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Biomedical subjects

M L Ferraz

Publications and source records attributed to M L Ferraz.

At least 19 recordsLinked to original sources
PubMed2001

High prevalence of hepatitis C infection in a Brazilian prison: identification of risk factors for infection.

Hepatitis C virus (HCV) causes infectious hepatitis worldwide. It is transmitted mainly by blood products and sharing of intravenous paraphernalia during illicit drug use. High prevalence rates have been described among specific groups considered to be at higher risk for HCV infection, including prison inmates. The objectives of this study were: to determine the HCV seroprevalence among inmates of Casa de Detenção de São Paulo; to identify risk factors for HCV infection; and to compare the seroprevalence of HCV to other blood borne or sexually transmitted diseases. From December, 1993, to January, 1994, a total of 779 inmates were interviewed to collect information on sociodemographic status, sexual behavior, and past experience with illicit drugs. Blood samples were obtained from 756 inmates for serological tests. 310 (41%) blood samples were positive for anti-HCV, 425 (56.2%) were negative, and 21 (2.8%) showed indeterminate results. In this population, we found a seroprevalence of 13.7% for HIV, 3.3% for syphilis (VDRL), and 68.1% for hepatitis B virus previous infection. Four variables were each identified as associated with a positive anti-HCV serologic test: a positive VDRL (OR = 2.63 IC 95% 1.08 to 6.36); a time of current imprisonment longer than 130 months (OR = 2.44 IC 95% 1.04 to 5.71); previous incarceration at Casa de Detenção de São Paulo (OR = 1.73 IC 95% 1.19 to 2.52) and; illicit drug use before admission to the Casa de Detenção de São Paulo (OR = 1.64 IC 95% 1.15 to 2.33). The seroprevalence of HCV antibodies among the study population was high (41%), indeed, one of the highest clusters of HCV infection recorded until now. Four variables were each shown to be associated with HCV infection. The simultaneous presence of these 4 variables is associated with an 82% probability of being anti-HCV positive. Although risk factor analysis indicates most HCV infections occur prior to inprisonment, initiation of control measures to prevent continued transmission after incarceration should be done.

Adult↗
PubMed1998

Prevalence of hepatitis C virus antibodies in primary glomerulonephritis in Brazil.

The association between hepatitis B virus and membranous glomerulonephritis and membranoproliferative glomerulonephritis (MPGN) was first described in 1971. Recently, a similar association between hepatitis C virus (HCV) and glomerulonephritis (GN) has been reported. We investigated the prevalence of hepatitis C serum antibodies (anti-HCV) in patients with primary GN followed up at our Nephrology Outpatient Clinic between March 1993 and November 1995. The diagnosis of primary GN was established after excluding the presence of connective tissue disease, diabetes, infectious disease, and malignancy. Anti-HCV antibodies were detected by a second-generation enzyme immunosorbent assay and HCV RNA by polymerase chain reaction. Of 81 patients with primary GN, 24 had membranous glomerulonephritis, 17 MPGN, 15 minimal-change disease, 12 focal-segmental glomerulosclerosis, 9 diffuse proliferative GN, and 4 IgA nephropathy. Anti-HCV were detected in 2 cases (2.5%), both were HCV RNA positive and had a polyclonal mixed cryoglobulinemia (IgM-IgG). These 2 cases both came from the group of 17 patients with MPGN. Biochemical investigation in these patients revealed persistent elevation of serum aminotransferase activity, and a liver biopsy specimen in 1 of them showed evidence of chronic active hepatitis. We conclude that in our setting the prevalence of anti-HCV among patients with primary GN is low, being higher (11.8%) only if we consider the patients with MPGN as the reference group. Further studies are necessary to clarify this association and to determine appropriate therapy for these patients.

Adolescent↗
PubMed1996

Fulminant hepatitis in patients undergoing liver transplantation: evidence for a non-A, non-B, non-C, non-D, and non-E syndrome.

Fulminant hepatic failure (FHF) in the absence of serum markers of hepatitis A (HAV) or B (HBV) infection or another cause is called non-A, non-B (NANB) FHF. The pathogenetic role of viral infection in NANB FHF remains controversial. To better define this relationship, we studied patients who underwent orthotopic liver transplantation (OLT) for FHF. Thirty-six patients with FHF underwent transplantation between 1987 and 1992. Pre-OLT serum was available for 24 patients, 14 with NANB FHF (all female; mean age, 32 years), and 10 (3 males, 7 females; mean age, 20 years) with a defined origin for FHF who formed the control group. Sera were tested using polymerase chain reaction for HAV, HCV, HDV, and HEV RNA and HBV DNA, and also serologically for antibodies to these viruses. In the NANB group, pre-OLT serum was negative for all viruses tested. Four patients in the control group had HBV serologically, 2 with HBV DNA in serum. One of these 4 also had hepatitis C and one hepatitis D infection. There was no difference in intensive care unit or hospital stay between the groups. The only significant difference in laboratory data was for peak creatinine pre-OLT (0.94 mg/dL in NANB v 1.62 mg/dL; P < .05). Two patients in the NANB groups and 3 in the control group required early retransplantation for graft primary nonfunction. One case of NANB FHF appeared to recur at 6 months but not after subsequent retransplantation. NANB FHF is not associated with hepatitis A, B, C, D, or E in plasma. It has a later age of onset but a similar clinical course to other forms of FHF and appears to preferentially affect women.

