Publications by authors named "Edmundo P Lopes"

14 Publications

  • Page 1 of 1

The Coutinho index as a simple tool for screening patients with advanced forms of Schistosomiasis mansoni: a validation study.

Trans R Soc Trop Med Hyg 2021 Mar 16. Epub 2021 Mar 16.

Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife-Pernambuco, 50670-420, Brasil.

Background: Periportal fibrosis (PPF) is the major pathological consequence of Schistosoma mansoni infection. The Coutinho index-the alkaline phosphatase (ALP) to platelet ratio ([ALP/upper limit of normality {ULN}]/platelet count [106/L] x 100)-was validated. Validation consisted of modest laboratory tests to predict advanced PPF.

Methods: A total of 378 individuals from an endemic area of Brazil with a previous history of the disease and/or a positive parasitological examination were evaluated. We used ultrasound examination as the gold standard for classification of the PPF pattern and measured the biological markers of the index.

Results: Forty-one individuals (10.8%) without PPF, 291 (77%) with moderate PPF and 46 (12.2%) with advanced PPF, were identified. ALP and platelet count were used for the index. The cut-off point ≥0.228 predicted the presence of fibrosis with an area under the receiver operating characteristic curve (AUROC) of 0.56, sensitivity of 68.6% and specificity of 46.3%. There was an absence of PPF in 46.3% of individuals without fibrosis and the presence of PPF in 68.5% of cases with moderate and advanced ultrasound fibrosis. The identification of advanced fibrosis with a cut-off point ≥0.316 revealed an AUROC curve of 0.70, sensitivity of 67.4% and specificity of 68.3%, thus confirming the advanced phase in 65.2% of cases compared with ultrasound.

Conclusion: The Coutinho index was able to predict advanced PPF in most individuals. It is valid as a new tool, uses routine laboratory tests and therefore is more accessible for screening patients with a severe form of the disease in endemic areas.
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March 2021

Remission of long-term hepatic and renal disease induced by HCV after direct-acting antivirals therapy.

J Bras Nefrol 2021 Jan-Mar;43(1):117-120

Universidade Federal de Pernambuco, Departamento de Medicina Clínica, Recife, PE, Brasil.

In addition to liver disease, the hepatitis C virus (HCV) has been associated with autoimmune phenomena, such as mixed cryoglobulin and glomerulonephritis (GN). Until recently, both chronic hepatitis and HCV extra-hepatic manifestations were treated with peg-interferon plus ribavirin, however these drugs presented low efficacy and induced severe side effects. Nowadays, the HCV chronic hepatitis has been treated with direct acting antivirals (DAA), but studies on the DAA therapy for HCV-associated glomerulonephritis are scarce. Here, we describe two cases of HCV-associated glomerulonephritis that were treated with DAAs. In these two cases, previously experienced to peg-interferon plus ribavirin, the sofosbuvir plus simeprevir therapy was effective, without significant side effects, and interrupted the evolution of at least 20 years of both hepatic and renal diseases. These cases join the seven previously described cases that were treated with this DAAs association.
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August 2021

Hepatotoxicity during TB treatment in people with HIV/AIDS related to NAT2 polymorphisms in Pernambuco, Northeast Brazil.

Ann Hepatol 2020 Mar - Apr;19(2):153-160. Epub 2019 Oct 24.

Laboratório de Virologia, Centro de Pesquisas Aggeu Magalhães/FIOCRUZ, Recife, PE, Brazil.

Introduction And Objective: Hepatotoxicity during tuberculosis (TB) treatment is frequent and may be related to the Arylamine N-Acetyltransferase (NAT2) acetylator profile, in which allele frequencies differ according to the population. The aim of this study was to investigate functional polymorphisms in NAT2 associated with the development of hepatotoxicity after initiating treatment for TB in people living with HIV/AIDS (PLWHA) in Pernambuco, Northeast Brazil.

Material And Methods: This was a prospective cohort study that investigated seven single nucleotide polymorphisms located in the NAT2 coding region in 173 PLWHA undergoing TB treatment. Hepatotoxicity was defined as elevated aminotransferase levels and identified as being three times higher than it was before initiating TB treatment, with associated symptoms of hepatitis. A further 80 healthy subjects, without HIV infection or TB were used as a control group. All individuals were genotyped by direct sequencing.

