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Bevilaqua JR, Rodrigues NN, Rossi GF, Pupin MAF, Silva MO, Borges MS, Fernandes LG, Mercadante MEZ, Monteiro FM, Oliveira MEF. Effect of follicular wave stage on potential fertility predictors and their repeatability coefficient in prepubertal Bos indicus (Nellore) and Bos taurus (Caracu) heifers. Animal 2022; 16:100678. [PMID: 36493570 DOI: 10.1016/j.animal.2022.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
In an attempt to develop accessible methods for the precocious individual selection based on phenotypic attributes related to reproductive superiority, this study evaluated the effects of follicular wave stages (emergence and dominance) and the repeatability coefficients of potential fertility predictors (vulvar morphometry, uterine biometry, echogenicity and echotexture, ovarian biometry, and antral follicle count - AFC) in two breeds of purebred prepubertal heifers. Nellore (n = 30) and Caracu (n = 28) heifers were submitted to a sequence of 11 evaluations conducted every 48 h (D0 - random day of the antral follicular wave until D20) to study potential fertility indicators under natural conditions. The data obtained were compared according to breed and follicular wave stage. Statistical analysis included the fixed effects of breed, evaluation day, and their statistical interaction and was performed using MIXED, GENMOD, GLM, and CORR procedures of the SAS program. Breed was found to influence rima height, ovarian area, and AFC, which were greater in Nellore heifers (P < 0.02). The follicular wave stage also influenced most of the potential predictors, highlighting AFC which was higher in the presence of a dominant follicle in both breeds (P < 0.0001). The repeatability coefficients for vulvar width (0.76 and 0.66), ovarian area (0.70 and 0.62), and AFC (0.76 and 0.74) were considered to be high in Nellore and Caracu heifers, respectively. Only ovarian biometry was able to predict AFC (Pearson correlation coefficient ≥ 0.66; P < 0.0001) in prepubertal heifers. The results indicate that most of the phenotypic reproductive parameters analyzed can be characterized throughout prepuberty using a single measure since they are intrinsic attributes of the individual.
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Affiliation(s)
- J R Bevilaqua
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University, Via de Acesso Professor Paulo Donato Castelane - Vila Industrial, Jaboticabal, SP, Brazil
| | - N N Rodrigues
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University, Via de Acesso Professor Paulo Donato Castelane - Vila Industrial, Jaboticabal, SP, Brazil
| | - G F Rossi
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University, Via de Acesso Professor Paulo Donato Castelane - Vila Industrial, Jaboticabal, SP, Brazil
| | - M A F Pupin
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University, Via de Acesso Professor Paulo Donato Castelane - Vila Industrial, Jaboticabal, SP, Brazil
| | - M O Silva
- Beef Cattle Research Center, Institute of Animal Science (IZ), Road Carlos Tonani, 94 - Zona Industrial, Sertãozinho, SP, Brazil
| | - M S Borges
- Beef Cattle Research Center, Institute of Animal Science (IZ), Road Carlos Tonani, 94 - Zona Industrial, Sertãozinho, SP, Brazil
| | - L G Fernandes
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University, Via de Acesso Professor Paulo Donato Castelane - Vila Industrial, Jaboticabal, SP, Brazil
| | - M E Z Mercadante
- Beef Cattle Research Center, Institute of Animal Science (IZ), Road Carlos Tonani, 94 - Zona Industrial, Sertãozinho, SP, Brazil
| | - F M Monteiro
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University, Via de Acesso Professor Paulo Donato Castelane - Vila Industrial, Jaboticabal, SP, Brazil; Beef Cattle Research Center, Institute of Animal Science (IZ), Road Carlos Tonani, 94 - Zona Industrial, Sertãozinho, SP, Brazil
| | - M E F Oliveira
- Department of Pathology, Reproduction and One Health, School of Agricultural and Veterinarian Sciences, São Paulo State University, Via de Acesso Professor Paulo Donato Castelane - Vila Industrial, Jaboticabal, SP, Brazil.
