Abstract: INTRODUCTION: Hepatitis B and C viral infections remain an important cause of global morbidity and mortality. Studies have been conducted in population groups of large cities, leaving gaps in the knowledge regarding the situation in small municipalities. We aimed to measure the prevalence of hepatitis B and C markers and presence of infection-associated factors. METHODS: All inhabitants of Cássia dos Coqueiros aged ≥18 years who agreed to participate in the research were included. We collected blood as well as information via a questionnaire between March 2011 and December 2013. Univariate and multivariate analyses were conducted. RESULTS: Among the 1,001 participants, 41 (4.1%) participants had a serological profile of hepatitis B viral exposure, and only one (0.1%) participant was considered a virus carrier. The frequency of isolated antibody to hepatitis B virus surface antigen (anti-HBs) markers was 17.8% for the overall population. In the multivariate analysis, hepatitis B virus (HBV) infection was associated with age, birth outside the State of São Paulo, history of hepatitis, ≥2 sexual partners in the last 6 months, and tattoos. Four (0.4%) participants had a serological profile of hepatitis C viral exposure. However, after confirmation using viral ribonucleic acid (RNA) evaluation, only one (0.1%) individual remained positive. CONCLUSIONS: The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.

ABSTRACTINTRODUCTION:Although deaf people are exposed to hepatitis B and C risk factors, epidemiological studies regarding these diseases in deaf people are lacking.METHODS:After watching an explanatory digital versatile disc (DVD) in Brazilian Sign Language, 88 deaf people were interviewed and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), and hepatitis C virus antibody (anti-HCV).RESULTS:The prevalence of hepatitis B markers was 8%; they were associated with incarceration and being born outside the State of São Paulo. No cases of hepatitis C were identified.CONCLUSIONS:Participants showed a substantial lack of knowledge regarding viral hepatitis, indicating a need for public policies that consider linguistic and cultural profiles.

Introduction Pseudomonas aeruginosa isolates related to nosocomial infections are often resistant to multiple antibacterial agents. In this study, antimicrobial combinations were evaluated to detect in vitro synergy against clinical isolates of P. aeruginosa. Methods Four clinical P. aeruginosa isolates were selected at random among other isolates from inpatients treated at the public University hospital in Ribeirão Preto, SP, Brazil. Two isolates were susceptible to imipenem (IPM-S) and several other antimicrobials, while the other two isolates were imipenem and multidrug resistant (IPM-R). The checkerboard method was used to assess the interactions between antimicrobials. Results Combinations of imipenem or other anti-Pseudomonas drugs with complementary antibiotics, such as aminoglycosides, fosfomycin and rifampin, reached synergy rates of 20.8%, 50%, 62.5% and 50% for the two IPM-S and two IPM-R Pseudomonas isolates, respectively. Imipenem, piperacillin-tazobactam and ceftazidime yielded a greater synergy rate than cefepime or ciprofloxacin. Synergist combinations were more commonly observed when the complementary drug was tobramycin (65%) or fosfomycin (57%). Conclusions Some antibacterial combinations led to significant reductions of the minimum inhibitory concentrations of both drugs, suggesting that they could be clinically applied to control infections caused by multidrug-resistant P. aeruginosa.

