terça-feira, 19 de julho de 2016

How China Is Rewriting the Book on Human Origins

On the outskirts of Beijing, a small limestone mountain named Dragon Bone Hill rises above the surrounding sprawl. Along the northern side, a path leads up to some fenced-off caves that draw 150,000 visitors each year, from schoolchildren to grey-haired pensioners. It was here, in 1929, that researchers discovered a nearly complete ancient skull that they determined was roughly half a million years old. Dubbed Peking Man, it was among the earliest human remains ever uncovered, and it helped to convince many researchers that humanity first evolved in Asia.
Since then, the central importance of Peking Man has faded. Although modern dating methods put the fossil even earlier — at up to 780,000 years old — the specimen has been eclipsed by discoveries in Africa that have yielded much older remains of ancient human relatives. Such finds have cemented Africa's status as the cradle of humanity — the place from which modern humans and their predecessors spread around the globe — and relegated Asia to a kind of evolutionary cul-de-sac.
But the tale of Peking Man has haunted generations of Chinese researchers, who have struggled to understand its relationship to modern humans. “It's a story without an ending,” says Wu Xinzhi, a palaeontologist at the Chinese Academy of Sciences' Institute of Vertebrate Paleontology and Paleoanthropology (IVPP) in Beijing. They wonder whether the descendants of Peking Man and fellow members of the species Homo erectus died out or evolved into a more modern species, and whether they contributed to the gene pool of China today.
Keen to get to the bottom of its people's ancestry, China has in the past decade stepped up its efforts to uncover evidence of early humans across the country. It is reanalysing old fossil finds and pouring tens of millions of dollars a year into excavations. And the government is setting up a $1.1-million laboratory at the IVPP to extract and sequence ancient DNA.
The investment comes at a time when palaeoanthropologists across the globe are starting to pay more attention to Asian fossils and how they relate to other early hominins — creatures that are more closely related to humans than to chimps. Finds in China and other parts of Asia have made it clear that a dazzling variety of Homo species once roamed the continent. And they are challenging conventional ideas about the evolutionary history of humanity.
“Many Western scientists tend to see Asian fossils and artefacts through the prism of what was happening in Africa and Europe,” says Wu. Those other continents have historically drawn more attention in studies of human evolution because of the antiquity of fossil finds there, and because they are closer to major palaeoanthropology research institutions, he says. “But it's increasingly clear that many Asian materials cannot fit into the traditional narrative of human evolution.”
Chris Stringer, a palaeoanthropologist at the Natural History Museum in London, agrees. “Asia has been a forgotten continent,” he says. “Its role in human evolution may have been largely under-appreciated.”