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Silva MO, Almeida BS, Sales NS, Diniz MO, Aps LRMM, Rodrigues KB, Silva JR, Moreno ACR, Porchia BFMM, Sulczewski FB, Boscardin SB, Ferreira LCS. Antigen Delivery to DEC205 + Dendritic Cells Induces Immunological Memory and Protective Therapeutic Effects against HPV-Associated Tumors at Different Anatomical Sites. Int J Biol Sci 2021; 17:2944-2956. [PMID: 34345218 PMCID: PMC8326119 DOI: 10.7150/ijbs.57038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/02/2021] [Indexed: 12/27/2022] Open
Abstract
The generation of successful anticancer vaccines relies on the ability to induce efficient and long-lasting immune responses to tumor antigens. In this scenario, dendritic cells (DCs) are essential cellular components in the generation of antitumor immune responses. Thus, delivery of tumor antigens to specific DC populations represents a promising approach to enhance the efficiency of antitumor immunotherapies. In the present study, we employed antibody-antigen conjugates targeting a specific DC C-type lectin receptor. For that purpose, we genetically fused the anti-DEC205 monoclonal antibody to the type 16 human papillomavirus (HPV-16) E7 oncoprotein to create a therapeutic vaccine to treat HPV-associated tumors in syngeneic mouse tumor models. The therapeutic efficacy of the αDEC205-E7 mAb was investigated in three distinct anatomical tumor models (subcutaneous, lingual and intravaginal). The immunization regimen comprised two doses of the αDEC205-E7 mAb coadministered with a DC maturation stimulus (Polyinosinic:polycytidylic acid, poly (I:C)) as an adjuvant. The combined immunotherapy produced robust antitumor effects on both the subcutaneous and orthotopic tumor models, stimulating rapid tumor regression and long-term survival. These outcomes were related to the activation of tumor antigen-specific CD8+ T cells in both systemic compartments and lymphoid tissues. The αDEC205-E7 antibody plus poly (I:C) administration induced long-lasting immunity and controlled tumor relapses. Our results highlight that the delivery of HPV tumor antigens to DCs, particularly via the DEC205 surface receptor, is a promising therapeutic approach, providing new opportunities for the development of alternative immunotherapies for patients with HPV-associated tumors at different anatomical sites.
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Affiliation(s)
- Mariângela O Silva
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Bianca S Almeida
- Laboratory of Antigen Targeting to Dendritic Cells, Department of Parasitology, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil
| | - Natiely S Sales
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Mariana O Diniz
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Luana R M M Aps
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Karine B Rodrigues
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Jamile R Silva
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Ana C R Moreno
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Bruna F M M Porchia
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Fernando B Sulczewski
- Laboratory of Antigen Targeting to Dendritic Cells, Department of Parasitology, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil
| | - Silvia B Boscardin
- Laboratory of Antigen Targeting to Dendritic Cells, Department of Parasitology, Institute of Biomedical Sciences University of São Paulo, São Paulo, Brazil
| | - Luís C S Ferreira
- Vaccine Development Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
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Silva JR, Sales NS, Silva MO, Aps LRMM, Moreno ACR, Rodrigues EG, Ferreira LCS, Diniz MO. Expression of a soluble IL-10 receptor enhances the therapeutic effects of a papillomavirus-associated antitumor vaccine in a murine model. Cancer Immunol Immunother 2019; 68:753-763. [PMID: 30806747 PMCID: PMC11028134 DOI: 10.1007/s00262-018-02297-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/28/2018] [Indexed: 12/25/2022]
Abstract
The presence of IL-10, produced either by tumor cells or immunosuppressive cells, is frequently associated with a poor prognosis for cancer progression. It may also negatively impact anticancer treatments, such as immunotherapies, that otherwise would promote the activation of cytotoxic T cells capable of detecting and destroying malignant cells. In the present study, we evaluated a new adjuvant approach for anticancer immunotherapy using a plasmid vector encoding a soluble form of the IL-10 receptor (pIL-10R). pIL-10R was coadministered to mice with a DNA vaccine encoding the type 16 human papillomavirus (HPV-16) E7 oncoprotein genetically fused with glycoprotein D of herpes simplex virus (HSV) (pgDE7h). Immunization regimens based on the coadministration of pIL-10R and pgDE7h enhanced the antitumor immunity elicited in mice injected with TC-1 cells, which express HPV-16 oncoproteins. The administration of the DNA vaccines by in vivo electroporation further enhanced the anticancer effects of the vaccines, leading to the activation of tumor-infiltrating polyfunctional E7-specific cytotoxic CD8+ T cells and control of the expansion of immunosuppressive cells. In addition, the combination of immunotherapy and pIL-10R allowed the control of tumors in more advanced growth stages that otherwise would not be treatable by the pgDE7h vaccine. In conclusion, the proposed treatment involving the expression of IL-10R enhanced the antitumor protective immunity induced by pgDE7h administration and may contribute to the development of more efficient clinical interventions against HPV-induced tumors.