Adolescent↗
PubMed1996

Significance of the presence of antibodies against hepatitis C virus in asymptomatic blood donors.

In order to determine the significance of anti-hepatitis C virus (anti-HCV) antibodies in blood donors, 46 consecutive asymptomatic individuals were recruited at the blood bank of Hospital São Paulo, São Paulo, Brazil. They were submitted to an interview to collect epidemiological data and to clinical examination and blood samples were obtained for biochemical, serological and virological analysis. All patients were followed for a minimum period of six months and those with abnormal mean alanine aminotransferase (ALT) levels were submitted to a liver biopsy after giving informed consent. Hepatitis C virus RNA (HCVRNA) was detected by the polymerase chain reaction (PCR) in 22/47 (47.8%) patients and this finding was associated with parenteral risk factors (P = 0.03) and ethanol abuse (P = 0.03). HCVRNA positivity was also associated with abnormal levels of ALT (P < 0.001) and gamma-glutamyl transpeptidase (gamma-GT) (P = 0.01). Abnormal ALT levels were good marker of viremia, with 86.4% sensitivity and 79.2% specificity. Twenty-three patients with elevated mean ALT levels were submitted to a liver biopsy and histopathological changes were observed in 17 of them (73.9%). HCVRNA positivity was associated with severe forms of hepatic disease (chronic hepatitis and cirrhosis). These results indicate the need for a judicious evaluation of all anti-HCV-positive blood donors, including clinical examination, biochemical tests and liver histology when ALT is persistently elevated.

Adult↗
PubMed1995

Comparison of three different schedules of vaccination against hepatitis B in health care workers.

Health care workers (HCW) are a group at risk for hepatitis B virus (HBV) infection; as a result, vaccination is recommended. However, elevated cost of the vaccination schedule is one of the limiting factors to this approach. Our aim in this study was to evaluate alternative schedules for vaccination against hepatitis B, in order to obtain safe immunization with reduced costs. We studied 300 HCW, randomized to be submitted to one of three vaccination schedules against hepatitis B: Group A--three doses of 20 micrograms i.m. (n = 103); Group B--first dose i.d. (2 micrograms), second and third doses i.m. (20 micrograms) (n = 97); Group C--first and second doses i.d. (2 micrograms), third dose i.m. (20 micrograms) (n = 100). All individuals received recombinant vaccine at 0, 1 and 6 months. After the first dose, there was no difference among the three schedules, either in terms of anamnestic response or in seroconversion rate. After the second dose, there was statistical difference among the three schedules (A > B > C), in terms of seroconversion rates. After the third dose, seroconversion rates were 92.2% in Group A and 92.8% in group B; geometric mean titers (GMT) in Group B (789.6 UI l-1) were similar to group A (1248.0 UI l-1). Group C presented a seroconversion rate of 78% and a GMT of 323.0 UI l-1, both statistically inferior to other schedules. We concluded that the schedule applied in Group B had similar results when compared to schedule A, with estimated savings of 30% in vaccine costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Incidence of and risk factors for hepatitis B virus and hepatitis C virus infection among haemodialysis and CAPD patients: evidence for environmental transmission.

Hepatitis B virus (HBV) serum markers (HBsAg, anti-HBs, anti-HBc) and antihepatitis C antibody (anti-HCV) were prospectively followed in haemodialysis and CAPD patients. From January 1987 to January 1990, 185 patients on haemodialysis and 124 on CAPD were analysed. Among patients susceptible to HBV (69 on haemodialysis and 70 on CAPD), there were 17 HBsAg seroconversions on haemodialysis (0.19/patient-year) and 1 on CAPD (0.01/patient-year). A Cox proportional hazards model showed that haemodialysis treatment was the only risk factor significantly associated with HBV infection, thus suggesting transmission through the environment. Regarding hepatitis C, 83 anti-HCV-negative patients on haemodialysis and 46 on CAPD were followed. There were 18 seroconversions on haemodialysis (0.15/patient-year) and two seroconversions on CAPD (0.03/patient-year). Haemodialysis treatment was also the only risk factor significantly associated with a higher risk of HCV infection. The hazard ratio for HCV infection in haemodialysis patients was 5.7 compared to CAPD patients. Nevertheless, for one patient on CAPD treatment transfusions were the only possible source of HCV infection. In conclusion, both viruses were transmitted mainly through the haemodialysis environment, but the role of transfusions could not be excluded.

