Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon.

Background: There was a high proportion of pregnant women who were attending prenatal care who were not tested for syphilis or tested but not treated, among priority countries. The coverage for prenatal care visits, syphilis screening, and treatment are priority indicators for monitoring of the elimination of syphilis. The aim was to determine the factors associated with gestational syphilis among postpartum women who were in a prenatal care program in the Brazilian Amazon. Methods: An unmatched case-control study was conducted at the hospital in Brazil. Data collection was carried out from November 2020 to July 2021 during hospitalization using a pretested structured questionnaire. The criteria for selection of cases and control followed the guidelines established by the Ministry of Health of Brazil; postpartum women with a laboratory diagnosis based on treponemal and/or nontreponemal tests, symptoms of syphilis or asymptomatic, treatment or not treated, and in a prenatal care program. Gestational syphilis cases were identified as women who tested positive for syphilis, and those who tested negative were controls, at minimally one prenatal care visit, childbirth, and/or the puerperium. The sample size encompassed 59 cases and 118 controls (1: 2 ratio of cases to controls). Data were analyzed using Minitab 20® and BioEstat 5.3® software. The odds ratio was calculated by multiple logistic regression. Results: One hundred and seventy-seven postpartum women were included in the study, 59 cases and 118 controls. Among all participants, 95.5% (169) were tested for syphilis in any trimester during pregnancy and at the delivery and 4.5% (8) were tested in the maternity only, at the time childbirth and/or puerperium. The final multiple logistic regression model evidenced that cases had higher odds compared to controls if they had past history of sexually transmitted infections (AOR: 55.4; p: 0.00), difficulty talking about condom use with their sexual partner (AOR: 4.92; p: 0.01), one to six prenatal care visits (AOR: 4.93; p: 0.01), had not received a sexually transmitted infections test result in the maternity hospital (AOR: 4.09; p: 0.04), lower monthly income (AOR: 4.32; p: 0.04), or one to three miscarriages (AOR: 4.34; p: 0.01). Conclusion: The sociodemographic, programmatic, obstetric, and sexual factors are associated with gestational syphilis among postpartum women.

Causa de mortalidade materna na região metropolitana I no triênio 2013-2015, Belém, PA / Cause for maternal mortality in the metropolitan region I in the 2013-2015 trien, Belém, PA / Causa de mortalidad materna en la región metropolitana I en el trienio 2013-2015, Belém, PA

Objetivo: estudo sobre a ocorrência de óbitos maternos na região metropolitana de Belém no período de janeiro de 2013 a dezembro de 2015. Método: Trata-se de uma abordagem epidemiológica, descritiva, quantitativa, retrospectiva e documental. Incluindo: óbitos classificados como morte materna por causas obstétricas diretas e indiretas. Sendo excluído: óbitos classificados como acidentais. Por intermédio da estatística descritiva. Resultado: No período de janeiro de 2013 a dezembro de 2015, foram declarados 53 óbitos em 2013, 45 óbitos maternos no ano de 2014 e 40 óbitos em 2015. Os dados identificaram uma razão de mortalidade materna de 160,3 no ano de 2013, 136,0 no ano de 2014 e 121,9 em 2015. Conclusão: A morte materna na região metropolitana I é caracterizada por RMM acima do recomendado pela OMS, evidenciando a necessidade de atenção integral e de qualidade à saúde da gestante, desde o pré-natal até o puerpério, no Estado do Pará.(AU)

Objective: a study on the occurrence of maternal deaths in the metropolitan region of Belém from January 2013 to December 2015. Method: This is an epidemiological, descriptive, quantitative, retrospective and documentary approach. Including: deaths classified as maternal deaths from direct and indirect obstetric causes. Being excluded: deaths classified as accidental. By means of descriptive statistics. Outcome: From January 2013 to December 2015, 53 deaths were reported in 2013, 45 maternal deaths in 2014 and 40 deaths in 2015. The data identified a maternal mortality ratio of 160.3 in the year 2013, 136.0 in 2014 and 121.9 in 2015. Conclusion: Maternal death in the metropolitan region I is characterized by MMR above that recommended by the WHO, evidencing the need for integral attention and quality to the health of the pregnant woman, to the puerperium in the state of Pará.(AU)

Objetivo: Estudio sobre la ocurrencia de muertes maternas en la región metropolitana de Belém en el período de enero de 2013 a diciembre de 2015. Método: Se trata de un abordaje epidemiológico, descriptivo, cuantitativo, retrospectivo y documental. Incluyendo: óbitos clasificados como muerte materna por causas obstétricas directas e indirectas. Si se excluye: muertes clasificadas como accidentales. Por medio de la estadística descriptiva. Resultado: En el período de enero de 2013 a diciembre de 2015, se declararon 53 muertes en 2013, 45 muertes maternas en el año 2014 y 40 muertes en 2015. Los datos identificaron una razón de mortalidad materna de 160,3 en el año 2013, En el año 2014 y 121,9 en 2015. Conclusión: La muerte materna en la región metropolitana I se caracteriza por RMM por encima de lo recomendado por la OMS, evidenciando la necesidad de atención integral y de calidad a la salud de la gestante, desde el preescolar, -natal hasta el puerperio, en el Estado de Pará.(AU)

Letramento funcional em saúde de idosos acerca de acidentes por quedas e sua prevenção / Functional health literacy of elderly people about fall accidents and their prevention / Letra funcional en salud de ancianos sobre accidentes por caída y su prevención

Objetivou-se conhecer o nível de letramento sobre acidentes por queda e sua prevenção relativamente a idosos frequentadores de praças públicas no município de Belém, estado do Pará, Brasil. Pesquisa exploratório-descritiva com abordagem qualitativa, realizada com 80 idosos, cujos dados foram coletados por meio da aplicação assistida do instrumento "Alfabetização em saúde". As baixas percentagens de respostas mostraram o baixo nível do letramento funcional em saúde dos idosos, revelando aparente conformidade e passividade acerca das informações de saúde.