EVOLVING STORY

In its typical form, the story of Homo sapiens starts in Africa. The exact details vary from one telling to another, but the key characters and events generally remain the same. And the title is always 'Out of Africa'.
In this standard view of human evolution, H. erectus first evolved there more than 2 million years ago (see 'Two routes for human evolution'). Then, some time before 600,000 years ago, it gave rise to a new species: Homo heidelbergensis, the oldest remains of which have been found in Ethiopia. About 400,000 years ago, some members of H. heidelbergensis left Africa and split into two branches: one ventured into the Middle East and Europe, where it evolved into Neanderthals; the other went east, where members became Denisovans — a group first discovered in Siberia in 2010. The remaining population of H. heidelbergensis in Africa eventually evolved into our own species, H. sapiens, about 200,000 years ago. Then these early humans expanded their range to Eurasia 60,000 years ago, where they replaced local hominins with a minuscule amount of interbreeding.
A hallmark of H. heidelbergensis — the potential common ancestor of Neanderthals, Denisovans and modern humans — is that individuals have a mixture of primitive and modern features. Like more archaic lineages, H. heidelbergensis has a massive brow ridge and no chin. But it also resembles H. sapiens, with its smaller teeth and bigger braincase. Most researchers have viewedH. heidelbergensis — or something similar — as a transitional form between H. erectus and H. sapiens.
Unfortunately, fossil evidence from this period, the dawn of the human race, is scarce and often ambiguous. It is the least understood episode in human evolution, says Russell Ciochon, a palaeoanthropologist at the University of Iowa in Iowa City. “But it's central to our understanding of humanity's ultimate origin.”
The tale is further muddled by Chinese fossils analysed over the past four decades, which cast doubt over the linear progression from African H. erectus to modern humans. They show that, between roughly 900,000 and 125,000 years ago, east Asia was teeming with hominins endowed with features that would place them somewhere between H. erectus and H. sapiens, says Wu (see‘Ancient human sites’).
“Those fossils are a big mystery,” says Ciochon. “They clearly represent more advanced species than H. erectus, but nobody knows what they are because they don't seem to fit into any categories we know.”
The fossils' transitional characteristics have prompted researchers such as Stringer to lump them with H. heidelbergensis. Because the oldest of these forms, two skulls uncovered in Yunxian in Hubei province, date back 900,000 years, Stringer even suggests that H. heidelbergensis might have originated in Asia and then spread to other continents.
But many researchers, including most Chinese palaeontologists, contend that the materials from China are different from European and African H. heidelbergensis fossils, despite some apparent similarities. One nearly complete skull unearthed at Dali in Shaanxi province and dated to 250,000 years ago, has a bigger braincase, a shorter face and a lower cheekbone than most H. heidelbergensis specimens, suggesting that the species was more advanced.
Such transitional forms persisted for hundreds of thousands of years in China, until species appeared with such modern traits that some researchers have classified them as H. sapiens. One of the most recent of these is represented by two teeth and a lower jawbone, dating to about 100,000 years ago, unearthed in 2007 by IVPP palaeoanthropologist Liu Wu and his colleagues. Discovered in Zhirendong, a cave in Guangxi province, the jaw has a classic modern-human appearance, but retains some archaic features of Peking Man, such as a more robust build and a less-protruding chin.
Most Chinese palaeontologists — and a few ardent supporters from the West — think that the transitional fossils are evidence that Peking Man was an ancestor of modern Asian people. In this model, known as multiregionalism or continuity with hybridization, hominins descended from H. erectus in Asia interbred with incoming groups from Africa and other parts of Eurasia, and their progeny gave rise to the ancestors of modern east Asians, says Wu.
Support for this idea also comes from artefacts in China. In Europe and Africa, stone tools changed markedly over time, but hominins in China used the same type of simple stone instruments from about 1.7 million years ago to 10,000 years ago. According to Gao Xing, an archaeologist at the IVPP, this suggests that local hominins evolved continuously, with little influence from outside populations.

POLITICS AT PLAY?