Results: The NAT2*13A and NAT2*6B variant alleles were significantly associated with the development of hepatotoxicity during TB treatment in PLWHA (p<0.05). Individual comparisons between the wild type and each variant genotype revealed that PLWHA with signatures NAT2*13A/NAT2*13A (OR 4.4; CI95% 1.1-18.8; p 0.037) and NAT2*13A/NAT2*6B (OR 4.4; CI95% 1.5-12.7; p 0.005) significantly increased the risk of hepatotoxicity.

Conclusion: This study suggests that NAT2*13A and NAT2*6B variant alleles are risk factors for developing hepatotoxicity, and PLWHA with genotypes NAT2*13A/NAT2*13A and NAT2*13A/NAT2*6B should be targeted for specific care to reduce the risk of hepatotoxicity during treatment for tuberculosis.
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February 2021

How are HCV-infected patients being identified in Brazil: a multicenter study.

Braz J Infect Dis 2019 Jan - Feb;23(1):34-39. Epub 2019 Mar 6.

Universidade Federal de São Paulo, São Paulo, SP, Brazil. Electronic address:

Background: Hepatitis C is an important health problem. In Brazil, 1-2 million people are infected. Despite this expressive number, and the availability of very successful treatment, many patients remained undiagnosed mainly because of the asymptomatic nature of the infection.

Objectives: To describe epidemiological characteristics of HCV-infected patients seen at referral centers in Brazil, the source of referral, and the time spanned to reach a reference center, in order to improve the identification of undiagnosed patients.

Methods: Multicenter observational, cross-sectional study carried out in 15 centers of Brazil, between January/2016 and June/2017. Data of patients with a confirmed diagnosis (anti-HCV and HCV-RNA) were collected by interview using standard questionnaires and by review of charts.

Results: Two thousand patients were included; 55.1% were male, mean age 58±11 years. Only 14.9% had higher education and 84.2% received up to five monthly minimum Brazilian wages (approximately US$260.00/month). The time between diagnosis and beginning of follow-up was 22.9 months. The most common reasons for testing were check-up (33.2%) and blood donation (19%). General practitioners diagnosed most of the patients (30.1%). Fibrosis stage was mainly evaluated by liver biopsy (61.5%) and 31.3% of the patients were cirrhotic at diagnosis.

Conclusions: This multicenter Brazilian study showed that the mean time to reach a referral center for treatment was almost two years. Primary care physicians diagnoses most hepatitis C cases in the country. Population campaigns and medical education should be encouraged to intensify screening of asymptomatic individuals, considering the efficiency of check-ups in identifying new patients.
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May 2019

Correlation between platelet count and both liver fibrosis and spleen diameter in patients with schistosomiasis mansoni.

Arq Gastroenterol 2014 Jan-Mar;51(1):34-8

Gastroenterology Section, Department of Internal Medicine, Universidade Federal de Pernambuco - UFPE, Recife, PE, Brasil.

Context: Studies have described the correlation between platelet count and the stages of fibrosis in chronic viral hepatitis, but few publications have studied this correlation in Schistosomiasis mansoni.

Objectives: Therefore, this study aimed to correlate platelet count with both the periportal fibrosis pattern and spleen diameter evaluated by ultrasound exam in patients with Schistosomiasis mansoni.

Methods: Patients with Schistosomiasis mansoni were evaluated by abdominal ultrasound by a single examiner for the determination of periportal fibrosis pattern (Niamey classification) and spleen diameter. Platelet counts were performed in an automated cell counter.

Results: One hundred eighty-seven patients with Schistosomiasis mansoni (mean age: 50.2 years) were included in the study, 114 of whom (61%) were women. Based on the Niamey classification, the ultrasound analysis revealed that 37, 64, 64 and 22 patients exhibited patterns C, D, E and F, respectively. In these four groups, the mean number of platelets was 264, 196, 127 and 103 x 109/L and mean spleen diameter was 9.2, 11.9, 14.9 and 16.2 centimeters, respectively. A reduction in platelet count was significantly associated with both the progression of the periportal fibrosis and the increase in spleen size.