This study aimed to know the level how elderly that frequent public parks health information about preventing falls accidents in the municipality of Belém, Pará, Brazil. An exploratory descriptive research with a qualitative approach was conducted with 80 elderly. The data collection occurred through an assisted application of the instrument "Health Literacy". The low percentages of answers showed the poor level of the functional literacy in the elderly, revealing apparent compliance and passivity about health.

Conocer el nivel de letra funcional em salud sobre prevención de accidentes por caídas de ancianos frecuentadores de plazas públicas en el municipio de Belém, Pará, Brasil. La investigación exploratorio-descriptiva con abordaje cualitativo, realizada con 80 ancianos, cuyas informaciones fueron recogidas por medio de aplicación asistida del instrumento de "Alfabetización en salud". Las bajas porcentajes de respuestas mostraron el bajo nivel del letra funcional en salud de los ancianos, revelando aparente conformidad y pasividad acerca de dicha condición.

Software for systematization of nursing care in medical units.

OBJECTIVE: To describe the development of a software prototype to apply the nursing process in clinical units of a general hospital, and assess its usefulness. METHOD: Applied methodological research of technological production of a program based on prototyping software engineering developed in three stages: specification, development, and validation. RESULTS: Produced under the name of INFOSAE, the system represents a set of stages (history, diagnosis, expected outcomes, and nursing intervention) providing guidance to nurses to direct and guarantee the necessary care to patients, also allowing an assessment of this care. CONCLUSION: The INFOSAE software prototype, an easy-to-use computerized technology, obtained a favorable assessment by the user nurses that participated in the whole development process, from the specification to the validation of the system.

Software for systematization of nursing care in medical units / Software para sistematización de la Atención de Enfermería en unidad de internación hospitalaria / Software para Sistematização da Assistência de Enfermagem em unidade de internação hospitalar

ABSTRACT Objective: To describe the development of a software prototype to apply the nursing process in clinical units of a general hospital, and assess its usefulness. Method: Applied methodological research of technological production of a program based on prototyping software engineering developed in three stages: specification, development, and validation. Results: Produced under the name of INFOSAE, the system represents a set of stages (history, diagnosis, expected outcomes, and nursing intervention) providing guidance to nurses to direct and guarantee the necessary care to patients, also allowing an assessment of this care. Conclusion: The INFOSAE software prototype, an easy-to-use computerized technology, obtained a favorable assessment by the user nurses that participated in the whole development process, from the specification to the validation of the system.

RESUMEN Objetivo: Describir el desarrollo de un software prototipo para aplicar el Proceso de Enfermería en unidades de clínica médica de un hospital general y evaluar su utilidad. Método: Investigación metodológica aplicada de producción tecnológica de un software, basada en la ingeniería de software piloto, desarrollada en tres fases: especificación, desarrollo y validación. Resultado: Programado bajo la denominación de INFOSAE, el sistema representa un conjunto de etapas (Histórico, Diagnóstico, Resultados esperados e Intervención de enfermería), que brinda orientación a los enfermeros para dirigir y garantizar la atención necesaria al paciente, permitiendo también evaluar dicha atención. Conclusión: El software prototipo INFOSAE, tecnología informática de fácil aplicación, contó con evaluación favorable por parte de los enfermeros usuarios que participaron de todo el proceso de desarrollo, desde la especificación hasta la validación del sistema.

RESUMO Objetivo: Descrever o desenvolvimento de um software protótipo para aplicar o Processo de Enfermagem em unidades de clínica médica de um hospital geral e avaliar sua utilidade. Método: Pesquisa metodológica aplicada de produção tecnológica de um software, baseada na engenharia de software de prototipação, desenvolvida em três fases: especificação, desenvolvimento e validação. Resultado: Produzido com a denominação de INFOSAE, o sistema representa um conjunto de etapas (Histórico, Diagnóstico, Resultados esperados e Intervenção de enfermagem) que fornece orientação aos enfermeiros para direcionar e garantir a assistência necessária ao paciente, possibilitando ainda avaliar essa assistência. Conclusão: O software protótipo INFOSAE, tecnologia informatizada de fácil aplicação, teve avaliação favorável dos enfermeiros usuários que participaram de todo o processo de desenvolvimento, desde a especificação até a validação do sistema.

Lipid Profile of Children with Malaria by Plasmodium vivax.

Background. Changes in lipid profile are commonly reported in adult patients with malaria. However, a few studies evaluated lipid abnormalities in children continuously exposed to P. vivax. Objective. To evaluate lipid abnormalities in children with P. vivax infection and to assess if parasite count or the history of malaria correlates with lipid levels at admission. Methods. A total of 75 children were included in the study, from which 43 were slide confirmed infection by P. vivax. Serial blood samples were collected at admission and, on days 7 and 14, evaluated for the colorimetric measurements of triglycerides, very low-density lipoprotein (VLDL), total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Results. The levels of total cholesterol, LDL, and HDL were significantly lower in malaria cases. The levels of VLDL and triglycerides were significantly higher in children with malaria. Such changes were transient and were not associated with parasite counting as well as with the history of malaria of patients. Conclusion. There are significant lipid abnormalities in children with low level of P. vivax infection and mild signs and symptoms of the disease, which are not associated with parasitaemia and previous episodes of disease.

Transmissão vertical do HIV em maternidade de referência na amazônia brasileira. / Transmission of HIV in reference motherwood in the brasilian amazon

Objetivo: avaliar a transmissão vertical (TV) do Human Immunodeficiency Virus (HIV) em bebês de mulheressoropositivas que deram a luz na Fundação Santa Casa de Misericórdia do Pará (FSCMPA). Método: estudotransversal, descritivo, tendo como amostra 70 bebês nascidos de mulheres soropositivas para o HIV, que deram a luzna FSCMPA, no período de janeiro de 2000 a julho de 2003. Resultados: dos 70 bebês, filhos de mulheres soropositivas,4,3% (3-70) nasceram por via vaginal; nenhum (0%) foi amamentado ao seio; 11,3% (6-53) foram prematuros; todosreceberam zidovudina (AZT) por seis semanas após o nascimento e nove (12,85%) foram contaminados. Conclusão:a TV do HIV foi expressiva, considerando-se que a aplicabilidade de determinadas medidas é capaz de reduzir estatransmissão para menos de 2%, o que sinaliza a necessidade da melhoria da assistência pré-natal.