Some Western researchers suggest that there is a hint of nationalism in Chinese palaeontologists' support for continuity. “The Chinese — they do not accept the idea that H. sapiens evolved in Africa,” says one researcher. “They want everything to come from China.”
Chinese researchers reject such allegations. “This has nothing to do with nationalism,” says Wu. It's all about the evidence — the transitional fossils and archaeological artefacts, he says. “Everything points to continuous evolution in China from H. erectus to modern human.”
But the continuity-with-hybridization model is countered by overwhelming genetic data that point to Africa as the wellspring of modern humans. Studies of Chinese populations show that 97.4% of their genetic make-up is from ancestral modern humans from Africa, with the rest coming from extinct forms such as Neanderthals and Denisovans. “If there had been significant contributions from Chinese H. erectus, they would show up in the genetic data,” says Li Hui, a population geneticist at Fudan University in Shanghai. Wu counters that the genetic contribution from archaic hominins in China could have been missed because no DNA has yet been recovered from them.
Many researchers say that there are ways to explain the existing Asian fossils without resorting to continuity with hybridization. The Zhirendong hominins, for instance, could represent an exodus of early modern humans from Africa between 120,000 and 80,000 years ago. Instead of remaining in the Levant in the Middle East, as was thought previously, these people could have expanded into east Asia, says Michael Petraglia, an archaeologist at the University of Oxford, UK.
Other evidence backs up this hypothesis: excavations at a cave in Daoxian in China's Hunan province have yielded 47 fossil teeth so modern-looking that they could have come from the mouths of people today. But the fossils are at least 80,000 years old, and perhaps 120,000 years old, Liu and his colleagues reported last year. “Those early migrants may have interbred with archaic populations along the way or in Asia, which could explain Zhirendong people's primitive traits,” says Petraglia.
Another possibility is that some of the Chinese fossils, including the Dali skull, represent the mysterious Denisovans, a species identified from Siberian fossils that are more than 40,000 years old. Palaeontologists don't know what the Denisovans looked like, but studies of DNA recovered from their teeth and bones indicate that this ancient population contributed to the genomes of modern humans, especially Australian Aborigines, Papua New Guineans and Polynesians — suggesting that Denisovans might have roamed Asia.
María Martinón-Torres, a palaeoanthropologist at University College London, is among those who proposed that some of the Chinese hominins were Denisovans. She worked with IVPP researchers on an analysis, published last year, of a fossil assemblage uncovered at Xujiayao in Hebei province — including partial jaws and nine teeth dated to 125,000–100,000 years ago. The molar teeth are massive, with very robust roots and complex grooves, reminiscent of those from Denisovans, she says.
A third idea is even more radical. It emerged when Martinón-Torres and her colleagues compared more than 5,000 fossil teeth from around the world: the team found that Eurasian specimens are more similar to each other than to African ones. That work and more recent interpretations of fossil skulls suggest that Eurasian hominins evolved separately from African ones for a long stretch of time. The researchers propose that the first hominins that left Africa 1.8 million years ago were the eventual source of modern humans. Their descendants mostly settled in the Middle East, where the climate was favourable, and then produced waves of transitional hominins that spread elsewhere. One Eurasian group went to Indonesia, another gave rise to Neanderthals and Denisovans, and a third ventured back into Africa and evolved into H. sapiens, which later spread throughout the world. In this model, modern humans evolved in Africa, but their immediate ancestor originated in the Middle East.
Not everybody is convinced. “Fossil interpretations are notoriously problematic,” says Svante Pääbo, a palaeogeneticist at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany. But DNA from Eurasian fossils dating to the start of the human race could help to reveal which story — or combination — is correct. China is now making a push in that direction. Qiaomei Fu, a palaeogeneticist who did her PhD with Pääbo, returned home last year to establish a lab to extract and sequence ancient DNA at the IVPP. One of her immediate goals is to see whether some of the Chinese fossils belong to the mysterious Denisovan group. The prominent molar teeth from Xujiayao will be an early target. “I think we have a prime suspect here,” she says.

FUZZY PICTURE

Despite the different interpretations of the Chinese fossil record, everybody agrees that the evolutionary tale in Asia is much more interesting than people appreciated before. But the details remain fuzzy, because so few researchers have excavated in Asia.
When they have, the results have been startling. In 2003, a dig on Flores island in Indonesia turned up a diminutive hominin, which researchers named Homo floresiensis and dubbed the hobbit. With its odd assortment of features, the creature still provokes debate about whether it is a dwarfed form of H. erectus or some more primitive lineage that made it all the way from Africa to southeast Asia and lived until as recently as 60,000 years ago. Last month, more surprises emerged from Flores, where researchers found the remains of a hobbit-like hominin in rocks about 700,000 years old.
Recovering more fossils from all parts of Asia will clearly help to fill in the gaps. Many palaeoanthropologists also call for better access to existing materials. Most Chinese fossils — including some of the finest specimens, such as the Yunxian and Dali skulls — are accessible only to a handful of Chinese palaeontologists and their collaborators. “To make them available for general studies, with replicas or CT scans, would be fantastic,” says Stringer. Moreover, fossil sites should be dated much more rigorously, preferably by multiple methods, researchers say.
But all agree that Asia — the largest continent on Earth — has a lot more to offer in terms of unravelling the human story. “The center of gravity,” says Petraglia, “is shifting eastward.”
This article is reproduced with permission and was first published on July 12, 2016.

