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- Prevalência do anticorpo contra o vírus da Hepatite A numa população do norte de PortugalPublication . Cunha, I; Antunes, HAIM: To find the prevalence of antibody to hepatitis A virus in the population of the North of Portugal. MATERIAL AND METHODS: Ten General Practitioners were asked to provide blood samples from patients who would need blood tests for any reason other than acute hepatitis, during January and February 1996. In this way, 381 samples were obtained for assessment of anti hepatitis A virus antibodies using a commercial radioimmunassay ELISA. All subjects gave their informed consent and answered to a protocol regarding age, sex, geographic area, number of people per household and sewage systems. The statistics were performed using SPSS. RESULTS: The 381 subjects were distributed into eight age groups: I (1-4 years)--57; II (5-9 years)--57; III (10-14 years)--26; IV (15-19 years)--41; V (20-29 years)--55; VI (30-39 years)--51; VII (40-49 years)--41; VIII--(equal or more than 50 years)--53. The prevalence of anti HAV antibodies per group-percentage (number), (confidence intervals), were: I--7.0% (4) (3-17%); II--15.8% (9), (9-27%); III--26.9% (7) (14-46%); IV--51.2% (21) (37-66%); V--85.5% (47) (74-92%); VI--72.5% (37) (59-83%); VII--87.8% (36) (75-95%); VIII--88.7% (47) (80-93%). CONCLUSION: The comparison with previous data (Lecour et al.) shows improvement in sanitary conditions of population, with associated lower prevalence of anti hepatitis A virus antibody.
- A new case of autosomal recessive agammaglobulinaemia with impaired pre-B cell differentiation due to a large deletion of the IGH locusPublication . Milili, M; Antunes, H; Blanco-Betancourt, C; Nogueiras, A; Santos, E; Vasconcelos, J; Castro e Melo, J; Schiff, CMales with X-linked agammaglobulinaemia (XLA) due to mutations in the Bruton tyrosine kinase gene constitute the major group of congenital hypogammaglobulinaemia with absence of peripheral B cells. In these cases, blockages between the pro-B and pre-B cell stage in the bone marrow are found. The remaining male and female cases clinically similar to XLA represent a genotypically heterogeneous group of diseases. In these patients, various autosomal recessive disorders have been identified such as mutations affecting IGHM, CD79A, IGLL1 genes involved in the composition of the pre-B cell receptor (pre-BCR) or the BLNK gene implicated in pre-BCR signal transduction. In this paper, we report on a young female patient characterised by a severe non-XLA agammaglobulinaemia that represents a new case of Igmu defect. We show that the B cell blockage at the pro-B to pre-B cell transition is due to a large homologous deletion in the IGH locus encompassing the IGHM gene leading to the inability to form a functional pre-BCR. The deletion extends from the beginning of the diversity (D) region to the IGHG2 gene, with all JH segments and IGHM, IGHD, IGHG3 and IGHG1 genes missing. CONCLUSION: alteration in Igmu expression seems to be relatively frequent and could account for most of the reported cases of autosomal recessive agammaglobulinaemia.
- O atraso de desenvolvimento nas crianças com anemia por deficiência de ferro. Poderá ser revertido pela terapêutica com ferro?Publication . Antunes, H; Gonçalves, S; Teixeira-Pinto, A; Costa-Pereira, AOBJECTIVE: To compare development of 17 children aged 12 months with iron deficiency anaemia (IDA) and 18 controls without IDA after a 3-months follow-up period and iron therapy in the IDA group. SUBJECTS AND METHODS: Development of all children was evaluated using the Griffith's Scale. Data was collected on parent's social class and education, breast-feeding, number of siblings and clinical nutritional status. RESULTS: At 12 months children with IDA had significantly lower development scores--mean (sd)--than those without IDA: 112(5) vs. 121(7). At 15 months, after iron therapy, there were no significant differences between cases and controls. Non-IDA children showed significantly lower development scores at 15 months when compared with 12 months (121 vs 115). CONCLUSIONS: The study shows that iron therapy can revert some of the adverse effects in the development of children with IDA and therefore both IDA prevention and treatment can be justified.