Objective: to evaluate the vertical transmission of Human Immunodeficiency Virus (HIV ) in HIV-positive babies ofwomen who gave birth at the Fundação Santa Casa de Misericórdia do Pará (FSCMPA) . Method : Cross-sectional, descriptive study , with a sample of 70 babies born of HIV-positive women, who gave birth at FSCMPA , fromJanuary 2000 to July 2003. Results: of the 70 babies, children of HIV-positive women , 4% ( 3-70 ) were bornvaginally , none (0 %) was breastfed , 11% ( 6-53 ) were premature , all received zidovudine (AZT ) for six weeksafter birth and nine ( 12.85% ) were contaminated . Conclusion: vertical transmission (VT ) of HIV was high ,considering that the applicability of certain measures can reduce the VT to less than 2 % , what signals the need forimproved prenatal care.

Avaliação da abordagem médica em gestantes HIV positivas. / Medical evaluation approach to HIV positive pregnant women

Objetivo: avaliar a abordagem médica às gestantes HIV positivas que deram a luz na Fundação Santa Casa deMisericórdia do Pará (FSCMPA). Método: estudo epidemiológico, descritivo, tendo como amostra 70 mulheresHIV positivas que deram a luz na FSCMPA, no período de janeiro de 2000 a julho de 2003. Resultados: a médiadas idades foi 25,32 anos, sendo a faixa etária mais prevalente de 20 a 30 anos (61,42%). Em 13 casos (18,57%)as gestantes eram adolescentes; a maioria das pacientes (33%) informou ter cursado até o primeiro grau completo;nenhuma era analfabeta ou cursou nível superior; assistência pré-natal foi referida por 91% das pacientes; drogadiçãopor 8 (11,4%). A introdução da zidovudina (AZT) profilática no segundo trimestre da gestação foi referida por 52,8%das pacientes; entretanto, 18,6% dessas mulheres só receberam a droga no momento do parto. Todas as pacientesreceberam AZT injetável durante o trabalho de parto ou durante a operação cesariana. Parto por via vaginal ocorreuapenas em 4,3% (3-70) das pacientes, não constituindo no entanto, indicação médica, visto que as mesmas já seencontravam em período expulsivo quando da internação. Todas as mães participantes do estudo foram orientadasa não amamentarem seus filhos. A transmissão vertical (TV) ocorreu em 12,85% dos conceptos Conclusão: apesarda realização de assistência pré-natal por 91% das pacientes, apenas 52,8% tivessem acesso ao AZT profilático nosegundo trimestre de gestação; acrescido do agravante de 18,6% só terem recebido o medicamento no momento doparto. Parto por via vaginal com as gestantes em período expulsivo ocorreu em em 4,3% dos casos, sugerindo que asgestantes desconheciam as medidas de prevenção da TV. A TV do HIV sem qualquer intervenção situa-se em tornode 20%; a aplicação combinada de determinadas intervenções pode reduzir esse percentual para valores menoresque 2%. O elevado percentual de TV observado neste estudo aponta para a necessidade da melhoria da assistênciapré-natal.

Objective: to evaluate the medical approach to HIV positive pregnant women who gave birth at the Fundação SantaCasa de Misericórdia do Pará (FSCMPA). Method: a descriptive epidemiological study in a sample of 70 HIVpositive women who gave birth in FSCMPA, from January 2000 to July 2003. Results: the mean age was 25.32years, being the most prevalent age group of 20 to 30 years (61.42%). In 13 cases (18.57%) pregnant women wereteenagers; most patients (33%) reported having attended to the primary school; none were illiterate or attended highereducation; prenatal care was reported by 91% of patients; addiction by 8 (11.4%). The introduction of zidovudine(AZT) prophylaxis in the second trimester of pregnancy was reported by 52.8% of patients; however, 18.6% ofwomen only received the drug at birth. All patients received injectable AZT during labor or during cesarean section.Vaginal delivery occurred in only 4.3% (3-70) of patients and does not constitute however, medically indicated,since they were already in the second stage when at the hospital. All mothers participants in the study were advisednot to breastfeed their children. The vertical transmission (VT) occurred in 12.85% of fetuses Conclusion: despitethe realization of prenatal care by 91% of patients, only 52.8% had access to prophylactic AZT in the secondtrimester of pregnancy; increased by 18.6% aggravating that have only received the drug at birth. Vaginal deliveryon pregnant women in second stage occurred in 4.3% of cases, suggesting that pregnant women were unaware of theVT preventive measures. The VT HIV without any intervention stands at around 20%; the combined application ofcertain interventions can reduce this percentage to less than 2%. The high percentage of VT observed in this studypoints to the need for improved prenatal care.

Dez anos de sífilis congênita em maternidade de referância na Amazônia brasileira / Ten years of congenital syphilis in reference motherhood in the Brazilian Amazon

Estudar em uma série histórica de 10 anos, os casos de sífilis congênita(SC) em maternidade pública de referência na Amazônia Brasileira. Método: estudo seccional, descritivo, realizado na maternidade da Santa Casa de Misericórdia do Pará, por meio da análise de prontuários de mulheres cujos filhos tiveram o diagnóstico de sífilis ao nascimento, no período de 2004 a 2013. Resultados: a frequência anual de óbitos de neonatos com diagnóstico de sífilis, nascidos no período, foi mais expressiva nos anos de 2006 (8,9%) e 2007 (10,8%) e aprevalência no período de 10 anos foi de 2,5% (19-754). Peso menor 2.500 gramas foi importante na evolução para óbito. Dos 10 bebês que tiveram peso de nascimento menor 1.500 gramas, 6 (60%) evoluíram para óbito. Observa-se que a mortalidade foi inversamente proporcional ao peso do nascimento. A frequência de SC foi maior nos bebês de mães procedentes da capital. Considerando a existência de melhores condições de assistência à saúde na capital, seria plausível esperar um quantitativo menor de óbitos de neonatos de mulheres com essa procdência. Conclusão: maiores esforços e investimentos são necessários para o controle da SC