Atom Wranglers Create Rewritable Memory

Engineers can only stuff so much computing power into devices like smartphones and tablets before they run up against physical barriers. Although Moore's law famously predicts that the number of transistors people can squeeze onto memory chips will double every couple of years,technology cannot be miniaturized indefinitely.
Researchers are trying to get around this by starting small—using individual atoms—to make big gains in data-storage capacity. Now, a team has developed a 1-kilobyte rewritable data-storage device using chlorine atoms arranged on a small metal surface. If the team expanded that surface to one square centimetre, it could hold about 10 terabytes of information, the researchers report on July 18 in Nature Nanotechnology.
“It’s by far the largest assembly on an atomic scale that’s ever been created, and it outperforms state-of-the-art hard disk drives by orders of magnitude in data capacity,” says lead study author Sander Otte, a physicist at Delft University of Technology in the Netherlands.

PUZZLE PIECES

The technique depends on the ability to reliably and quickly rearrange individual atoms. Scientists demonstrated how to do this in 1990 when they carefully gathered xenon atoms scattered across a surface to spell out 'IBM'. Now, Otte and his team have taken the concept further. They arranged chlorine atoms into square grids on a copper surface, and then placed those grids side-by-side like uninterrupted terraces.
Each grid contains a few empty slots, or holes. This allows the research team to move atoms around, much like sliding pieces around in a tile puzzle. Each line on a grid encodes one unit of digital information called a byte.
Otte’s team uses a scanning tunnelling microscope with a sharp needle, like the tiniest of tweezers, to probe the atoms and make them hop into adjacent spaces. One chlorine atom and one vacancy make one bit (there are 8 bits in one byte). Moving chlorine atoms in and out of vacant spots means researchers can switch between ones and zeroes, the basis for computer code.
The researchers were also able to place atomic markers at the upper left corner of each grid, which reduced the amount of time necessary to read the information encoded into each arrangement. The device reading the grids can simply read the marker that indicates the end of a line of code, for instance, rather than slog through the entire pattern bit by bit. The automated process only takes a few hours to read or write, whereas earlier ones would take days.

NOT FOR PRIME TIME

One of the big drawbacks of this device is that it must be kept at –196 °C: the boiling point of liquid nitrogen. This is a far cry from room temperature, but it’s warmer and less expensive than using liquid helium as a coolant, as did previous attempts to develop atomic memory.
“It’s very nice proof-of-principle work, demonstrating the first step of applying this technique of atomic manipulation to something that could lead to a functional memory device,” says Stefan Fölsch, a materials physicist at the Paul Drude Institute for Solid State Electronics in Berlin.
If researchers could scale the technology up to larger structures and arrange their grids in three dimensions, then one could pack hundreds of terabytes—equivalent to all the information contained in the US Library of Congress—into a cube the size of a grain of salt. Further improvements could prove useful to data storage in the cloud, reducing the need for new data centres.
But data storage is just one application. “Otte’s research gets people interested in thinking about what we want to do on an atomic scale,” says Chris Lutz, a staff scientist at IBM Research at Almaden Research Center in San Jose, California. In the long term, Otte and his colleagues’ research could pave the way to designing new materials, atom by atom.
This article is reproduced with permission and was first published on July 18, 2016.

How Well Can We Remember Someone's Life after They Die?

Our memories of our own lives are often unreliable, so it should be no surprise that the same is true for our departed loved ones