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Affiliation(s)
- Jamile R Silva
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, Av. Prof. Lineu Prestes, 1374, São Paulo, SP, 05508-000, Brazil
| | - Natiely S Sales
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, Av. Prof. Lineu Prestes, 1374, São Paulo, SP, 05508-000, Brazil
| | - Mariângela O Silva
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, Av. Prof. Lineu Prestes, 1374, São Paulo, SP, 05508-000, Brazil
| | - Luana R M M Aps
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, Av. Prof. Lineu Prestes, 1374, São Paulo, SP, 05508-000, Brazil
| | - Ana C R Moreno
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, Av. Prof. Lineu Prestes, 1374, São Paulo, SP, 05508-000, Brazil
| | - Elaine G Rodrigues
- Tumor Immunobiology Laboratory, Department of Microbiology, Immunology and Parasitology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Luís C S Ferreira
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, Av. Prof. Lineu Prestes, 1374, São Paulo, SP, 05508-000, Brazil.
| | - Mariana O Diniz
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, Av. Prof. Lineu Prestes, 1374, São Paulo, SP, 05508-000, Brazil
- Division of Infection and Immunity, University College London, 5 University St, Bloomsbury, London, WC1E 6JF, UK
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Medeiros P, de Freitas RL, Silva MO, Coimbra NC, Melo-Thomas L. CB1 cannabinoid receptor-mediated anandamide signaling mechanisms of the inferior colliculus modulate the haloperidol-induced catalepsy. Neuroscience 2016; 337:17-26. [PMID: 27595886 DOI: 10.1016/j.neuroscience.2016.08.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 10/21/2022]
Abstract
The inferior colliculus (IC), a midbrain structure that processes acoustic information of aversive nature, is distinguished from other auditory nuclei in the brainstem by its connections with structures of the motor system. Previous evidence relating the IC to motor behavior shows that glutamatergic and GABAergic mechanisms in the IC exert influence on systemic haloperidol-induced catalepsy. There is substantial evidence supporting a role played by the endocannabinoid system as a modulator of the glutamatergic neurotransmission, as well as the dopaminergic activity in the basal nuclei and therefore it may be considered as a potential pharmacological target for the treatment of movement disorders. The present study evaluated if the endocannabinoid system in the IC plays a role in the elaboration of systemic haloperidol-induced catalepsy. Male Wistar rats received intracollicular microinjection of either the endogenous cannabinoid anandamide (AEA) at different concentrations (5, 50 or 100pmol/0.2μl), the CB1 cannabinoid receptor antagonist AM251 at 50, 100 or 200pmol/0.2μl or vehicle, followed by intraperitoneal (IP) administration of either haloperidol at 0.5 or 1mg/kg or physiological saline. Systemic injection of haloperidol at both doses (0.5 or 1mg/kg, IP) produced a cataleptic state, compared to vehicle/physiological saline-treated group, lasting 30 and 50min after systemic administration of the dopaminergic receptors non-selective antagonist. The midbrain microinjection of AEA at 50pmol/0.2μl increased the latency for stepping down from the horizontal bar after systemic administration of haloperidol. Moreover, the intracollicular administration of AEA at 50pmol/0.2μl was able to increase the duration of catalepsy as compared to AEA at 100pmol/0.2-μl-treated group. Intracollicular pretreatment with AM251 at the intermediate concentration (100pmol/0.2μl) was able to decrease the duration of catalepsy after systemic administration of haloperidol. However, neither the intracollicular microinjection of AM251 at the lowest (50pmol/0.2μl) nor at the highest (200pmol/0.2μl) concentration was able to block the systemic haloperidol-induced catalepsy. Furthermore, the intracollicular administration of AM251 at 100pmol/0.2μl was able to decrease the duration of catalepsy as compared to AM251 at 50pmol/0.2μl- and AM251 at 200pmol/0.2-μl-treated group. The latency for stepping down from the horizontal bar - induced by haloperidol administration - was decreased when microinjection of AEA at 50pmol/0.2μl was preceded with blockade of CB1 receptor with AM251 (100pmol/0.2μl). Our results strengthen the involvement of CB1-signaled endocannabinoid mechanisms of the IC in the neuromodulation of catalepsy induced by systemic administration of the dopaminergic receptors non-selective antagonist haloperidol.
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Affiliation(s)
- P Medeiros
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, 14049-900 São Paulo, Brazil; Department of Neurocience and Behavioral Sciences, Division of Neurology, Post-Graduation Section, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900, Brazil; Neuroelectrophysiology Multiuser Center and Neurobiology of Pain and Emotions Laboratory, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900, Brazil; Department of Biosciences, Federal University of São Paulo (UNIFESP), Av. D. Ana Costa, 95, Vila Mathias, Santos, São Paulo 11060-001, Brazil
| | - R L de Freitas
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, 14049-900 São Paulo, Brazil; Neurobiology of Emotions Research Center (NAP-USP-NuPNE), Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, 14049-900 São Paulo, Brazil; Neuroelectrophysiology Multiuser Center and Neurobiology of Pain and Emotions Laboratory, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900, Brazil
| | - M O Silva
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, 14049-900 São Paulo, Brazil; Neuroelectrophysiology Multiuser Center and Neurobiology of Pain and Emotions Laboratory, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900, Brazil
| | - N C Coimbra
- Laboratory of Neuroanatomy and Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, 14049-900 São Paulo, Brazil; Neurobiology of Emotions Research Center (NAP-USP-NuPNE), Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, 14049-900 São Paulo, Brazil; Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, Ribeirão Preto, 14050-220 São Paulo, Brazil; Department of Neurocience and Behavioral Sciences, Division of Neurology, Post-Graduation Section, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900, Brazil; Neuroelectrophysiology Multiuser Center and Neurobiology of Pain and Emotions Laboratory, Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, São Paulo 14049-900, Brazil.