Objective: to study in a historical series of 10 years, cases of congenital syphilis (CS) in a public maternity reference in the Brazilian Amazon. Method: cross-sectional, descriptive study conducted at the maternity of the Holy House of Mercy of Para, through the analysis of medical records of women whose children were diagnosed with syphilis at birth, from 2004 to 2013. Results: the yearly number of deaths of newborns diagnosed with syphilis, born in the period, was more significant in 2006 (8.9%) and 2007 (10.8%) and the prevalence in the 10-year period was 2.5% (19-754). Weight less 2,500 grams important in the evolution to death. Of the 10 babies who had birth weight less1,500 g, 6 (60%) had died. It is observed that mortality was inversely related to birth weight. SC the frequency in relation to sex was similar, however, it is interesting that twice more girls had died (3.32%) than boys (1,66%). Despite the higher frequency of women from the countryside, death from SC was higher in babies of mothers from the capital city. Considering the existence of better health service conditions in the capital, it is plausible to expect a smaller quantity of newborn deaths of women with this origin, Conclusion: increased efforts and investiments are necessary for the control of SC.

Prevalência de HIV e sífilis em parturientes atendidas em uma maternidade de referência na cidade de Marabá-Pará. / Prevalence of HIV and syphilis in parturients attended in a reference maternity in Marabá, Pará

Objetivo: conhecer a prevalência da infecção pelo HIV e pelo Treponema pallidum em parturientes atendidas em uma maternidade de referência do SUS. Método: estudo transversal, descritivo com dados coletados do cartão pré-natal e dos prontuários de 480 parturientes envolvidas no estudo. Para o diagnóstico de sífilis e de infecção pelo HIV foi considerado a realização de 2 testes na gravidez e um no parto. Resultados: as prevalências de infecção pelo HIV e de sífilis na amostra estudada foram de 0,4% e 1,9% respectivamente; houve predomínio da faixa etária de 20 a 29 anos nas mulheres com VDRL reagente no parto. A maioria das parturientes frequentou o pré-natal; destas, 48,5% iniciou no primeiro trimestre; 67,6% com o primeiro teste de HIV e 76,3% com o primeiro VDRL e entre as que tiveram 6 ou mais consultas a cobertura do segundo teste foi 37,6% para VDRL e 12,4% para HIV. Ressalte-se que 107 (23,7%) e 146 (32,4%) parturientes respectivamente, só tiveram a oportunidade de fazer o VDRL e a sorologia para HIV no mo-mento do parto. Conclusão: a prevalência de HIV e sífilis em parturientes é elevada e está na dependência da qualidade da assistência pré-natal.

Objective: To know the prevalence of HIV and Treponema pallidum infections among parturients attended at SUS Maternity reference. Method: Cross-sectional and descriptive study. Data was collected from pre-natal cards and from medical records of 480 parturients attended in a Maternity reference, in Marabá, Pará, Brasil. Diagnosis of syphilis and HIV were based on two tests performed during pregnancy and one test performed in labor. Results: Prevalence of HIV infection and syphilis were respectively 0.4% and 1.9%. Predominance of reagent VDRL during labor was observed among 20-29 years old women. The majority attended prenatal care, 48.5% in the first trimester of pregnancy. Among those women 67.6% performed the first HIV test and 37.6% the first VDRL test. Among those who had six or more prenatal visits the coverage of second test was 37.6% for VDRL and 12.4% for HIV. It is worth to note that 23.7% (107/480) and 32.4% (146/480) of pregnant women performed VDRL and HIV serology only at delivery. Conclusion: High prevalence of HIV and syphilis were observed in pregnant attended in a reference maternity of Marabá, Pará, Brazil, and it was associated with quality of prenatal care.

Sífilis congênita em município da Amazônia brasileira / Congenital syphilis in brazilian amazon city

Objetivo: estudar a epidemiologia da sífilis congênita(SC) em mulheres que deram a luz em uma maternidade de refe-rência do Sistema Único de Saúde (SUS) na cidade de Marabá-Pará. Método: estudo retrospectivo, transversal, onde foram estudadas 170 mulheres com sífilis, registradas no Sistema Nacional de Agravos de Notificação (SINAN), no período de 2008 a 2010. Resultados: A prevalência de SC foi de 43,5% (74/170); 82,4% das mães realizaram o pré-na-tal, sendo que 12,2% delas foram diagnosticadas nesse período; 23% eram adolescentes (15 a 19 anos) e 68,9% tinham entre 20 a 34 anos; 8ª série incompleta (41,9%) foi a escolaridade mais prevalente; o VDRL foi reagente em 97,3% das crianças; 4,1% delas receberam tratamento inadequado e 14,9% não foram tratadas; 16,2% dos parceiros das mães dessas crianças não foram tratados. Conclusão: dados como alta prevalência da doença na fase reprodutiva da mulher, baixa escolaridade, crianças não tratadas ou tratadas de modo inadequado e o não tratamento do parceiro demonstram que maiores esforços e investimentos são necessários para o controle da SC.

Objective: to study the epidemiology of congenital syphilis (CS) in women who gave birth in a reference maternity of the Unified Health System (SUS) in the city of Maraba Para. Method: a retrospective, cross-sectional study were stud-ied 170 women with syphilis, registered in the National System for Notifiable Diseases (SINAN), from 2008 to 2010. Results: the prevalence of CS was 43.5% (74/170 ); 82.4% of the mothers had prenatal care, and 12.2% were diagnosed during that period; 23% were adolescents (15-19 years) and 68.9% were between 20-34 years; 8th grade incomplete (41.9%) was the most prevalent schooling; VDRL was positive in 97.3% of children; 4.1% of them received inadequate treatment and 14.9% were not treated; 16.2% of partners of these children?s mothers were not treated. Conclusion: data as high prevalence in the reproductive phase of women, low education, untreated children or improperly treated and the partner?s non-treatment demonstrate that greater efforts and investiments are needed to control the SC.