- Taxa de cobertura vacinal com imunização para o vírus da hepatite BPublication . Antunes, H; Macedo, M; Estrada, AThe hepatitis B virus is an important cause of morbidity and mortality in humans, thus making it a serious public health issue. The purpose of this study was to determine the hepatitis B virus vaccination rate with immunization, the risk of this population group becoming infected before vaccination and the prevalence of hepatitis B virus infection. The study involved randomly analyzing the serum of 311 adolescents of both sexes aged 14 from a total population of 536 adolescents attending schools in Braga, Portugal. A questionnaire was administered to the adolescents and asked them if they had received the Hepatitis B vaccine, how many doses they received, if they had a history of acute hepatitis, drug abuse, whether or not they had had sexual intercourse and if so, if they had used protection. The determination of the hepatitis B surface antigen (HbsAg), the antibody to HbsAg and the antibody to hepatitis B core antigen was carried out using the chemoluminiscence method. The vaccination rate with immunization was 85.8 %, [95% CI 81.9-89.7%]. The prevalence of hepatitis B virus infection was 0.6%, [95% CI 0-1.5%]. Conclusions: The prevalence of hepatitis B virus infection was low in this adolescent population of Braga. The vaccination rate with immunization is satisfactory, but does not reach 100%, which means that the risk of transmission is still present in this age group.
- Lymphadenopathy after BCG vaccination in a child with chronic granulomatous diseasePublication . Vieira, AP; Vasconcelos, J; Fernandes, JC; Antunes, H; Sousa-Basto, A; Macedo, C; Zaman, A; Santos, E; Melo, JC; Roos, D
- Prevalência do vírus da hepatite A: primeiros resultados de baixa endemicidade em PortugalPublication . Antunes, H; Macedo, M; Estrada, AThe prevalence of the hepatitis A virus in a population determines the degree of morbidity associated with this illness, that is, the higher the morbidity, the lower the prevalence. This study aims to obtain the prevalence of total antibody to the hepatitis A virus in children, 5 and 8 years of age, and in adolescents, 14 years of age. The study was based on two samples: the serum of 64 healthy five-year-olds and 76 healthy eight-year-olds living in the proximity of the São Marcos Hospital in Braga and the serum of 311 adolescents, aged 14, from a total population of 536 adolescents attending schools in Braga, North of Portugal. The samples were collected in 1999 for the adolescent group, in 2000 and 2001 for the group of the five-year-olds and in 2002 and 2003 for the group of the eight-year-olds. None of the persons involved had been vaccinated with the hepatitis A virus vaccine. The Enzyme Linked Fluorescent Assay method was used to measure the serum total antibody to the hepatitis A virus. The prevalence of total antibody to the hepatitis A virus was 1.6% at 5 years of age, [95% confidence intervals (CI), 0-4.7%]; 3.9% at 8 years of age, [95% CI, 0-8,4%]; and 32.5% at 14 years of age +/- 6 months, [95% CI, 27.3-37.7%]. The prevalence of total antibody to the hepatitis A virus in this population revealed lower natural immunity. The results obtained for the five and eight-year-olds were the first Portuguese results of low endemicity to the hepatitis A virus.
- Choque tóxico por streptococcus B hemoliticus do grupo APublication . Pontes, T; Antunes, HIn the last years has been observed an increased incidence of invasive group A beta-hemolytic streptococcal infections, including the toxic shock syndrome. The most common portal of entry is the skin and mucous membranes. The toxic shock syndrome can occurred as a rare complication of pharyngitis. The association between varicella and the use of nonsteroidal antiinflammatory drugs with necrotizing fasciitis by Streptococcus pyogenes has been discussed without reach at consensus, but some authors disapproved the use of nonsteroidal antiinflammatory drugs in this viral infection. The authors reported the clinical case of a 12 year old adolescent, that 15 days after the diagnosis of mononucleosis infectious confirmed by serology and treated with ibuprofen, was internment by streptococcal toxic shock syndrome with rhabdomyolysis, hepatitis, cellulitis of the leg, arthritis of the knee and pleural effusion. Therapeutics was made with penicillin G and clindamycin. We present this case for the severity of the clinical situation and for the questions that rise.