FUNDAMENTOS - Anticorpos antifosfolípides (AAF), como antiβ2GP1 (β2-glicoproteína 1), são descritos na hanseníase multibacilar (MB) sem, contudo, caracterizar a síndrome do anticorpo antifosfolípide (SAF), constituída por fenômenos tromboembólicos (FTE). A mutação Val247Leu no V domínio da β2GP1 - substituição da leucina por valina - expõe epítopos crípticos com consequente formação de anticorpos antiβ2GP1. OBJETIVO: Avaliar a associação do polimorfismo Val247Leu do gene β2GP1 com títulos de anticorpos antiβ2GP1 na hanseníase. MÉTODO: O polimorfismo Val247Leu foi detectado por PCR-RFLP, e os títulos de anticorpos antiβ2GP1, por Elisa. RESULTADOS: O genótipo Val/Val estatisticamente predominou no grupo de hansênicos, em relação ao controle. Embora maiores títulos de anticorpos antiβ2GP1 IgM estivessem alocados no grupo MB com genótipos Val/Val e Val/Leu, não houve diferença estatística em relação ao genótipo Leu/Leu. Dos sete pacientes MB com FTE, quatro apresentaram heterozigose, e três Val/Val homozigose. CONCLUSÃO: A prevalência do genótipo Val/Val no grupo de hansênicos pode justificar parcialmente a presença de anticorpos antiβ2GP1 na forma MB. A heterozigose ou homozigose Val/Val nos sete pacientes com hanseníase MB e FTE corroboram a implicação de expressão fenotípica anômala da β2GPl e formação de anticorpos antiβ2GPl, com consequente FTE e SAF.

BACKGROUND - Multibacillary (MB) leprosy may be manifested with antiphospholipid antibodies (aPL), among which anti-β2GP1 (β2-glycoprotein 1). High titers of aPL are associated with APS (Antiphospholipid Syndrome), characterized by thrombosis. The mutation Val247Leu in the domain V of β2GP1 exposes hidden epitopes with consequent development of anti-β2GP1 antibodies. OBJECTIVE: To evaluate the Val247Leu polymorphism of β2GP1 gene and its correlation with anti-β2GP1 antibodies in leprosy patients. METHODS: The Val247Leu polymorphism was performed by PCR-RFLP and anti-β2GP1 antibodies were measured by ELISA. RESULTS: The genotypic Val/Val was more prevalent in the leprosy group, compared to controls. Regarding the 7 MB patients with APS, four presented heterozygosis and three, Val/Val homozygosis. Although higher titrations of anti-β2GP1 IgM antibodies were seen in MB leprosy group with Val/Leu and Val/Val genotypes, there was no statistical difference when compared to Leu/Leu genotype. CONCLUSION: The prevalence of Val/Val homozygosis in leprosy group can partially justify the presence of anti-β2GP1 IgM antibodies in MB leprosy. The description of heterozygosis and Val/Val homozygosis in 7 patients with MB leprosy and thrombosis corroborates the implication of anomalous phenotype expression of β2GP1 and development of anti-β2GP1 antibodies, with consequent thrombosis and APS.

This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5%), reaching 50.8% in the professionals. The overall prevalence for hepatitis C was 7.2%, with values of 11% among professionals and 5.5% among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36% and 0.8% among amateurs; 21.9% and 0% among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.

OBJETIVOS: Estimar a prevalência de marcadores de hepatite B e estudar os fatores de risco para esta doença entre mulheres profissionais do sexo na cidade de Ribeirão Preto, Brasil. MÉTODOS: Foi aplicado um questionário a 449 mulheres profissionais do sexo, com a finalidade de levantar informações demográficas, socioeconômicas e comportamentais. Amostras de sangue das participantes foram analisadas através de técnicas imunoenzimáticas, para detecção dos marcadores HBsAg, anti-HBs e anti-HBc. RESULTADOS: A idade média das participantes foi 23 anos, variando de 13 a 64 anos. Uma elevada mobilidade espacial foi verificada, com 47,9% delas residindo em locais fora da região de Ribeirão Preto ou em outros estados brasileiros. Completa ausência de vacinação prévia contra hepatite B foi referida por 98,2%. No total, observou-se presença de qualquer marcador de hepatite B em 106 participantes (prevalência de 23,6%; IC95%: 19,7 27,5), com 84 positivos para anti-HBs (18,7%), 100 para anti-HBc (22,3%) e apenas 3 para HBsAg (0,7%). A análise por regressão logística evidenciou associação entre marcadores de hepatite B e as seguintes co-variáveis: idade, baixo nível socioeconômico, consumo de crack, relações sexuais com indivíduos infectados pelo HIV, história de hepatite prévia, relações sexuais com pessoas portadoras de hepatite e positividade para hepatite C. CONCLUSÕES: As profissionais do sexo em Ribeirão Preto apresentam diversos fatores de risco para hepatite B e quase total ausência de vacinação prévia específica, tornando necessários esforços concentrados na aplicação dessa medida de baixo custo, preferencialmente através do uso de equipes móveis que levem a vacina até os seus locais de trabalho.