Gestantes soropositivas para o HIV em município da Amazônia brasileira. / Pregnant soropositive for HIV in the brazilian amazon city

OBJETIVO: estudar o perfil sócio demográfico de gestantes infectadas pelo vírus da imunodeficiência humana (VIH). MÉTODO: estudo retrospectivo, transversal, abrangendo 31 gestantes infectadas com o HIV, registradas no Sistema Nacional de Agravos de Notificação (SINAN), no período de 2008 a 2010. RESULTADOS: 74,2% das gestantes rea-lizaram o pré natal (PN); destas, 61,3% tiveram o diagnóstico laboratorial durante essa assistência e 19,4% somente no momento do parto; 9,7% foram submetidas à cesárea eletiva; 22,6% fizeram profilaxia anti retroviral (ARV) e 29% de seus recém nascidos (RN) também; 64,5% tinham de 20 a 29 anos e 19,4% eram adolescentes (14 a 19 anos); 25,8% tinham ensino fundamental completo. DISCUSSÃO: mais de 60% das gestantes estudadas tiveram conhecimento de seu status sorológico durante o PN, o que possibilitaria a profilaxia da transmissão vertical (TV). O baixo percentual de cesáreas eletivas em gestantes sabidamente soropositivas denotam o desconhecimento ou descaso com a possível contaminação do RN. Apesar do expressivo percentual de realização de PN, o percentual de RN que receberam terapia anti retroviral foi baixa. Dados como a baixa escolaridade e a taxa de adolescentes contaminadas pelo HIV reforçam a necessidade de estratégias direcionadas à educação em saúde nas escolas. CONCLUSÃO: maiores esforços e investi-mentos se fazem necessários para garantir o nascimento de bebês saudáveis de mães contaminadas pelo HIV.

OBJECTIVE: To study the social-demographic profile of pregnant women infected with human immunodeficiencyvirus (HIV). METHODS: A retrospective, cross-sectional study involving 31 pregnant women infected with HIV, registered in the National System for Notifiable Diseases (SINAN), from 2008 to 2010. RESULTS: 74.2% of pregnantwomen received prenatal cares; of these, 61.3% had laboratory diagnosis during such assistance and 19.4% only at de-livery; 9.7% were submited to elective cesarean; 22.6% had anti retroviral prophylaxis and 29% of their newborn too;64.5% were 20-29 years old and 19.4% were adolescents (14-19 years old); 25.8% had completed elementary school.DISCUSSION: more than 60% of the women studied were aware of their HIV status during the prenatal cares, whatwould allow the prophylaxis of vertical transmission (VT). The low percentage of elective cesareans in known HIVpositive pregnant women denotes ignorance or negligence of possible contamination of the RN. Despite the significantpercentage of prenatal cares realized, RN percentage that received antiretroviral therapy was low. Data such as low education and the rate of adolescents infected with HIV reinforce the need for strategies directed to health education inschools. CONCLUSION: greater efforts and investments are needed to ensure the birth of healthy babies of mothers infected with HIV.

Norovirus diversity in diarrheic children from an African-descendant settlement in Belém, Northern Brazil.

Norovirus (NoV), sapovirus (SaV) and human astrovirus (HAstV) are viral pathogens that are associated with outbreaks and sporadic cases of gastroenteritis. However, little is known about the occurrence of these pathogens in relatively isolated communities, such as the remnants of African-descendant villages ("Quilombola"). The objective of this study was the frequency determination of these viruses in children under 10 years, with and without gastroenteritis, from a "Quilombola" Community, Northern Brazil. A total of 159 stool samples were obtained from April/2008 to July/2010 and tested by an enzyme immunoassay (EIA) and reverse transcription-polymerase chain reaction (RT-PCR) to detect NoV, SaV and HAstV, and further molecular characterization was performed. These viruses were detected only in the diarrheic group. NoV was the most frequent viral agent detected (19.7%-16/81), followed by SaV (2.5%-2/81) and HAstV (1.2%-1/81). Of the 16 NoV-positive samples, 14 were sequenced with primers targeting the B region of the polymerase (ORF1) and the D region of the capsid (ORF2). The results showed a broad genetic diversity of NoV, with 12 strains being classified as GII-4 (5-41.7%), GII-6 (3-25%), GII-7 (2-16.7%), GII-17 (1-8.3%) and GI-2 (1-8.3%), as based on the polymerase region; 12 samples were classified, based on the capsid region, as GII-4 (6-50%, being 3-2006b variant and 3-2010 variant), GII-6 (3-25%), GII-17 (2-16.7%) and GII-20 (1-8.3%). One NoV-strain showed dual genotype specificity, based on the polymerase and capsid region (GII-7/GII-20). This study provides, for the first time, epidemiological and molecular information on the circulation of NoV, SaV and HAstV in African-descendant communities in Northern Brazil and identifies NoV genotypes that were different from those detected previously in studies conducted in the urban area of Belém. It remains to be determined why a broader NoV diversity was observed in such a semi-isolated community.

Risk factors and pregnancy outcomes in women with syphilis diagnosed using a molecular approach.

OBJECTIVES: To investigate the risk factors for infection and the outcome of pregnancy in women diagnosed with syphilis using a molecular approach. METHODS: Case-control study of pregnant women admitted to a maternity ward, with the cases classified as early or latent maternal syphilis, based on clinical-serological diagnoses. The DNA of total peripheral blood was used to detect the polA gene using nested PCR (nPCR). The case and control groups were divided into subgroups based on whether the birth was successful (infant survived) or had a lethal outcome (miscarriage, stillbirth or neonatal death). RESULTS: The frequency of maternal syphilis was 1% (237/25 600), considering both those that had live births (71.3%, 169/237) and those with a lethal outcome (28.7%, 68/237), with a higher detection rate being provided by the nPCR in women with early syphilis. The cases of nPCR(+) congenital syphilis were more frequent in the women with early syphilis, nPCR(+) mothers and those who did not have treatment during the prenatal. The risk of maternal syphilis was greater in women who had not received preventive counselling, initiated sexual activity at 16 years of age or younger, had multiple partners, used drugs, were from households with a low income and poor sanitation, and had a history of miscarriage. CONCLUSIONS: The risk factors for congenital syphilis are closely related to the health of the mother, reflecting the lack of adequate prenatal care. The high frequency of maternal syphilis was associated in particular to the socio-economic conditions of the mother and her sexual and reproductive health.