As a memory scientist, I don’t trust my memories of my own life. So, why should I trust memories of a deceased loved one? My grieving brain responds to this with "because I desperately want to," but I know this is a childishly flawed argument made in a moment of weakness.
If all memories can be flawed, as I argue at length in my book ‘The Memory Illusion’, then these memories can be too. There is no memory safe house that keeps our most cherished memories from corruption. All memories can be false memories, even memories of those we love most.
Because I consider writing cathartic, and enjoy gaining insight into my own internal processes by understanding the science behind them, let’s talk about memories and death.
Mark
Here is the background behind this post. My stepfather, Mark, to whom I was exceptionally close, passed away suddenly six weeks ago. I was the first responder, with 911 on the line as I kept him breathing until the paramedics arrived. He had been in good health, so we suspected that everything would be fine. Then the medics told us he had suffered a blockage in his heart. My efforts had been in vain. In my memory of the event I can still see him where I found him at home, with his head against the glass and his eyes rolled back, breathing heavily. It was the last time I saw him alive.
Grief is the deepest emotion I have ever felt; a combination of devastation, despair, powerlessness, and existential fear. But it was not all bad, for in this darkest time I still found moments of light: the beautiful memories that remained of his life. I wanted to hold the memories. I wanted to touch them. I wanted them to materialize.
I was overcome with an immeasurable desire to tell and retell everyone who would listen about every moment I could remember spending with him. I saw this happening to all his family and friends. We desperately needed to keep his memories alive. Memories were all we had left of him.
But I encountered a conundrum that many others did not. I realized that much of what we were sharing as memories had probably never happened.
Reconstructive Narratives
Memory is often a social construction. Certainly in the context of grief, memories are often elicited and shared in group settings with family members and friends. Information is disclosed, information is absorbed, and memories change in the process.
According to psychological scientist Robert Neimeyer and his colleagues in 2014, grief involves “processes by which meanings are found, appropriated or assembled at least as fully between people as withinthem.”
After the death of a loved one we look for meaning, we create meaning, and in the process we often agree with others on what a person’s life must have been like. As Neimeyer and his colleagues say “a central task of grieving is the reconstruction of those narratives.” From my own research, I can tell you that these reconstructive processes can be very creative, covertly weaving compelling pieces of fiction into the story of a life.
Mark, as the family remembers him, never existed until now. The family has created a past that never was, in our own attempt to understand our relationship with his death.
Like a mosaic, we all contribute the broken shards of our memories to a larger picture that, while imperfect, creates a beautiful whole life.
Complicated Grief
But it’s not all pretty art analogies and family memories. Being touched by death also has the potential to adversely affect our memories. For one thing, we can have intrusive memories of the deceased that pop up when we don’t want them to. I certainly keep thinking back to Mark’s head against the glass.
In the worst cases, we can even experience something referred to as ‘complicated grief.’ According to memory scientists Donald Robinaugh and Richard McNally in a research paper published in 2013; “Complicated grief is associated with impairment in the ability to retrieve specific autobiographical memories.”
In their research on the subject, Robinaugh and McNally recruited 33 participants who had lost a life partner within the last three years. They found that the 13 participants who met the criteria for complicated grief had trouble accessing specific memories of their lives, and they had difficulty imagining events in the future. This phenomenon was generally referred to as having ‘overgeneral memory’.
However, the memories of the complicated grievers were only overgeneral when they did not involve the deceased. Memories involving the person who had passed away were comparatively intact.
Those who suffer from complicated grief seem to have memories that override the present, making them unable to concentrate or function in their normal lives. They lose themselves, and their memories of their own lives, and can only retain memories involving the person they have lost.
In my personal experience of grief I mostly doubted memories of another’s life, whereas complicated grievers doubt memories of their own lives. Grief affects everyone differently, and this too applies to how it impacts our memories.
Death gives life meaning
So can we accurately remember someone’s life after they die? I think not.
I think there are too many psychological processes and biases that enter once someone has passed away to believe that our memories of that person can possibly remain unscathed.
But that’s OK. One must only look at the average eulogy to see that we usually remember our loved ones in the best (im)possible light. We should all be so lucky to be remembered as the best version of ourselves, even if this version is partially the result of distorted memories.
As for my own grief, I will forever cherish all my true and false memories of Mark.


The views expressed are those of the author(s) and are not necessarily those of Scientific American.

Interpretando os testes diagnósticos nas hepatites A, B e C


Como são muitas as duvidas de quem recebe o resultado dos exames de detecção das hepatites neste artigo tentarei explicar com palavras simples (sem "mediques") a interpretação de cada exame, mas somente para servir de simples orientação, já que a interpretação definitiva deverá sempre ser realizada por um médico. Não utilize informações para auto-interpretação ou auto-diagnostico! 



Hepatite A


São dois os exames de sangue que devem ser utilizados para diagnosticar a hepatite A. 

O ANTI-HAV IgM quando positivo indica que a pessoa se contaminou recentemente, o que é chamado de infecção aguda. 