Conclusions: Platelet count in patients with Schistosomiasis mansoni was inversely correlated with the severity of periportal fibrosis and spleen diameter.
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November 2014

Frequency and risk factors associated with non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus.

Arq Bras Endocrinol Metabol 2010 Jun;54(4):362-8

Departamento de Medicina Clínica, Universidade Federal de Pernambuco, Recife, PE, Brazil.

Objective: To evaluate the frequency of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (DM2) and to describe its risk factors.

Subjects And Methods: Blood samples of 78 patients were collected for assessment of glycemic and lipid profile, liver enzymes, TNF-alpha and HOMA-IR. The diagnosis of NAFLD was established by ultrasound.

Results: NAFLD was observed in 42% of patients who had greater BMI (p < 0.001), and frequency of hypertension (p < 0.001). Metabolic syndrome was more frequent in those with NAFLD (p = 0.019). The levels of aspartate, alanine aminotransferase, gamma-glutamyl transpeptidase, uric acid, TNF-alpha, insulin and HOMA-IR were significantly higher in patients with NAFLD than those without NAFLD.

Conclusion: Almost half of patients with DM2 were found to have NAFLD, and they have more elevated BMI, as well as higher levels of aminotransferases, gamma-GT, uric acid, TNF-alpha, insulin and HOMA-IR than subjects without NAFLD.
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June 2010

[Serum globulin levels and intensity of hepatic fibrosis in patients with mansonic schistosomiasis].

Arq Gastroenterol 2009 Jul-Sep;46(3):194-8

Estudo desenvolvido no Ambulatório de Esquistossomose e no Laboratório Central do Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE.

Background: A correlation between the levels of serum globulins and the hepatic fibrosis degree in chronic hepatitis was described, but reports in schistosomiasis mansoni have not been found.

Objective: To evaluate the serum globulins and IgG levels, and periportal fibrosis intensity measured by ultrasound in patients with schistosomiasis mansoni.

Methods: Between November, 2006 and February 2007, 41 patients which were eligible, filled them a questionnaire and had their levels of serum IgG measured by immunoturbidimetry and globulins indirectly measured by the Biuret method. The ultrasound was carried out by a single researcher, according to the Cairo and Niamey protocols.

Results: The average age was 41 years old and 25 female patients (61%). Ten patients (24%) from 41 showed serum globulins levels raised and 21 (51%) presented elevated IgG levels. According to the Cairo classification, 21 patients showed grade I of fibrosis, 18 grade II and 2 grade III; and by the Niamey classification 8 showed standard C, 20 D, and 13 E. Those with grade II or III of fibrosis had higher IgG levels than the ones with grade I (P = 0.047), as well as those who showed standards D and E as compared to C (P = 0.011). There was no association between the globulins levels and the intensity of fibrosis.

Conclusion: In patients with schistosomiasis mansoni, an increase of the IgG serum levels was observed according to the progression from periportal fibrosis intensity, but the same was not founded with globulins levels.
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March 2010

Hepatitis G virus infection in patients with hepatocellular carcinoma in Recife, Brazil.

Jpn J Clin Oncol 2007 Aug 18;37(8):632-6. Epub 2007 Aug 18.

Federal University of Pernambuco, Brazil.

The evidence of a higher incidence of hepatitis G virus (HGV) infection among patients with hepatocellular carcinoma (HCC) and the relatively high prevalence of patients with primary liver carcinoma without apparent risk factors in our country motivated the present study, the objective of which was to determine the frequency of HGV-ribonucleic acid (RNA) in a series of patients with HCC. The diagnosis of HCC was established based on alpha-fetoprotein levels (>400 ng/ml), a compatible image and/or biopsy of the hepatic nodules. Markers of hepatitis B virus (HBV) (HBsAg and anti-HBc), hepatitis C virus (HCV) (anti-HCV) and HGV (HGV-RNA) were investigated using MEIA and RT-PCR (reverse transcriptase polymerase chain reaction). There were 32 patients evaluated, including 20 males (63%), with a mean age of 58 years. Twenty-eight (88%) patients were cirrhotic (Child-Pugh: A = 8 patients, B = 14, and C = 6) and 50% reported alcohol consumption. Serological hepatitis markers were detected in 26 (81%) patients, including HBV in 19 (59%), HCV in 12 (38%) and HGV in 9 (28%). Only one (3%) patient was positive for HGV alone. The prevalence of HGV in blood donors from the same region is 10%. The findings suggest that, despite the frequent detection of HGV markers in patients with HCC, isolated infection with this agent does not seem to be a relevant factor in the etiology of this carcinoma.
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August 2007

Evaluation of splenomegaly in the hepatosplenic form of mansonic schistosomiasis.