| | - L Melo-Thomas
- Laboratory of Experimental and Physiological Psychology, Philipps-University of Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany; Behavioural Neurosciences Institute (INeC), Av. do Café, 2450, Ribeirão Preto, 14050-220 São Paulo, Brazil; Department of Biosciences, Federal University of São Paulo (UNIFESP), Av. D. Ana Costa, 95, Vila Mathias, Santos, São Paulo 11060-001, Brazil.
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Gane E, Kershenobich D, Seguin-Devaux C, Kristian P, Aho I, Dalgard O, Shestakova I, Nymadawa P, Blach S, Acharya S, Anand AC, Andersson MI, Arendt V, Arkkila P, Baatarkhuu O, Barclay K, Ben-Ari Z, Bergin C, Bessone F, Blokhina N, Brunton CR, Choudhuri G, Chulanov V, Cisneros L, Croes EA, Dahgwahdorj YA, Daruich JR, Dashdorj NR, Davaadorj D, de Knegt RJ, de Vree M, Gadano AC, Gower E, Halota W, Hatzakis A, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kostrzewska K, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Mossong J, Norris S, Nurmukhametova E, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prins M, Puri P, Radke S, Rakhmanova A, Razavi H, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanchez Avila JF, Sanduijav R, Saraswat V, Schréter I, Shah SR, Shevaldin A, Shibolet O, Silva MO, Sokolov S, Sonderup M, Souliotis K, Spearman CW, Staub T, Stedman C, Strebkova EA, Struck D, Sypsa V, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuckerman E, Zuure FR, Prabdial-Sing N, Flisiak R, Estes C. Strategies to manage hepatitis C virus (HCV) infection disease burden - volume 2. J Viral Hepat 2015; 22 Suppl 1:46-73. [PMID: 25560841 DOI: 10.1111/jvh.12352] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries, and the relative impact of two scenarios was considered: (i) increased treatment efficacy while holding the treated population constant and (ii) increased treatment efficacy and increased annual treated population. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. In most countries, the annual treated population had to increase several fold to achieve the largest reductions in HCV-related morbidity and mortality. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. In most of the studied countries, the majority of patients were born between 1945 and 1985.
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Affiliation(s)
- E Gane
- Auckland Hospital Clinical Studies Unit, Auckland, New Zealand
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Hatzakis A, Chulanov V, Gadano AC, Bergin C, Ben-Ari Z, Mossong J, Schréter I, Baatarkhuu O, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Arkkila P, Barclay K, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Knegt RJ, de Vree M, Estes C, Flisiak R, Gane E, Gower E, Halota W, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Norris S, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Radke S, Rakhmanova A, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanchez Avila JF, Sanduijav R, Saraswat V, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Silva MO, Sokolov S, Sonderup M, Souliotis K, Spearman CW, Staub T, Stedman C, Strebkova EA, Struck D, Sypsa V, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuckerman E, Zuure FR, Puri P, Razavi H. The present and future disease burden of hepatitis C virus (HCV) infections with today's treatment paradigm - volume 2. J Viral Hepat 2015; 22 Suppl 1:26-45. [PMID: 25560840 DOI: 10.1111/jvh.12351] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Morbidity and mortality attributable to chronic hepatitis C virus (HCV) infection are increasing in many countries as the infected population ages. Models were developed for 15 countries to quantify and characterize the viremic population, as well as estimate the number of new infections and HCV related deaths from 2013 to 2030. Expert consensus was used to determine current treatment levels and outcomes in each country. In most countries, viremic prevalence has already peaked. In every country studied, prevalence begins to decline before 2030, when current treatment levels were held constant. In contrast, cases of advanced liver disease and liver related deaths will continue to increase through 2030 in most countries. The current treatment paradigm is inadequate if large reductions in HCV related morbidity and mortality are to be achieved.