- Iron deficiency anemia in infants. Preliminary development results at five yearsPublication . Antunes, H; Gonçalves, S; Teixeira-Pinto, A; Costa-Pereira, A; Tojo-Sierra, R; Aguiar, AINTRODUCTION: Research, mostly conducted in developing countries, have suggested short and long term developmental delay in children who had iron-deficiency anemia (IDA) in their early life. This study aims to evaluate the development of 5-years old children who were diagnosed IDA at 9 months of age. METHODS: 27 children with IDA diagnosed at 9 months of age and 28 non-anemic controls were followed-up until they were 5 years old. At 9 months of age and at 5 years of age, blood samples were collected for blood count, iron, transferrin and ferritin. Children with hemoglobin < 110 g/l and ferritin < 12 ng/ml were diagnosed with IDA and received iron treatment for IDA correction. C Reactive Protein and antibody to hepatitis A virus were also studied at 5 years of age. At this age, children's motor and cognitive development were accessed using Griffith's test. RESULTS: At 9 months of age, IDA children had [mean (SD)] 102.5 g/ l (5.9) g/l of hemoglobin and 5.6 ng/l (3.1) ng/ml of ferritin. At 5 years of age all children were healthy and without anemia. One child had positive antibody to hepatitis A virus. The results of Griffith's test at five years--anemic/non-anemic at 9 months of age. The mean (sd)-p: general coefficient--100.8 (6.6)/99.5 (7.1)-0.48; locomotor 110.2 (6.9)/109.3 (6.5)-0.62; personal-social--99.1 (11.4)/95.7(11.6)-0.28; hearing-speech--93.8 (9.1)/95.3 (13.7)-0.64; hand-eye--98.2 (13.2)/99.1 (14.3)-0.79; performance--97.5 (17.6)/96.9 (13.6)-0.88; practical reasoning--89.8 (9.1)/86.3(7.1)-0.21. CONCLUSIONS: As only one child had positive antibody to hepatitis A virus, the study population may be considered as belonging to a developed region. These results suggest that, at least in developed regions, infants who receive an early treatment for their mild IDA may not be affected in global development at the age of five.
- Primeira determinação de prevalência de doença celíaca numa população portuguesaPublication . Antunes, H; Abreu, I; Nogueira, A; Sá, C; Gonçalves, C; Cleto, P; Garcia, F; Alves, A; Lemos, DThe prevalence of celiac disease is unknown in Portugal. In European countries the prevalence is between 1:200 and 1:400. The incidence obtained through diagnosed cases in the paediatric gastroenterology units in Portugal was 1:3648. To determine the best current celiac disease screening method and its prevalence in a portuguese population, 536 sera of teenagers with 14 years +/- 6 months from Braga town schools were tested as follows: a) total IgA, b) anti-tissue transglutaminase antibodies c) anti-endomysium antibodies (AEA). One female adolescent, with negative AEA and anti-transglutaminase antibodies had a diagnosed celiac disease; this patient was under appropriate diet. Eleven adolescents had positive anti-transglutaminase antibodies and 4 of these had also positive AEA. A jejunal biopsy was carried out on the latter adolescents. Three presented intestinal villous atrophy, 2 a flat mucosa and 1 a moderate atrophy. One female adolescent had a normal mucosa. The prevalence was 1:134, [confidence interval at 95%, 1:53-1:500]. Conclusions: Presently, total IgA with determination of anti-tissue transglutaminase antibodies is apparently the best screening method; it is less expensive test and, given the use of ELISA, less dependent on the observer. The celiac disease prevalence found in the present study falls within the range of prevalence recently found in other European populations, which implies that the celiac disease is under-diagnosed in Portugal.
- Determinantes da colonização materna e da infecção neonatal por Streptococcus do grupo BPublication . Areal, A; Moreira, M; Nunes, S; Faustino, MA; Cardoso, L; Sá, CAim and Objective: During the past three decades, group B Streptococcus (GBS) neonatal infection has been the subject of little research. The aim of this study was to evaluate the association between maternal risk factors, as established by the Center for Disease Control and Prevention (CDC), and maternal colonization. We also analysed the association between risk factors present in newborns and early-onset GBS disease. Study design: Cross-sectional study. Population: All pregnant women admitted for delivery in our institution and their newborns, between 1st February and 31st July 2005. Methods: Maternal and neonatal characteristics were collected from hospital clinical data, including information on risk factors established by the CDC. Descriptive statistics was used to characterize the study sample. Qui-square and Mantel-haenszel tests were applied to compare proportions and to measure the strength of associations, respectively, setting significance at p < 0,05. Results: In this sample only 47% of women were screened for GBS colonization in suitable time and 34,9% of these women were colonized. The incidence of early neonatal infection by SGB was 9/1000 neonates. Significant associations between GBS maternal colonization ant the following parameters were observed: maternal age [p=0,012; OR=1,659 (IC a 95%, 1,218-2,260)], gestational age at labour [p=0,001; OR= 2,621 (IC a 95%, 1,641- 4,188)], and urinary GBS infection during pregnancy (p<0,001). Maternal colonization occurred in women without CDC defined risk factors. Early neonatal infection by SGB was strongly associated with unscreened women (p=0,014). Conclusion: In this study, maternal GBS colonization occurred in the absence of CDC defined risk factors and varied according to maternal age and gestational week. Neonatal GBS infection was more frequent in unscreened women.