O ANTI-HAV IgG quando positivo indica que a pessoa teve contato com o vírus da hepatite A e que curou espontaneamente a doença. Quando positivo indica que a pessoa apresenta imunidade. Essa imunidade pode ser ocasionada pela vacina ou por uma infecção já curada. O resultado positivo irá permanecer por toda a vida. 

Para auxiliar na interpretação dos resultados na hepatite A observe o seguinte:

- Se os resultados do ANTI-HAV IgG e o ANTI-HAV IgM apresentam resultadospositivos o resultado indica uma infecção aguda (recente); 

- Se o resultado do ANTI-HAV IgG e positivo e o ANTI-HAV IgM apresenta um resultado negativo, o individuo curou de uma infecção passada ou recebeu a vacina, apresentando imunidade; 

- Se os resultados do ANTI-HAV IgG e o ANTI-HAV IgM apresentam resultadosnegativos o resultado indica que o individuo nunca teve contato com a hepatite A nem apresenta imunidade vacinal, sendo por tanto suscetível a ter a doença caso tenha contato com o vírus. Nestes casos e recomendável aplicar a vacina para prevenir a hepatite A. 



Hepatite B


A interpretação dos exames para diagnosticar a hepatite B e altamente complicada e até médicos não especialistas na doença podem se confundir com os resultados. Vou explicar o que cada resultado de cada antígeno do vírus interpreta, mas para servir somente como conhecimento geral. Nunca tente chegar a qualquer conclusão por conta própria e, apresente sempre os resultados a um médico especialista (veja relação de especialistas na seção ONDE TRATAR da nossa páginaWWW.HEPATO.COM) 

Os dois primeiros marcadores utilizados na triagem para o diagnostico da hepatite B sã o HBsAg e o ANTI-HBc TOTAL. 

O antígeno HBsAg surge logo após acontecer a infecção, entre 30 e 45 dias. Pode permanecer detectável por até 120 dias e se encontra presente nas infecções agudas e crônicas. 

O antígeno Anti-HBc indica que o individuo teve contato com o vírus e o resultadopositivo vai permanecer por toda a vida, estejam curados ou continuem infectados de forma crônica. 

Esses dois marcadores devem ser interpretados pelo médico para continuar com a estratégia diagnostica. Nunca devem ser solicitados todos os exames ao mesmo tempo, pois representa um desperdiço muito grande de recursos. 

Para auxiliar na interpretação dos resultados na hepatite B observe o seguinte: 


- Se o resultado do HBsAg e positivo e o Anti-HBc apresenta um resultado negativo, o individuo foi recentemente infectado (fase aguda), assim, como pode se tratar de um resultado falso positivo, motivo pelo qual se recomenda repetir os dois exames após 15 dias. 

- Se os resultados do HBsAg e o Anti-HBc apresentam resultados positivos o resultado pode indicar uma infecção aguda (recente) ou já a doença estabelecida na forma crônica (doença existente por mais de seis meses). O médico vai solicitar um exame chamado ANTI-HBc IgM para diferenciar o estagio da infecção. 

- Se o resultado do HBsAg e negativo e o Anti-HBc apresenta um resultado positivo, pode indicar que o individuo foi infectado recentemente e se encontra na chamada janela imunológica (primeiros dias após o contagio quando ainda não se apresentam anticorpos detectáveis) ou, também, pode ser um resultado falso positivo, ou se tratar de um paciente que curou a doença espontaneamente. O médico vai solicitar um exame chamado ANTI-HBs para diferenciar o estado em que se encontra o paciente. 

- Se os resultados do HBsAg e o Anti-HBc apresentam resultados negativos o resultado indica que o individuo não está infectado. 