Adolescent↗
PubMed1989

[Histochemical study of the skeletal muscle in chronic alcoholism].

Twenty-two chronic alcoholic patients were assessed by neurologic examination and muscle biopsy. The patients manifested proximal muscular weakness to a variable extent. One case presented as an acute bout of myopathy, according to the Manual Muscle Test, MMT. The most prominent histologic feature observed was muscle atrophy (95.3%) better evidenced through the ATPase stain with the predominance of type II A fibers (71.4%). Lack of the mosaic pattern (type grouping) seen in 76% of the cases and an important mitochondrial proliferation with intrasarcoplasmatic lipid accumulation in 63% of the patients. In case of acute presentation of muscle weakness the pathological substrate is quite different, i.e. presence of myositis mainly interstitial characterized by lymphoplasmocytic infiltrate and several spots of necrosis like Zencker degeneration. Based on histologic criteria, our data suggest that: the main determinant of muscle weakness seen in chronic alcoholic patients is neurogenic in origin (alcoholic polyneuropathy); the direct toxic action of ethanol under the skeletal muscle is closely related to the mitochondrial metabolism; the so-called acute alcoholic myopathy has probably viral etiology.

Adult↗
PubMed1988

Production of anti-HBsAg monoclonal antibodies.

The production of monoclonal antibodies against the HBsAg is reported. Balb/c mice immunized against a commercial vaccine were used. Upon fusion of spleen cells from an animal having a high titer with the SP2/0 myeloma cell line, we obtained 6 stable cell lines, all of the IgG1 subclass. They showed a wide range of specificities against the classical HBsAg subtypes. These monoclonal antibodies can be used as the basis for the development of new methods for the screening and study of the hepatitis B virus.

Animals↗
PubMedDate not supplied

Hepatitis B vaccine--proposal for a standardized assessment of immune response.

The authors developed a comparative study of the various methods of assessment of immune response to Hepatitis B vaccine. Eighty-six health care professionals underwent a vaccination programme with three doses of plasma-derived vaccine against Hepatitis B (H-B-Vax, Merck, Sharp & Dohme) given intramuscularly. Assessment of immune response was carried out three months after the end of the programme, by radioimmunoassay (RIA) and enzyme immunoassay (EIA). The results showed that the semi-quantitative assessment of Anti-HBs antibodies by RIA or EIA was perfectly comparable to the reference method (quantitative determination of antibodies by RIA). In view of these findings, the authors suggest a standardization of assessment of immune response to the vaccine, thus permitting correct planning of booster doses and easier comparison between different studies.

Adolescent↗
PubMedDate not supplied

The value of adenosine deaminase (ADA) determination in the diagnosis of tuberculous ascites.

In order to evaluate the role of the determination of adenosine deaminase activity (ADA) in ascitic fluid for the diagnosis of tuberculosis, 44 patients were studied. Based on biochemical, cytological, histopathological and microbiological tests, the patients were divided into 5 groups: G1-tuberculous ascites (n = 8); G2-malignant ascites (n = 13); G3-spontaneous bacterial peritonitis (n = 6); G4-pancreatic ascites (n = 2); G5-miscelaneous ascites (n = 15). ADA concentration were significantly higher in G1 (133.50 +/- 24.74 U/l) compared to the other groups (G2 = 41.85 +/- 52.07 U/l; G3 = 10.63 +/- 5.87 U/l; G4 = 18.00 +/- 7.07 U/l; G5 = 11.23 +/- 7.66 U/l). At a cut-off value of > 31 U/l, the sensitivity, specificity and positive and negative predictive values were 100%, 92%, 72% and 100%, respectively. ADA concentrations as high as in tuberculous ascites were only found in two malignant ascites caused by lymphoma. We conclude that ADA determination in ascitic fluid is a useful and reliable screening test for diagnosing tuberculous ascites. Values of ADA higher than 31 U/l indicate more invasive methods to confirm the diagnosis of tuberculosis.

Adenosine Deaminase↗
PubMedDate not supplied

Autoantibodies before, during and after administration of recombinant interferon-alpha for chronic viral hepatitis.