Crianças HIV positivas: características antropométricas e sociodemográficas / HIV positive children: anthropometric and social demographic characteristics

Introdução: crianças infectadas pelo vírus HIV por transmissão vertical geralmente apresentam baixopeso. Objetivo: estudar as características antropométricas e sociodemográficas de crianças soropositivaspara o HIV, infectadas por transmissão vertical, que faziam uso de antirretrovirais. Método: estudotransversal, descritivo com 30 crianças soropositivas, em uso de terapia antirretroviral (TARV). Aavaliação nutricional foi feita, segundo os índices de altura para idade, peso para idade e Índice de MassaCorporal (IMC) para idade. Outros dados foram obtidos por meio de um formulário semi-estruturado,respondido pelos pais/responsáveis pela criança. Resultados: a maioria das crianças era meninos (60%).As mães tinham até 8 anos de estudo (73,4%), viviam com até 1 salário mínimo e somente 3,3% usaramTARV durante a gestação e parto. A avaliação do estado nutricional das crianças apontou percentual de13,3% para baixo peso para idade e 23,3% de baixa estatura para idade. Em todas as idades foramobservados déficits estaturais, embora os mesmos não se apresentassem de forma regular e crescente como aumento da idade. Em relação ao IMCI observou-se adequação de peso para altura e sobrepeso.Conclusão: a desnutrição crônica traduzida pela baixa estatura foi comum nas crianças HIV positivasestudadas, agravada, possivelmente, pela situação socioeconômica materna e a baixa adesão ao prénatal.

Introduction: vertical transmission HIV virus infected children generally present a low weight.Objective: to study the socio-demographic and anthropometric characteristics of HIV positive childreninfected by vertical transmission, which made use of antiretrovirals. Methods: transversal study,descriptive with 30 HIV serum-positive children, under the use of antiretroviral therapy (ART). Thenutritional evaluation has been performed according to the height-for-age, weight-for-age indexes andBody Mass Index (BMI) for-age. Other data have been collected through a semi-structured form,answered by the parents who are responsible for the child. Results: most of the children were male (60%).The mothers had a maximum of 8 years of formal education (73.4%) and live with up to one minimumwage and only 3.3% used ART during pregnancy and delivery. The evaluation of the children?s nutritionalconditions has pointed out a percentage of 13.3% for low weight to the age and 23.3% for low height tothe age. In all ages it was observed structure deficits, although they did not show up in a regular andraising basis, mainly with aging. As for BMI, it was observed an appropriation of weight to height andoverweight. Conclusion: Chronic malnutrition translated by low height was common amongst the studiedHIV positive children, possibly aggravated by the social-economical situation of the mother and the lowadhesion to prenatal programs.

Aspectos imunopatogênicos da sífilis materno-fetal: revisão deliteratura / Immunopathogenic characteristics of maternal-fetal syphilis: review of literature

Objetivo: revisar os aspectos imunopatogênicos da sífilis materno-fetal. Método: uma pesquisabibliográfica foi realizada utilizando-se as palavras-chave: sífilis congênita + imunopatogenia, sífilis materna+ imunopatogenia, sífilis + interface materno-fetal. As bases de dados pesquisadas foram a Medline (MedicalLiterature Analysis and Retrieval System Online) da National Library of Medicine (EUA) e a LILACS(Literatura Latino-Americana e do Caribe em Ciências da Saúde). Considerações finais: a infecção peloTreponema pallidum e o desenvolvimento das características clínicas deletérias deve-se ao êxito dosmecanismos de invasão, evasão e da resposta imunológica do hospedeiro. Na gestação ocorrem mudançashormonais, imunológicas e nutricionais necessárias ao bom desenvolvimento fetal que, porém, modulam asuscetibilidade materno-fetal à infecção. Nesse contexto, o perfil de citocinas na placenta tende a proteger ofeto de ser expulso, ao inibir a resposta celular citotóxica, dificultando, no entanto, a eliminação dotreponema da interface materno-fetal. Por outro lado, a resposta imunológica do feto ainda é imatura até a10ª - 20ª semana de gestação, permitindo que o patógeno invada, dissemine e escape. Assim, o diagnósticoprecoce para instituição do tratamento no recém-nascido é mandatório para prevenção das seqüelas e, comoainda não existe um exame laboratorial disponível na rede pública que permita esse diagnóstico em tempohábil, fica claro que um maior conhecimento da fisiopatogenia da doença é prioritário no sentido decontribuir para o avanço nas pesquisas clínicas

Objective: the objective of this study was to revise the immunopathogenic aspects of maternalfetalsyphilis. Methods: a detailed literature search of the Medline (Medical Literature Analysisand Online Retrieval System) of the American National Library of Medicine and the LILACS(Latin American and Caribbean Health Sciences) databases was conducted using the key wordscongenital syphilis + immunopathogeny, maternal syphilis + immunopathogeny, and syphilis +maternal-fetal interface. Final Considerations: the success of infection by T. pallidum and thedevelopment of deleterious clinical symptoms is due to the effectiveness of the mechanisms ofinvasion a, evasion and immunological response of the host. The hormonal, immunological, andnutritional changes that occur during pregnancy and are necessary for the successfuldevelopment of the fetus also modulate the susceptibility of the fetus to infection. In thiscontext, the cytokine profile of the placenta protects the fetus from expulsion by inhibiting thecytotoxic cell response, although this also hampers the elimination of the treponema from thematernal-fetal interface. However, the immunological response of the fetus is immature up untilthe 10-10th week of gestation, allowing the pathogen to invade, spread, and escape. Thus, theearly diagnosis for the treatment of the neonate is essential for the prevention of sequels, but asthe public health service does not provide clinical exams for the timely for the diagnosis of thiscondition, there is a clear need for a better understanding of the physiopathogeny of the diseasewith the specific objective of contributing to the advance of clinical research into the problem