Quadro de interpretação dos resultados para o diagnostico da hepatite B: 


HBsAg
Anti-HBs
Anti-Hbc (total)
Anti-HBc IgM
HBeAg
Anti-HBe
HBV DNA
Interpretação
+
-
+
+
+
-
+
primeira fase de infecção aguda
+
-
+
+
-
+
-
segunda fase da infecção aguda
-
-
+
+
-
+
-
terceira fase da infecção aguda
-
+
+
-
-
+ ou -
-
Recuperação com imunidade
-
+
-
-
-
-
-
Imunizado por vacinação
+
-
+
-
+
-
+
Infecção crônica com replicação ativa
+
-
+
-
-
+
-
Infecção crônica na fase inativa
+
-
+
-
-
+
+
Infecção crônica com replicação ativa
-
-
+
-
-
+ ou -
-
Recuperação, Falso resultado positivo, ou infecção Crônica
-
-
-
-
-
-
-
Susceptível - Recomendada vacinação

Breve descrição dos marcadores utilizados no diagnostico: 


- Anti-HBc IgM (anticorpos da classe IgM contra o antígeno do núcleo do HBV) - é um marcador utilizado para confirmar o diagnóstico de hepatite B aguda (recentemente acontecida), podendo persistir por até 6 meses após o início da infecção. 

- Anti-HBs (anticorpos contra o antígeno de superfície do HBV) - indica imunidade, indicando que o individuo está protegido contra uma nova infecção. É detectado geralmente entre 1 a 10 semanas após o desaparecimento do HBsAg e indica bom prognóstico. Quando encontrado isoladamente com todos os outros marcadores negativos indica que o individuo foi vacinado.

- HBeAg (antígeno "e" do HBV) - um resultado positivo indica que existe replicação viral e, portanto, um paciente que transmite a doença. Está presente na fase aguda, surge após o aparecimento do HBsAg e pode permanecer por até 10 semanas. Na hepatite B crônica, a presença do HBeAg indica replicação viral e atividade da doença (maior probabilidade de evolução para cirrose). 

- Anti-HBe (anticorpo contra o antígeno "e" do HBV) - marcador que indica um bom prognóstico na fase aguda da hepatite B. A soroconversão HBeAg para Anti-HBeindica alta probabilidade de cura nos casos agudos (ou seja, provavelmente o indivíduo não vai se tornar um portador crônico do vírus). Nos casos de pacientes com hepatite B crônica a presença do anti-HBe indica ausência de replicação do vírus, ou seja, menor atividade da doença, sendo um prognostico de menor possibilidade de desenvolvimento de cirrose. - HBV DNA e o que conhecemos como carga viral. Diagnostica a circulação do vírus no organismo, sendo considerado o melhor marcador existente para acompanhar pacientes infectados cronicamente com a hepatite B. É utilizado para recomendar o tratamento, para acompanhar a resistência viral aos medicamentos e para prognosticar a progressão da doença. 



Hepatite C


O diagnóstico da hepatite C e muito fácil de ser interpretado. Todo individuo que teve contato com o vírus vai apresentar por toda sua vida um resultado positivo ao exame chamado ANTI-HCV. Este exame não deve ser realizado repetitivamente, pois sempre vai aparecer com um resultado positivo, mas o ANTI-HCV não indica se a hepatite C foi curada ou se ela permanece. 

A chamada janela imunológica para que possa ser detectado o anticorpo do vírus C demora até 120 dias, assim, em casos de infecção aguda este exame pode dar um resultado negativo. Na suspeita de casos agudos e sempre recomendável a realização do PCR/RNA/HCV, por apresentar uma janela imunológica menor, inferior a duas semanas. 

Todos os casos positivos do ANTI-HCV devem ser confirmados mediante a realização do exame chamado PCR/RNA/HCV QUALITATIVO, por ser este o exame que detecta o próprio vírus circulando no sangue. Um resultado positivo indica que o individuo se encontra infectado com a hepatite C. Se a infecção aconteceu há mais de seis meses o paciente e considerado crônico. 

Um resultado negativo para o PCR/RNA/HCV junto a um resultado positivo para oANTI-HCV indica que o individuo curou a hepatite C, seja espontaneamente (acontece em aproximadamente 15% dos casos) ou pelo tratamento com interferon e ribavirina. 

Carlos Varaldo
www.hepato.com
hepato@hepato.com


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Carlos Varaldo e o Grupo Otimismo declaram não possuir conflitos de interesse com eventuais patrocinadores das diversas atividades.

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O Grupo Otimismo é afiliado da AIGA - ALIANÇA INDEPENDENTE DOS GRUPOS DE APOIO