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Affiliation(s)
- A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Saraswat V, Norris S, de Knegt RJ, Sanchez Avila JF, Sonderup M, Zuckerman E, Arkkila P, Stedman C, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Baatarkhuu O, Barclay K, Ben-Ari Z, Bergin C, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Chulanov V, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Vree M, Estes C, Flisiak R, Gadano AC, Gane E, Halota W, Hatzakis A, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Mossong J, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Puri P, Radke S, Rakhmanova A, Razavi H, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanduijav R, Schréter I, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Sokolov S, Souliotis K, Spearman CW, Staub T, Strebkova EA, Struck D, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuure FR, Silva MO, Sypsa V, Gower E. Historical epidemiology of hepatitis C virus (HCV) in select countries - volume 2. J Viral Hepat 2015; 22 Suppl 1:6-25. [PMID: 25560839 DOI: 10.1111/jvh.12350] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of liver related morbidity and mortality. In many countries, there is a lack of comprehensive epidemiological data that are crucial in implementing disease control measures as new treatment options become available. Published literature, unpublished data and expert consensus were used to determine key parameters, including prevalence, viremia, genotype and the number of patients diagnosed and treated. In this study of 15 countries, viremic prevalence ranged from 0.13% in the Netherlands to 2.91% in Russia. The largest viremic populations were in India (8 666 000 cases) and Russia (4 162 000 cases). In most countries, males had a higher rate of infections, likely due to higher rates of injection drug use (IDU). Estimates characterizing the infected population are critical to focus screening and treatment efforts as new therapeutic options become available.
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Affiliation(s)
- V Saraswat
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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8
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Ridruejo E, Marciano S, Galdame O, Reggiardo MV, Muñoz AE, Adrover R, Cocozzella D, Fernandez N, Estepo C, Mendizábal M, Romero GA, Levi D, Schroder T, Paz S, Fainboim H, Mandó OG, Gadano AC, Silva MO. Relapse rates in chronic hepatitis B naïve patients after discontinuation of antiviral therapy with entecavir. J Viral Hepat 2014; 21:590-6. [PMID: 24188363 DOI: 10.1111/jvh.12200] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 09/21/2013] [Indexed: 01/03/2023]
Abstract
Registration studies show entecavir (ETV) to be effective and safe in NUC-naïve patients with chronic hepatitis B, but relapse rates after treatment discontinuation have not been well established. Relapse rates and predictors of relapse were evaluated in naïve HBeAg-positive and HBeAg-negative patients treated with ETV. Treatment duration was defined according to international guidelines. Virological relapse was defined as reappearance in serum of hepatitis B virus (HBV) DNA to >2000 IU/mL after discontinuation of treatment. A hundred and sixty-nine consecutive patients were treated for a median 181 weeks. 61% were HBeAg positive, 23% had cirrhosis, and mean HBV DNA level was 6.88 ± 1.74 log10 IU/mL. Ninety-two per cent became HBV DNA negative; 71% of HBeAg+ve patients became HBeAg negative and 68% anti-HBe positive; 14% became HBsAg negative and 13% anti-HBs positive. At the end of the study, 36 patients discontinued treatment: one due to breakthrough associated with resistant variants and 35 (20%) due to sustained virological response; 33 of these patients developed HBeAg seroconversion and 18 HBsAg seroconversion. Median off-treatment time was 69 weeks. Nine patients (26%), all HBeAg positive at baseline, developed virological relapse after a median 48 weeks off-treatment, 3 of them showed HBeAg reversion and 4 lost anti-HBe. No patient with HBsAg seroconversion relapsed. HBeAg clearance after week 48 of treatment was associated with an increase risk of relapse. After ETV discontinuation, HBsAg seroconversion was maintained in 100% of the patients, HBeAg seroconversion maintained in 90%, and virological relapse rate was 24%.
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Affiliation(s)
- E Ridruejo
- Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno 'CEMIC', Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina; Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Provincia de Buenos Aires, Pilar, Argentina
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9
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Marciano S, Gaite LA, Bisignano L, Descalzi VI, Yantorno S, Mendizabal M, Silva MO, Anders M, Orozco OF, Traverso R, Gil O, Galdame OA, Bandi JC, de Santibañes E, Gadano AC. Use of liver grafts from anti-hepatitis B core-positive donors: a multicenter study in Argentina. Transplant Proc 2013; 45:1331-4. [PMID: 23726565 DOI: 10.1016/j.transproceed.2012.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 12/04/2012] [Indexed: 12/23/2022]
Abstract
Liver transplantation success is limited by the availability of donors. To overcome this limitation, anti-core-positive donors are increasingly being accepted, but underutilization of this resource still occurs. We performed the current study to determine the prevalence of anti-core-positive donors in our region and to describe the management of these donors and their recipients. Between January 2005 and July 2011, the national transplant database included 2,262 registered liver donors among whom 106 (4.7%) were anti-core-positive including 59 (56%) discarded and 47 (44%) implanted organs. A median of 14.5 offers (range 4-60) were rejected before harvesting and implanting the accepted grafts. The only difference between the implanted and the discarded grafts was found for the alanine aminotransferase level, which was higher among the discarded ones (50 ± 59 UI/L vs 25 ± 16, P < .05). Among 40 recipients included in the study, 5 (12.5%) did not receive any prophylaxis; 18 (45%) a nucleos(t)ide analog 11 (25.5%), heptitis B immunoglobulin and nucleos(t)ide analogs and 6 (15%) pretransplant hepatitis B vaccination. Over a mean follow-up of 871 ± 585 days, 4 de novo hepatitis B cases were identified at 545, 720, 748, and 1,080 days posttransplantation. None of these patients had received any prophylaxis. In all cases entecavir successfully controlled viral replication. We believe that better utilization of these donors and careful management of their recipients represent safe strategies to expand the liver donor pool in Argentina.