OBJECTIVE: To estimate the prevalence of hepatitis B markers and to study the risk factors for this disease among female sex workers in the city of Ribeirão Preto, Brazil. METHODS: A questionnaire was given to 449 female sex workers in order to obtain information about demographic, socioeconomic and behavioral variables. Blood samples were collected and analyzed by immunoenzymatic techniques for detection of HBsAg, anti-HBs, anti-HBc and anti-HCV markers. RESULTS: The mean age of participants was 23 years, varying from 13 to 64 years. A high spatial mobility was observed, with 47.9% of participants residing in places out of the region of Ribeirão Preto or in other Brazilian states. Complete absence of previous vaccine against hepatitis B was referred by 98.2%. Overall, the presence of any hepatitis B marker was observed in 106 participants (prevalence of 23.6%; 95% CI: 19.7 27.5), with 84 positive for anti-HBs (18.7%), 100 for anti-HBc (22.3%), and only 3 for HBsAg (0.7%). The logistic regression analysis showed association between hepatitis B markers and the following co-variables: residence in Ribeirão Preto, age, low socioeconomic level, consumption of crack, intercourse with HIV-infected individuals, history of previous hepatitis, intercourse with a case of hepatitis, and positivity for hepatitis C. CONCLUSIONS: Ribeirão Preto's female sex workers present several risk factors for hepatitis B and almost absence of previous specific vaccination, making it necessary to emphasize this low-cost preventive measure, preferably through the use of a mobile team, taking the vaccine to their places of work.

OBJETIVOS: Estimar a prevalência de marcadores de hepatite B e estudar os fatores de risco para esta doença entre mulheres profissionais do sexo na cidade de Ribeirão Preto, Brasil. MÉTODOS: Foi aplicado um questionário a 449 mulheres profissionais do sexo, com a finalidade de levantar informações demográficas, socioeconômicas e comportamentais. Amostras de sangue das participantes foram analisadas através de técnicas imunoenzimáticas, para detecção dos marcadores HBsAg, anti-HBs e anti-HBc. RESULTADOS: A idade média das participantes foi 23 anos, variando de 13 a 64 anos. Uma elevada mobilidade espacial foi verificada, com 47,9% delas residindo em locais fora da região de Ribeirão Preto ou em outros estados brasileiros. Completa ausência de vacinação prévia contra hepatite B foi referida por 98,2%. No total, observou-se presença de qualquer marcador de hepatite B em 106 participantes (prevalência de 23,6%; IC95%: 19,7 27,5), com 84 positivos para anti-HBs (18,7%), 100 para anti-HBc (22,3%) e apenas 3 para HBsAg (0,7%). A análise por regressão logística evidenciou associação entre marcadores de hepatite B e as seguintes co-variáveis: idade, baixo nível socioeconômico, consumo de crack, relações sexuais com indivíduos infectados pelo HIV, história de hepatite prévia, relações sexuais com pessoas portadoras de hepatite e positividade para hepatite C. CONCLUSÕES: As profissionais do sexo em Ribeirão Preto apresentam diversos fatores de risco para hepatite B e quase total ausência de vacinação prévia específica, tornando necessários esforços concentrados na aplicação dessa medida de baixo custo, preferencialmente através do uso de equipes móveis que levem a vacina até os seus locais de trabalho.

