsAg identificada até o momento sugere que aquela região tenha uma endemicidade intermediária para infecção crônica pelo HBV.Palavras-chave: Hepatite. Prevalência. Maranhão.  PREVALENCE OF SEROLOGIC MARKERS OF HEPATITIS B VIRUS (HBV) IN THE TOWNS OF URBANO SANTOS, AXIXÁ, HUMBERTO DE CAMPOS, MORROS AND ICATÚ: PARTIAL RESULTS OF A POPULATIONAL SURVEY ABSTRACT: Viral hepatitis is a disease that presents universal distribution. In Brazil there is substantial regional variation in the prevalence of each hepatitis. The prevalence of infection with hepatitis B virus (HBV) in the capitals of the Northeast is 0.5%. There is no information about the prevalence of this infec-tion in the state of Maranhão. In a study conducted in 2010 patients with Maranhão be noted that many HBV carriers were from the cities of Urbano Santos, Axixá, Morros, Icatu and Humberto de Campos. This increased frequency also was already being observed by the State Department of Health Viral Hepatitis Program. These observations suggest that this is a region where the prevalence of HBV may be greater than that described for the Northeast region of Brazil. This paper intends to identify individuals with positive serology for HBsAg markers, anti-HBc and anti-HBs in HBV. This is a prevalence study based on a defined population. The sample consists of 4,000 people living in that cities. Patients were interviewed using an epidemiological, demographic and clinical questionnaire. Subsequently, blood samples were collected to measure the serological and molecular tests. Among 871 samples examined so far, the prevalence of HB-sAg was 2.99% so far. The prevalence of anti-HBc and anti-HBs were 32.53% and 40.34%, respectively. Positive isolated anti-HBs was present in 19.63%. This prevalence of HBV infection, detected so far in the study, identifies this region as intermediate endemicity.KEYWORDS: Hepatitis. Prevalence. Maranhão State PREVALENCIA DE MARCADORES SEROLÓGICOS DEL VIRUS DE HEPATITIS B (HBV) EN LOS MUNICIPIOS DE URBANO SANTOS, AXIXÁ, HUMBERTO DE CAMPOS, MORROS E ICATÚ: RESULTADOS PARCIALES DE UN ESTUDIO CON BASE EN LA POBLACIÓN.RESUMEN: Las hepatitis virales son enfermedades que presentan distribución universal. En Brasil, hay gran variación regional en la prevalencia de cada hepatitis. La prevalencia de la infección por el virus de hepatitis B (HBV) en las capitales del Nordeste es de 0,5%. No hay informaciones sobre la prevalencia de esta infección en el Estado de Maranhão. En estudio realizado en el año de 2010 con pacientes de Maranhão se observó que muchos portadores de HBV eran provenientes de los municipios de Urbano Santos, Axixá, Morros, Icatú y Humberto de Campos. Esta mayor frecuencia también ya estaba siendo observada por el Programa de Hepatitis Virales de la Secretaría Estadual de Salud. Estas observaciones sugieren que esta es una región donde la prevalencia de la HBV puede ser mayor que la descrita para la región Nordeste de Brasil. Este trabajo busca identificar a los individuos con serología positiva para los marcadores HBsAg, anti-HBc total y anti-HBs de la HBV. Se trata de un estudio de prevalencia con base en una población definida. La muestra es compuesta por 4.000 personas residentes en los municipios de Urbano Santos, Axixá, Humberto de Campos, Morros e Icatú. Los pacientes fueron entrevistados me-diante un cuestionario epidemiológico, demográfico y clínico. Posteriormente fueron recogidas muestras de sangre para realización de los exámenes serológicos y moleculares. De las 871 serologías realizadas, la prevalencia de HBsAg fue de 2.99%. Las prevalencias de anti-HBc Total y anti-HBs fueron 32.53% y 40.34%, respectivamente. Anti-HBs aisladamente positivo estuvo presente en 19.63%. La prevalencia de2.99% de la infección por la HBV, detectada hasta el momento por el estudio, identifica esta región como de endemicidad intermediaria.PALABRAS CLAVE: Hepatitis. Prevalencia. Maranhão