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Affiliation(s)
- S Marciano
- Hepatology Unit, Hospital Italiano de Buenos Aires, Argentina.
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10
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Ridruejo E, Adrover R, Cocozzella D, Reggiardo MV, Estepo C, Schroder T, Paz S, Mendizábal M, Fainboim H, Mandó OG, Silva MO. Effectiveness of entecavir in chronic hepatitis B NUC-naive patients in routine clinical practice. Int J Clin Pract 2011; 65:866-70. [PMID: 21762311 DOI: 10.1111/j.1742-1241.2011.02719.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Registration studies showed entecavir (ETV) to be effective and safe in NUC-naïve patients with chronic hepatitis B virus (HBV), but its effectiveness in routine clinical practice is unknown. MATERIALS AND METHODS Sixty-nine HBeAg positive and negative NUC naïve chronic HBV patients were treated with ETV for 110 weeks. 63% were HBeAg positive, 16% were cirrhotics, mean HBV-DNA was 7.09 log IU/ml and mean ALT was 157 IU/ml. RESULTS Sixty-one (88%) patients achieved undetectable DNA, with 46%, 77% and 100% virological response rates at week 24, 48 and 96 of treatment, respectively. Thirty-seven (84%) patients in the HBeAg-positive population achieved undetectable DNA, with 67% and 100% virological response rates at week 48 and 96 of treatment, respectively. Twenty-four (96%) patients in the HBeAg-negative population achieved undetectable DNA, with 91% and 100% virological response rates at week 48 and 96 of treatment, respectively. Twenty-three (53%) patients cleared HBeAg and 19 (44%) patients seroconverted to antiHBe positive status; seven (10%) patients cleared hepatitis B surface antigen and five (7%) patients developed antiHBs. At the end of the study, 10 patients successfully stopped therapy: nine HBeAg positive (four developed antiHBs positive) and one HBeAg negative. None of the patients had primary non-response. ETV resistance was not tested. None of the patients developed hepatocellular carcinoma, underwent liver transplantation or died because of liver-related events. No serious adverse events were reported. CONCLUSION The ETV monotherapy showed high virological response rates, a favourable safety profile for NUC-naive HBeAg-positive and negative patients treated in routine clinical practice.
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Affiliation(s)
- E Ridruejo
- Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno CEMIC, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
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11
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Silva JM, Campos EV, Silva MO, Amendola CP, Almeida SLS, Sousa JMA, Rezende E. Base excess and arterial lactate as early prognostic markers in severe sepsis patients. Crit Care 2005. [PMCID: PMC4097504 DOI: 10.1186/cc3597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Silva M, Amendola C, Longui S, Silva J, Campos E, Rezende E. Crit Care 2005; 9:P68. [DOI: 10.1186/cc3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Rezende EAC, Assunção MS, Leão GC, Silva MO, Silva JM, Campos EV, Manetta JA, Isola AM. Is it possible to use levosimedan to treat cardiovascular dysfunction in septic patients? Crit Care 2003. [PMCID: PMC3301035 DOI: 10.1186/cc2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Oliveira GC, Carmo RA, Rocha MO, Silva MO, Lima AT, Guimarães MD, Corrêa-Oliveira R. Hepatitis C virus genotypes in hemophiliacs in the state of Minas Gerais, Brazil. Transfusion 1999; 39:1194-9. [PMID: 10604245 DOI: 10.1046/j.1537-2995.1999.39111194.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a positive-strand RNA virus composed of at least 10 genotypes and dozens of subtypes. Six major genotypes can be distinguished by restriction fragment length polymorphism (RFLP) analysis of the amplified 5' noncoding region (NCR) of the genome. The genotypes are unequally distributed throughout the world. Types 1 and 3 are most common in Europe and the United States. Although fewer studies have been performed in Brazil, the pattern seems to mirror that in the other areas. HCV infection is highly prevalent among hemophiliacs and is a major cause of chronic liver disease. STUDY DESIGN AND METHODS This study investigated a sample of the hemophiliac population in the state of Minas Gerais, Brazil, by RFLP analysis of the 5' NCR. RESULTS It was observed that 84.1 percent were of genotype 1 and 13.6 percent of genotype 3. Sequence analysis of nine isolates confirmed the RFLP results and determined that all of the type 1 isolates belonged to subtype 1a. Phylogenetic analysis by parsimony and distance revealed that lineages of genotypes 1, 2, and 3, and 4 could be separated. The isolates of type 3 from this study were distinct from published sequences, which possibly indicated their different geographical origin. CONCLUSION Although the frequency of genotypes observed (types 1 and 3) among hemophiliacs in the state of Minas Gerais was higher than that in the southern part of the country, these frequencies were not different from those in other groups of patients in Brazil and other countries studied. Further investigation is needed of the evidence that the type 3 isolates observed in these studies are significantly different from other isolates previously characterized by sequence analysis.