OBJECTIVE: To estimate the prevalence of hepatitis B markers and to study the risk factors for this disease among female sex workers in the city of Ribeirão Preto, Brazil. METHODS: A questionnaire was given to 449 female sex workers in order to obtain information about demographic, socioeconomic and behavioral variables. Blood samples were collected and analyzed by immunoenzymatic techniques for detection of HBsAg, anti-HBs, anti-HBc and anti-HCV markers. RESULTS: The mean age of participants was 23 years, varying from 13 to 64 years. A high spatial mobility was observed, with 47.9% of participants residing in places out of the region of Ribeirão Preto or in other Brazilian states. Complete absence of previous vaccine against hepatitis B was referred by 98.2%. Overall, the presence of any hepatitis B marker was observed in 106 participants (prevalence of 23.6%; 95% CI: 19.7 27.5), with 84 positive for anti-HBs (18.7%), 100 for anti-HBc (22.3%), and only 3 for HBsAg (0.7%). The logistic regression analysis showed association between hepatitis B markers and the following co-variables: residence in Ribeirão Preto, age, low socioeconomic level, consumption of crack, intercourse with HIV-infected individuals, history of previous hepatitis, intercourse with a case of hepatitis, and positivity for hepatitis C. CONCLUSIONS: Ribeirão Preto's female sex workers present several risk factors for hepatitis B and almost absence of previous specific vaccination, making it necessary to emphasize this low-cost preventive measure, preferably through the use of a mobile team, taking the vaccine to their places of work.

O diagnóstico da Leishmaniose Tegumentar Americana (LTA) é feito com base nos dados clínicos e epidemiológicos e é confirmado por meio de diferentes métodos laboratoriais. Dentre estes, são utilizados, com desempenhos variáveis, a reação de imunofluorescência indireta (IFI), a reação intradérmica de Montenegro (IRM), a pesquisa de Leishmania em material de biópsia de pele ou mucosa e a reação em cadeia da polimerase (PCR). O objetivo do presente trabalho foi avaliar o desempenho de teste imunoenzimático (ELISA) como método alternativo de diagnóstico da LTA, comparando seus resultados com os obtidos por outros métodos tradicionais de diagnóstico dessa doença. Foi utilizado teste para pesquisa de IgG anti-Leishmania no soro, utilizando antígeno bruto de Leishmania braziliensis, com os seguintes resultados de sensibilidade: ELISA = 85%; PCR = 81%; IRM = 64.4%; IFI = 58,1%; presença de parasitas na biópsia = 34%. Além disso, o teste ELISA foi positivo em parcela expressiva dos pacientes que apresentavam outros testes diagnósticos negativos (foi positivo em 100% dos pacientes com PCR negativo; em 84,8% dos casos com biópsias mostrando ausência de parasitas e em 75% dos não reativos a IRM) mostrando-se útil como método alternativo de diagnóstico da LTA.

The diagnosis of American cutaneous leishmaniasis (ACL) is frequently based on clinical and epidemiological data associated with the results of laboratory tests. Some laboratory methods are currently being applied for the diagnosis of ACL, among them the indirect immunofluorescence reaction (IIFR), the Montenegro skin test (MST), histopathological examination, and the polymerase chain reaction (PCR). The performance of these methods varies in a considerable proportion of patients. After the standardization of an immunoenzymatic test (ELISA) for the detection of IgG in the serum of patients with ACL using a crude Leishmania braziliensis antigen, the results obtained were compared to those of other tests routinely used for the diagnosis. The tests revealed the following sensitivity, when analyzed separately: 85% for ELISA IgG, 81% for PCR, 64.4% for MST, 58.1% for IIFR, and 34% for the presence of parasites in the biopsy. ELISA was positive in 75% of patients with ACL presenting a negative MST, in 84.8% of ACL patients with negative skin or mucous biopsies for the presence of the parasite, and in 100% of cases with a negative PCR. Thus, ELISA presented a higher sensitivity than the other tests and was useful as a complementary method for the diagnosis of ACL.