Acta Trop 2007 Mar 25;101(3):183-6. Epub 2007 Jan 25.

Department of Medicine and Department of Surgery at the Hospital das, Recife, Brazil.

This study was aimed to evaluate splenomegaly in patients with the hepatosplenic (HS) form of mansonic schistosomiasis (MS), analyzing the size and weight of the spleen and their relationships with patients' gender and age. Between October, 1993 to July, 1998, 78 patients with the HS form of MS had undergone splenectomy as treatment of choice for bleeding due to portal hypertension, at Hospital das Clínicas, Pernambuco, Brazil. By means of abdominal palpation, the excess spleen felt below the left costal edge was measured, and the weight was obtained after splenectomy along with the histopathological analysis. Liver biopsy was performed intraoperatively in order to confirm MS and to rule out other liver diseases. The mean age of the 78 patients were 45 years and 41 of them (53%) were female. The average spleen weight was 912g and the mean spleen size palpable below the left costal edge was 9.1cm. There was a positive relationship between size and weight (p<0.001). Spleen weight and size were larger in males (p=0.007 and p=0.001, respectively). An inverse correlation between age and spleen weight was observed (p<0.001). A classification based upon spleen weight showed 53% of patients presenting a moderate (501-1000g) and 33% a severe (>1001g) splenomegaly. As for the spleen size, the classification showed 64% of patients presenting moderate (4.1-10cm below the left costal edge) and 21% severe (>10cm) splenomegaly. In conclusion, splenomegaly may be considered a key physical finding in patients with HS form of MS, and we found a good correlation between the spleen sizes clinically evaluated with its weight. The majority of cases presents a moderate to severe splenomegaly and spleen size is larger in men and it seems to decrease with aging.
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March 2007

Preliminar evaluation of cytokines in the hepatitis C-schistosomiasis co-infection.

Mem Inst Oswaldo Cruz 2006 Sep;101 Suppl 1:353-4

Centro de Pesquisas Aggeu Magalhães-Fiocruz, Av. Prof. Moraes Rego, 52020-020 Recife, PE, Brazil.

Evaluation of hepatic fibrosis is usually performed by histopathological examination of biopsies. However, this is an invasive and potentially dangerous procedure. Several studies have proposed serum biological markers of hepatic fibrosis. This communication evaluates the use of serum cytokines as markers of hepatic fibrosis in hepatitis C, schistosomiasis, and co-infection.
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September 2006

Determination of alanine aminotransferase in blood donor screening--evidence of its usefulness in the prevention of post-transfusion hepatitis.

Clin Lab 2004 ;50(5-6):291-4

Division of Gastroenterology, Universidade Federal de São Paulo, SP, Brazil.

A total of 408 HBsAg and anti-HCV-negative patients with elevated ALT levels referred from blood banks were studied. Of these, 359 were followed up. HBsAg and anti-HCV were repeated in the first visit and ALT was checked at a 3 months interval. A liver biopsy was indicated when ALT levels remained abnormal for more than 6 months. Of the patients included, 316/359 (88%) were men, with a mean age of 34 years. In the first visit, 3 (0.8%) patients were anti-HCV positive upon serological reevaluation, with persistence of elevated ALT in all of them. A biopsy revealed chronic hepatitis in all three cases. Twenty-two patients were positive for anti-HBc, 20 of them were immune (anti-HBs positive), one developed anti-HBs after a vaccine dose, and one was HBsAg positive. The present study suggests that ALT can be a useful marker for the detection of hepatitis C virus infected donors in whom technical problems might have occurred in serological screening.
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December 2004

[Identification of the cutoff value for serum alanine aminotransferase in hepatitis C screening of patients with chronic renal failure on hemodialysis].