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Affiliation(s)
- G C Oliveira
- René Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil.
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15
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Liang TJ, Jeffers L, Reddy RK, Silva MO, Cheinquer H, Findor A, De Medina M, Yarbough PO, Reyes GR, Schiff ER. Fulminant or subfulminant non-A, non-B viral hepatitis: the role of hepatitis C and E viruses. Gastroenterology 1993; 104:556-62. [PMID: 8381099 DOI: 10.1016/0016-5085(93)90426-d] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although non-A, non-B (NANB) viral hepatitis has been implicated as an etiology of fulminant hepatitis, hepatitis C virus (HCV) has not been shown to result in acute hepatic failure and hepatitis E virus (HEV) has predominantly been associated with fulminant hepatitis among pregnant women. METHODS Using polymerase chain reaction to detect HCV and HEV genomes, four-antigen radioimmunoblot assay (4-RIBA) to measure anti-HCV antibodies, and enzyme-linked immunosorbent assay (ELISA) to detect anti-HEV immunoglobulin M (IgM) antibodies, 17 patients with sporadic fulminant or subfulminant hepatitis of presumed NANB viral etiology were studied. RESULTS The diagnosis of acute NANB viral hepatitis was made based on clinical information, serological tests, biochemical profiles, and pathological features. All 17 patients were negative for anti-HEV IgM antibodies and HEV RNA in either serum and/or liver. HCV RNAs were detected in 2 patients although anti-HCV antibodies were negative in all of them. CONCLUSIONS It is shown that HCV is infrequently associated with and HEV is not an identifiable cause of presumed NANB fulminant or subfulminant hepatitis in this patient population. Although further studies will be required for identification of the causative agent, it is possible that another agent is responsible for the occurrence of sporadic NANB fulminant or subfulminant hepatitis.
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Affiliation(s)
- T J Liang
- Gastrointestinal Unit, Massachusetts General Hospital Cancer Center, Boston
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16
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Silva MO, Cabral H, Zuckerman B. Adolescent pregnancy in Portugal: effectiveness of continuity of care by an obstetrician. Obstet Gynecol 1993; 81:142-6. [PMID: 8416450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To improve health among newborn infants of pregnant adolescents in Portugal, we developed and evaluated a prenatal care intervention. METHODS The study group consisted of 80 adolescents recruited as they registered for prenatal care at Hospital Santa Maria in Lisbon. The intervention consisted of three components: initiation of prenatal care at registration, continuity of care by the same obstetrician, and emphasis on the specific nutritional and other health needs of pregnant adolescents. Controls were recruited after delivery on the maternity ward of the same hospital and were matched for age at conception, race, socioeconomic status, years of education, planned versus unplanned pregnancy, and previous body mass index. Controls received the routine care provided to pregnant adult women, including initiation of prenatal care at some point after registration and care by different general practitioners at each visit. RESULTS Twenty mothers in the control group did not receive prenatal care and were excluded from further analysis. Mothers in the intervention group had their first prenatal visit 2 weeks sooner (P = .02) and had on average almost twice the number of prenatal visits (P = .0001) as controls. They gained 2.0 kg more on average compared with controls (P = .05). Infants of the mothers in the intervention group weighed an average of 181 g more than those in the control group. Fewer infants in the intervention group needed care in the high-risk pediatric unit (P = .005). When potentially confounding variables were controlled in a multivariate analysis, infants in the intervention group weighed on average 174 g more than those in the routine-care group (P = .02). CONCLUSION This intervention, based on traditional tenets of good medical care, is effective in improving the outcomes of infants born to adolescent mothers in Portugal.