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 < 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

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p 465 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.Univ Sao Paulo, Fac Med, Dept Molestias Infecciosas & Parasitarias, Sao Paulo, SP, BrazilUniv Fed Rio de Janeiro, Rio De Janeiro, RJ, BrazilCtr Referencia & Treinamento DST Aids, Sao Paulo, SP, BrazilCDH, Rio De Janeiro, RJ, BrazilHosp Fed Servidores Estado Rio de Janeiro HFSE, Setor Gastrohepatol, Rio De Janeiro, RJ, BrazilUniv Sao Paulo, Fac Med, Dept Gastroenterol & Hepatol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Disciplina Gastroenterol, EPM, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Disciplina Infectol, Sao Paulo, SP, BrazilUniv Sao Paulo, FMRP, Dept Clin Med, Div Gastroenterol, Sao Paulo, SP, Brazil| Univ Fed do Maranhao UFMA, HUPD, Ctr Pesquisa Clin, Sao Luis, MA, BrazilUniv Fed Estado Rio de Janeiro UNIRIO, Disciplina Clin Med & Gastroenterol, Rio De Janeiro, RJ, BrazilUniv Fed Rio do Grande Sul UFRGS, Dept Med Interna, Porto Alegre, RS, BrazilUniv Fed Espirito Santo, Ambulatorio HIV AIDS Hepatites Virais, Vitoria, ES, BrazilSMS, Ctr Orientacao & Aconselhamento, Foz Do Iguacu, PR, BrazilUniv Estado Rio de Janeiro UERJ, Serv Gastroenterol, Rio De Janeiro, RJ, BrazilIMT, Lab Virol LIM 52, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Disciplina Gastroenterol, EPM, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Disciplina Infectol, Sao Paulo, SP, BrazilWeb of Scienc

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%,

Efficacy and safety of glecaprevir/pibrentasvir in treatment-naïve adults with chronic hepatitis C virus genotypes 1–6 in Brazil

Introduction and objectives: Glecaprevir/pibrentasvir is a highly effective and well tolerated treatment for hepatitis C infection. Brazilian patients were not included in the original development studies for glecaprevir/pibrentasvir. This study aimed to assess safety and efficacy of glecaprevir/pibrentasvir in treatment-naïve Brazilian adults without cirrhosis or with compensated cirrhosis. Patients and methods: EXPEDITION-3 was a Phase 3, open-label, multicenter study in treatment-naïve Brazilian adults with hepatitis C infection genotype 1–6. Patients without cirrhosis (F2 or F3) or with compensated cirrhosis (F4) received 8 or 12 weeks of glecaprevir/pibrentasvir, respectively. The primary efficacy endpoint was the rate of sustained virologic response at post-treatment Week 12. Secondary endpoints were on-treatment virologic failure and relapse rates. Baseline polymorphisms were assessed in NS3 and NS5A. Adverse events and laboratory abnormalities were monitored. Results: 100 patients were enrolled, 75 received 8 weeks of treatment and 25 received 12 weeks; all patients completed treatment. Overall sustained virologic response at post-treatment Week 12 rate was high (98.0%; 98/100; 95% confidence interval: 93.0–99.4) and remained high regardless of baseline viral or host factors, including demographics, hepatitis C virus RNA levels, polymorphisms in NS3 and/or NS5A, genotype, and relevant comorbidities. 55% of patients reported ≥1 adverse event, the most common beingheadache (18.0%). Four patients reported serious adverse events; none were considered drug related orled to study drug discontinuation. No hepatic decompensations were observed.Conclusions: Glecaprevir/pibrentasvir was effective and well tolerated in treatment-naïve Brazilianpatients with hepatitis C infection without cirrhosis and with compensated cirrhosis