Molecular detection of Treponema pallidum sp. pallidum in blood samples of VDRL-seroreactive women with lethal pregnancy outcomes: a retrospective observational study in northern Brazil / Detecção molecular do Treponema pallidum sp. pallidum em amostras de sangue de mulheres sororeativas ao VDRL com resultado letal da gravidez: um estudo observacional retrospectivo no norte do Brasil

INTRODUCTION: Although control measures of maternal and congenital syphilis are available in Brazil, difficulties exist within the healthcare network in providing a laboratory diagnosis of the infection during the prenatal period. The objective of this study was to confirm the presence of Treponema pallidum by PCR in women with positive VDRL serology and lethal pregnancy outcomes, i.e., abortion, stillbirth and neonatal death. METHODS: A retrospective study was conducted on VDRLseroreactive women with lethal pregnancy outcomes admitted to the Fundação Santa Casa de Misericórdia do Pará (FSCM-PA) between January and July 2004. Serum samples and DNA from whole blood were obtained at the time of screening by the VDRL test. These samples were analyzed by IgG ELISA, IgM FTA-Abs and simple PCR (polA). RESULTS: During the study period, 0.7% (36/4,912) of women with lethal pregnancy outcomes presented a positive VDRL test. The polAgene was amplified in 72.7% (24/33) of these women, with 55.6% (20/36) and 94.4% (34/36) presenting IgM and IgG antibodies against T. pallidum, respectively. Comparison of these results showed a significant difference, with agreement between the PCR and IgM FTA-Abs results, suggesting that maternal syphilis was an active infection. No basic cause of death of the conceptus was reported in 97.2% (35/36) of cases. Among women who were submitted to the VDRL test during the prenatal period, only four of the nine seroreactive patients underwent treatment. CONCLUSIONS: The high frequency of syphilis in the group studied indicates the fragility of the service of infection diagnosis, treatment and monitoring, compromising epidemiological control.

INTRODUÇÃO: Apesar das medidas de controle da sífilis materna e congênita estarem disponíveis no Brasil, existem dificuldades da rede em prover o diagnóstico laboratorial da infecção durante o pré-natal. O objetivo deste estudo foi confirmar a presença do Treponema pallidum pela PCR em mulheres com sorologia positiva ao VDRL e com resultado letal da gravidez, isto é, aborto, natimorto e neomorto. MÉTODOS: Estudo retrospectivo realizado em mulheres VDRL-sororeativas com resultado negativo da gravidez, admitidas na Fundação Santa Casa de Misericórdia do Pará FSCM-PA entre janeiro e julho de 2004. As amostras de soro e DNA de sangue total foram obtidas no mesmo período da triagem pelo VDRL. Estas amostras foram analisadas pelo ELISA IgG, FTA-Abs IgM e PCR simples (polA). RESULTADOS: Durante o período de estudo, 0,7% (36/4.912) das mulheres com resultado letal da gravidez apresentaram VDRL positivo. O genepolA foi amplificado em 72,7% (24/33) destas mulheres,com 55,6% (20/36) e 94,4% (34/36) apresentando anticorpos tipo IgG e IgM contra o T. pallidum, respectivamente. A comparação destes resultados mostrou uma diferença estatística significativa, sendo que os resultados da PCR versus FTA-Abs Ig Mmostraram-se concordantes, sugerindo que a sífilis materna era uma infecção ativa. A causa básica de morte dos conceptos não foi relatada em 97,2% (35/36) dos casos. Entre as mulheres que foram submetidas ao VDRL no pré-natal, somente quatro das nove soropositivas receberam tratamento. CONCLUSÕES: A elevada frequência de sífilis no grupo de estudo indica a fragilidade do serviço no diagnóstico, tratamento e monitoramento da infecção, comprometendo o controle epidemiológico.

Molecular detection of Treponema pallidum sp. pallidum in blood samples of VDRL-seroreactive women with lethal pregnancy outcomes: a retrospective observational study in northern Brazil.

INTRODUCTION: Although control measures of maternal and congenital syphilis are available in Brazil, difficulties exist within the healthcare network in providing a laboratory diagnosis of the infection during the prenatal period. The objective of this study was to confirm the presence of Treponema pallidum by PCR in women with positive VDRL serology and lethal pregnancy outcomes, i.e., abortion, stillbirth and neonatal death. METHODS: A retrospective study was conducted on VDRLseroreactive women with lethal pregnancy outcomes admitted to the Fundação Santa Casa de Misericórdia do Pará (FSCM-PA) between January and July 2004. Serum samples and DNA from whole blood were obtained at the time of screening by the VDRL test. These samples were analyzed by IgG ELISA, IgM FTA-Abs and simple PCR (polA). RESULTS: During the study period, 0.7% (36/4,912) of women with lethal pregnancy outcomes presented a positive VDRL test. The polAgene was amplified in 72.7% (24/33) of these women, with 55.6% (20/36) and 94.4% (34/36) presenting IgM and IgG antibodies against T. pallidum, respectively. Comparison of these results showed a significant difference, with agreement between the PCR and IgM FTA-Abs results, suggesting that maternal syphilis was an active infection. No basic cause of death of the conceptus was reported in 97.2% (35/36) of cases. Among women who were submitted to the VDRL test during the prenatal period, only four of the nine seroreactive patients underwent treatment. CONCLUSIONS: The high frequency of syphilis in the group studied indicates the fragility of the service of infection diagnosis, treatment and monitoring, compromising epidemiological control.