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Affiliation(s)
- M O Silva
- Department of Obstetrics and Gynecology, Hospital Santa Maria/Faculdade de Medicina de Lisboa, Lisbon, Portugal
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17
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Affiliation(s)
- M M Jonas
- Department of Pediatrics, University of Miami School of Medicine, Florida
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18
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Abstract
A 54-year-old man with chronic B hepatitis was treated with interferon alfa. Despite resolution of the hepatitis B viral infection, he experienced severe jaundice, ascites, and encephalopathy. Further work-up showed hyperglobulinemia, chiefly immunoglobulin G, and positive smooth muscle and anti-nuclear antibodies. Because of these "autoimmune" features, the patient was treated with prednisone. One month later, a significant clinical and biochemical improvement was observed. A possible autoimmune mechanism induced by interferon alfa is proposed as the cause for the perpetuation of the necroinflammatory activity.
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Affiliation(s)
- M O Silva
- Division of Hepatology, University of Miami School of Medicine, Florida
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Abstract
We identified 39 patients with acute cocaine intoxication and rhabdomyolysis over an 8-year period. Twenty-three of the patients (59%) demonstrated biochemical evidence for hepatic dysfunction. Sixteen of these patients had severe liver injury as defined by an alanine aminotransferase (ALT) of greater than 400 U/l (group A). Seven had an ALT between 36-399 U/l (group B) and 16 showed no evidence of liver injury (group C). In contrast to those with normal ALT, the clinical course of the group A patients was more often accompanied by profound hypotension (44 vs. 0%, p less than 0.025), disseminated intravascular coagulation (50 vs. 0%, p less than 0.005), hyperpyrexia (75 vs. 25%, p less than 0.025) and acute renal failure (81 vs. 0%, p less than 0.001). Seven of the group A patients expired (44%). Histologic examination of liver tissue obtained from post-mortem samples demonstrated extensive centrilobular and midzonal necrosis in three cases and panlobular necrosis in two others. A mild lymphocytic infiltrate with bile duct proliferation was present in each specimen. We conclude that cocaine intoxication can be accompanied by liver dysfunction which is most likely multifactorial; the presence of severe dysfunction identifies a patient with potentially significant morbidity and mortality.
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Affiliation(s)
- M O Silva
- University of Miami School of Medicine, Division of Hepatology, FL 33101
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20
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Graça LM, Clode N, Cardoso CG, Colaço A, Casal E, Jorge AF, Ferreira H, Pereira R, Martins C, Silva MO. [Doppler flowmetry of feto-maternal circulation: III --Absent and reverse diastolic flow in the umbilical artery]. ACTA MEDICA PORT 1991; 4:127-30. [PMID: 1950660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Twelve cases of extreme umbilical blood flow impairement (8 cases with loss of end-diastolic blood flow and 4 cases with reversed flow) found among 658 pregnancies studied by continuous Doppler between April 1st 1989 and March 31st 1990, are reported. The findings were associated to intra-uterine growth retardation (92%), maternal hypertensive disease (50%) and perinatal death (33%); fetal Trisomy 21 was the sole problem in one of the cases with absent end-diastolic frequencies. Our results are discussed and compared to similar data reported recently. Clinical management is proposed, according to umbilical blood flow patterns, length of gestation and underlying clinical situations.
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Affiliation(s)
- L M Graça
- Unidade de Alto Risco Obstétrico, Hospital de Santa Maria/Faculdade de Medicina, Lisboa
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21
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Silva MO, Reddy KR, McDonald T, Jeffers LJ, Schiff ER. Danazol-induced cholestasis. Am J Gastroenterol 1989; 84:426-8. [PMID: 2929566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 39-yr-old female on high-dose Danazol presented with jaundice and pruritus. Danazol-induced cholestasis was suspected, and the drug was discontinued. A liver biopsy revealed panlobular cholestasis with portal and periportal inflammation. The cholestasis resolved completely in 8 wk. This is a rare case of Danazol-induced cholestasis and should be considered in the differential diagnosis of drug-induced liver injury.
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Affiliation(s)
- M O Silva
- Center for Liver Diseases, University of Miami School of Medicine, VA Medical Center, Florida
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22
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Abstract
Foi realizado estudo sobre a prevalência da febre reumática em escolares do primeiro grau de uma unidade escolar do município de São Paulo, Brasil. Dos 1.532 alunos da faixa etária de 7 a 14 anos, foram examinados 316 dos quais surgiram 26 casos que exigiram exame cardiológico pormenorizado. O resultado obtido foi o seguinte: 17 normais, 5 portadores de cardiopatias congênitas, 3 suspeitos de atividade reumática e um caso de cardiopatia reumática. Constatou-se a inexistência de qualquer caso de atividade reumática atual, e apenas um caso de cardiopatia reumática, com passado reumático típico. Em relação aos achados brasileiros (1,1% e 0,3%), o presente resultado não difere estatisticamente ( P > 0,20%). Comentou-se o custo da investigação que resultou na descoberta de apenas um caso de doença reumática, já com comprometimento orovalvar, e a posição que a saúde pública ocupa em relação aos demais problemas observados, tais como: verminose, cárie dentária, subnutrição e outros.
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