O objetivo desta pesquisa foi estudar a prevalência de infecção pelo virus da hepatite B em 406 portadores do virus da imunodeficiência humana, maiores de dezoito anos de idade, atendidos na rede pública de saúde da cidade de Belém, Pará, assim como analisar possíveis fatores de risco para a infecção. A prevalência global de infecção pelo virus da hepatite B foi de 51% (IC: 46,1 - 55,8), com 7,9% (IC: 5,3 - 10,5) para o HBsAg, 45,1% (IC: 40,3 - 49,9) para o anti-HBc e 32,3% (IC: 27,5 - 36,8) para o anti-HBs. Após ajuste por regressão logística, os marcadores sorológicos de infecção pelo vírus da hepatite B apresentaram associação com as seguintes variáveis: idade, situação conjugal e preferência sexual. A prevalência dos marcadores do vírus B nos heterossexuais foi 28,7% e 68,8% nos homossexuais/bissexuais (IC: 3,50 - 9,08; OR: 5,63; p=0,000). Quanto à situação conjugal, a categoria com companheiro fixo/casado apresentou freqüência de 31%, e foi de 58,7% a observada no grupo sem companheiro fixo (IC: 1,29 - 3,63; OR: 2,16; p=0,003). A análise multivariada não mostrou associação do vírus B com o uso de drogas ilícitas injetáveis.

The objective of this investigation was to study the prevalence of hepatitis B virus infection in a sample of 406 adult patients with human immunodeficiency virus infection who attended at the public health care in the city of Belém, Pará, Brazil, as well as analyzing possible risk factors for hepatitis B virus infection. The overall prevalence of hepatitis B virus infection was 51% (CI: 46.1 - 55.8), with 7.9% (CI: 5.3 - 10.5) for HBsAg, 45.1% (CI: 40.3 - 49.9) for anti-HBc and 32.3% (CI: 27.5 - 36.8) for anti-HBs. After adjustment using logistic regression, hepatitis B serological markers were associated with the following variables: age, marital status and sexual preference. The frequency of hepatitis B markers was 28.7% in heterosexuals and 68.8% in homo/bisexuals (CI: 3.50 - 9.08; OR: 5.63; p=0.000). In married people the frequency was 31% and 58.7% in single people (CI: 1.29 - 3.63); OR: 2.16; p=0.003). Multivariate analysis showed no association between hepatitis B virus infection and illicit injectable drug use.

Este trabalho objetivou investigar a prevalência de infecção pelo vírus da hepatite C e identificar possíveis fatores de risco para sua transmissão, em 406 indivíduos portadores do vírus da imunodeficiência humana, maiores de dezoito anos de idade, atendidos na rede pública de saúde da cidade de Belém, Pará, situada na Amazônia brasileira. Os exames referentes ao anti-VHC foram realizados pelo método de Elisa e a pesquisa do VHC RNA através da reação de polimerase em cadeia. A prevalência de infecção, atual ou pregressa, pelo vírus da hepatite C foi de 16% (IC: 12,4 - 19,6). A análise multivariada mostrou associação do vírus C com as variáveis idade, cujo risco significante recaiu no grupo com cinqüenta ou mais anos (OR=9,75), antecedente de transfusão de sangue (OR=4,74) e uso de droga ilícita injetável (OR=149,28). A prevalência do vírus da hepatite C entre os usuários de drogas injetáveis foi de 83,7% e de 22,1% na população de transfundidos. Estes resultados indicam a efetiva transmissão do vírus C através da exposição percutânea e reafirmam o grande potencial de risco para hepatite C contido no uso injetável de drogas ilícitas.

The objective of this investigation was to study the prevalence of hepatitis C virus infection and to identify possible risk factors for its transmission, in 406 adult patients with HIV/Aids who attended at public health services, in Belém city, Pará, Brazil. The anti-HCV was performed by third generation immunoenzymatic technique, and the HCV RNA by polymerase chain reaction. The overall prevalence of hepatitis C virus was 16% (CI: 12.4 - 19.6). Multivariate analysis showed association between virus C infection and age, with significant risk in the group about fifty years old or more (OR=9.75), blood transfusion (OR=4.74) and use of injecting drugs (OR=149.28). The hepatitis C virus infection was detected in 83.7% of intravenous drug users and 22.1% of transfused patients. These data indicate the efficient transmission of the virus through the percutaneous exposition and reaffirm the high risk to hepatitis C among injectable illicit drug user.