Trauma da queimadura em crianças e suas implicações nutricionais / Burns trauma in children and its nutritional implications

Objetivo: Descrever particularidades relativas à nutrição em pacientespediátricos com queimaduras e a adesão à prescrição dietética no primeiro centro especializado do Pará. Método: Foram inclusos pacientes de zero a dez anos, internados no Centro de Tratamento de Queimados do Hospital Metropolitano de Urgência e Emergência do Estado do Pará. Os procedimentos de avaliação antropométrica, diagnóstico nutricional, estimativa das necessidades nutricionais, valor nutritivo das dietas oferecidas, adesão às dietas hospitalares, uso e indicação de suporte nutricional e tratamento estatístico foram cumpridos. Resultados: Um total de 49 pacientes foram estudados. As queimaduras observadas chegaram a comprometer até 53% da superfície corporal. Eutrofia esteve presente em mais de 50% da amostra. O estado nutricional foi inversamente proporcional ao tempo de internação hospitalar (p=0,0001). A dieta hospitalar atendeu às necessidadesde 97,95% dos pacientes em relação a calorias e 100% a proteínas, de acordo com a fórmula preditiva de necessidades nutricionais. Cerca de 88% das necessidades de suplementos foram cumpridas. Anorexia foi detectada em 71,43% da amostra, sendo observada em 100% dos pacientes com superfície corporal queimada acima de 21% (p<0,005). Conclusão: A manutenção do estado nutricional se mostrou importante para a recuperação do estado clínico. Apesar de a dieta hospitalar e o uso de suplementos atenderem às necessidades nutricionais da maioria dos pacientes, a anorexia limitou as possibilidades da terapia nutricional oral, comprovando a necessidade de estimular o uso de sondas e nutrição enteral neste centro de queimados.

Objective: To describe particularities related to nutrition in pediatric patients with burns and the adherence to dietary prescription in the first specialized center in the Para. Methods: We included patients from zero to ten years, admitted to the Burn Treatment Center ofMetropolitan Hospital of Urgency and Emergency State of Para. Methods:Procedures anthropometric, nutritional diagnosis, estimation of nutrient requirements, nutritional value of diets offered, adherence to hospital diets, requirements and use of nutritional supplements and statistical analysis were co™mpleted. Results: A total of 49 patients were studied. The total body surface area stricken represents 53%.Normal weight was present in more than 50% of the sample. Nutritional status was inversely proportional to the length of hospital stay (p<0.0001). The hospital diet attended the requirements of 97.95% of patients in terms of calories and protein to 100% according to the formula predictive of nutritional needs. About 88% of supplements needs are met. Anorexia was detected in 71.43% of the sample, being observed in 100% of patients with total body surface area over 21% (p <0.005). Conclusion: The maintenance of nutritional status was important for the recovery of clinical table. Although thehospital diet and use supplements meet the nutritional needs of most patients, anorexia has limited the possibilities of oral nutritional therapy, confirming the need to encourage the use of enteral nutrition in the place of study.

Cobertura vacinal para o vírus da hepatite B em cirurgiões-dentistas / Vaccine covering for the hepatitis B virus in surgeon-dentists

Conhecer a cobertura vacinal para hepatite B nos cirurgiões-dentistas que estejam exercendo a profissão, segundo sexo e faixa etária. MÉTODOS: Foi selecionada aleatoriamente, por meio de sorteio, uma amostra de 50 cirurgiões-dentistas registrados no Conselho Regional de Odontologia (PA) em pleno exercício da profissão e, após a obtenção do Termo de Consentimento Livre e Esclarecido foi aplicado um protocolo para a obtenção das seguintes variáveis: idade, sexo, realização da vacinação contra hepatite B e número de doses recebidas. Os dados foram agrupados e trabalhados com estatística descritiva e analisados, usando o programa BIOESTAT 5.0. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Instituto de Ciências da Saúde da Universidade Federal do Pará em 2 de outubro de 2007. RESULTADOS: A cobertura vacinal foi observada em pouco mais da metade dos entrevistados (56%); 30% não completaram o esquema vacinal e 14% não realizaram nenhuma dose. Dos que completaram o esquema vacinal, 75% eram do sexo feminino e57% tinham entre 20 e 29 anos. Dos que não fizeram nenhuma dose ou não completaram o esquema vacinal, 45,5% eram do sexo feminino e 68,2% tinham entre 20 e 29 anos. CONCLUSÕES: A cobertura vacinal no grupo estudado, apesar de baixa, foi três vezes maior no sexo feminino. O fato de 14% dos indivíduos entrevistados não ter realizado nenhuma dose da vacina, denota indiferença ou descaso com a própria segurança em profissionais que, por suas atividades, estão expostos ao vírus.Sugere-se a implementação de campanhas que visem a sensibilização dos profissionais de saúde para a importância da prevenção da hepatite B.

To know the vaccine covering for the hepatitis B virus in the surgeon-dentists who areexercising the profession, according to sex and age. METHODS: It was selected randomly, by meansof drawing, a sample of 50 surgeon-dentists registered, licensed and also in full exercise of theprofession. After the attainment of the Term of Free and Clarified Assent was applied a protocol forthe attainment of the following variables: age, sex, civil state, accomplishment of the vaccinationagainst hepatitis B and number of received doses. The data had been grouped and worked withdescriptive statistics and analyzed, using the program BIOESTAT 5.0. The study was approved by theCommittee of Ethics in Research of the Institute of Sciences of the Health of the Federal University ofPará in 2 of october of 2007. RESULTS: The vaccine covering was observed in little more than thehalf of the interviewed ones (56%); 30% had not completed the vaccine scheme and 14% had notcarried through no dose. Of that they had completed the vaccine scheme, 75% were of the femininesex and 57% had between 20 and 29 years. Of that they had not completed the vaccine project, 60%were of the masculine sex and 73% had between 20 and 29 years. The vaccine covering wasobserved in little more than the half of the interviewed ones (56%); 30% had not complete thevaccine scheme and 14% had not carried through no dose. Of that they had completed the vaccinescheme, 75% were of the feminine sex and 57% had between 20 and 29 years. CONCLUSIONS:The indifference or unconcern with the proper security, in professionals whom, for its activities aremore susceptible to the virus is preoccupying. It is suggested implementation of campaigns that praiseto the sensitization of the health professionals for the importance of the prevention of hepatitis B.