Rev Soc Bras Med Trop 2004 Jan-Feb;37(1):18-21. Epub 2004 Mar 19.

Departamento de Medicina Clínica, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil.

The patients with chronic renal failure in hemodialysis present low levels of serum alanine aminotransferases. In order to establish a better cutoff value for ALT in hepatitis C screening of hemodialysis patients, the ALT levels were measured monthly in 235 patients, being excluded those that presented average above the upper limit of normality. The cutoff value was identified by construction of a ROC curve (receiver operating characteristic). Among 202 patients, 15 (7.4%) presented antibodies to hepatitis C virus (anti-HCV) and 187 (92.6%) were anti-HCV negative, with an ALT average of 0.7 and of 0.5 from ULN (p <0.0001), respectively. The better cutoff value for ALT was at 0.6 from ULN, with sensitivity of 67% and specificity of 75% in anti-HCV screening. These results suggest that ULN of ALT could be reduced for 60% from conventional limit, when we are evaluating patients with CRF in hemodialysis.
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April 2004

Therapy with interferon-alpha plus ribavirin for membranoproliferative glomerulonephritis induced by hepatitis C virus.

Braz J Infect Dis 2003 Oct;7(5):353-7

Divisions of Gastroenterology and Nephrology, Department of Medicine, São Paulo Medical School, Federal University of São Paulo, São Paulo, SP, Brazil.

We describe a treatment made with interferon-alpha (IFN-alpha) plus ribavirin of two patients with membranoproliferative glomerulonephritis (MPGN) induced by hepatitis C virus (HCV): case # 1 was a 22-yr-old woman with leg and facial edema, hypertension and proteinuria, whose liver biopsy revealed chronic active hepatitis; and case # 2 was a 42-yr-old man with anasarca, hypertension and proteinuria, whose liver biopsy indicated cirrhosis. Both had anti-HCV, HCV-RNA and cryoglobulins. IFN-alpha (3 million units (MU), 3 times/week) and ribavirin (1 g/day) were administered for 12 months. The drugs were well tolerated by both patients. Serum alanine aminotransferase (ALT) levels normalized and HCV-RNA became negative. Cryoglobulins disappeared and an improvement in renal disease was seen after 6 months of therapy. However, after 9 months, case # 2 presented ALT elevation, and proteinuria was detected. Two years after the end of therapy, both patients were negative in repeated HCV-RNA and cryoglobulin tests. Case # 1 was asymptomatic, with normal liver and renal tests, and case # 2 had normal blood pressure, with mild edema of the ankles. Based on the evolution of these two cases, the association of IFN-alpha and ribavirin may be a therapeutic option for patients with MPGN related to HCV.
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October 2003

Seroprevalence of Helicobacter pylori antibodies in medical students and residents in Recife, Brazil.

J Clin Gastroenterol 2003 Feb;36(2):134-8

Departmento Medicina Clínica, Faculdade de Ciências Médicas, Univeridade de Pernambuco, Recife, Brazil.

Background: The epidemiology of Helicobacter pylori (Hp) still constitutes a relevant subject of investigation.

Goal: The goal of this study was to determine the seroprevalence rate of Hp antibodies in medical students and residents, and its relationship with medical practice, age, gender and parents' formal education level.

Study: The study was carried out from March 1999 to March 2000, on a population of 1,119 medical students and residents, from which a randomized and stratified sample was drawn. Each stratum comprised students attending the basic training level, students attending the professional training level, and residents. Independent samples were calculated for each group, making a total of 405 subjects. Each participant was interviewed using a questionnaire. After the interview, serum samples were collected and stored at -20 degrees C for detecting IgG antibodies against Hp by an enzyme-linked immunosorbent assay.

Results: A 31.4% seroprevalence rate of Hp antibodies was observed, which significantly increased during the graduation course according to the medical practices, ranging from 23.4% in students up to 38.6% in residents. Seroprevalence rate increased according to the age (p = 0.002), where older individuals had spent more time in practical activities. Seroprevalence was higher in males and was smaller among those whose parents had a university degree.

Conclusion: The seroprevalence rate of Hp antibodies amongst medical students and residents increases from the basic up to residence level, suggesting that contact with patients during clinical practice may constitute a risk factor for acquiring Hp infection.
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February 2003