This study was undertaken to investigate the presence of autoantibodies in patients with chronic viral hepatitis B and C, before, during and after interferon-alpha (IFN-alpha) therapy and to study their relation to dose and type of IFN-alpha and response to treatment. Fifty patients with chronic hepatitis were divided in two groups, a control-group of 21 patients (10 type B and 11 type C) who were followed for 6 months without treatment and an IFN-group consisting of 29 patients (8 type B and 21 type C) who received IFN therapy for 6 months. Serum samples were tested for a range of antibodies at the start of the study, during therapy and at the end of the 6 month period. Antibodies tested for included: antinuclear, smooth muscle, antimitochondrial, parietal cell and thyroid microsomal. Four (8%) of the total patient group had autoantibodies at the beginning of the study (two in each group). During the follow-up period no patient in the control group developed antibodies compared with 3 (11%) patients in the treatment group. Autoantibodies developed in patients treated with higher doses of IFN and were found in those patients who tended to show a poor response to IFN-therapy. Further studies are needed to establish the relationship between poor response to IFN-alpha and development of autoantibodies.

Adult↗
PubMedDate not supplied

Immunogenicity of low-dose intramuscular and intradermal vaccination with recombinant hepatitis B vaccine.

The study is a randomized trial using recombinant DNA vaccine to determine whether an intramuscular 10 micrograms dose or intradermal 2 micrograms induces satisfactory anti-HBs levels compared to the standard dose of intramuscular 20 micrograms. Participants were 359 healthy medical and nurse students randomly allocated to one of the three groups: Group I-IM 20 micrograms; Group II-IM 10 micrograms; Group III-ID 2 micrograms at 0, 1 and 6 months. Anti-HBs titres were measured after complete vaccine schedule by ELISA/Pasteur. Baseline variables were similar among groups and side effects were mild after any dose. Vaccines in the IM-10 micrograms group had seroconversion rate and geometric mean titre (GMT 2344 IU L-1), not significant different from the IM-20 micrograms group (GMT 4570 IU L-1). On the contrary, 21.4% of the ID-2 micrograms recipients mount antibody concentration below 10 IU L-1 and GMT of 91 IU L-1, a statistically significant difference compared with the standard schedule IM-20 micrograms (p < 0.001). A three dose regimen of half dose IM could be considered an appropriate schedule to prevent hepatitis B in young health adults which is of relevance to the expansion of hepatitis B vaccine programme.

Adolescent↗
PubMedDate not supplied

[The optimization of the use of economic resources for vaccination against hepatitis B in professionals in the health area].

In order to optimize the employment of financial resources to be allocated for hepatitis B vaccination programs involving health care workers, two different aspects were studied: the need of a pre-vaccination screening and the efficacy of low-doses schedules of HBV vaccine by the intradermal (ID) route. The economical analysis (a cost-minimization study) showed that when the prevalence of immune individuals is higher than 11% it is more cost-effective to perform pre-vaccination screening. This situation was observed in the employees group. For students and doctors vaccination without screening was the best approach. Regarding the schedules, 3 doses of HBV vaccine by the intramuscular (IM) route (group A) were compared to first dose by the ID route and second and third doses by the IM route (group B) and to first and second doses by the ID route and the last dose by the IM route (group C). After the third dose, soroconversion rates in groups A and B (92% and 93%, respectively) and geometric mean titers of antiHBs (1278 UI/L and 789.6 UI/L) were similar, and both were different from group A (p < 0.05), showing that alternative vaccination schedules may be cost-effective.

Brazil↗
PubMedDate not supplied

[Prevalence of serologic markers of hepatitis B and D viruses in children of the Caiabi and Txucarramãe tribes from the Indian Reservation of Xingu, central Brazil].

The medical literature has shown that the inhabitants of the Amazon region are highly affected by hepatitis B and delta viruses infection, but this has never been studied in Indian children by age group. A study of the prevalence of serological markers of hepatitis B and delta viruses in Indian children aged 0 to 14 years living in the PIX was carried out. This Park is located in Central Brazil, a region which is in the transition between the savannab to the south and the Amazon jungle to the north. To determine the prevalence of HBV and HDV markers in Indian children and to characterize the route of HBV transmission in this region. Out of the 17 tribes living in the PIX, two--the Caiabi and the Txucarramãe--were chosen because both live in the North part of the Park, but have quite different ways of life. The overall prevalence of HBV serum markers was: HBsAg, 4.5%; anti-HBs, 39.6%; anti-HBc, 44.1%; any marker of HBV, 47.3%; and anti-HDV, 0.0%. However, a striking difference in the prevalence of hepatitis B markers was observed between the two tribes: younger Caiabi children were much less affected than the Txucarramãe ones. The prevalence of HBsAg in fertile women was 12%, being anti-HBe positive. Our data suggest that HBV infection is highly prevalent among Indian children living in this Indigenous Park and vertical infection is not an important route of transmission in either tribes.

Adolescent↗