Liver Function in Patients with Long-Term Coronavirus Disease 2019 of up to 20 Months: A Cross-Sectional Study.

The long-term laboratory aspects of the effects of coronavirus disease 2019 (COVID-19) on liver function are still not well understood. Therefore, this study aimed to evaluate the hepatic clinical laboratory profile of patients with up to 20 months of long-term COVID-19. A total of 243 patients of both sexes aged 18 years or older admitted during the acute phase of COVID-19 were included in this study. Liver function analysis was performed. Changes were identified in the mean levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), and ferritin. A ferritin level of >300 U/L was observed in the group that presented more changes in liver function markers (ALT, AST, and GGT). Age ≥ 60 years, male sex, AST level > 25 U/L, and GGT level ≥ 50 or 32 U/L were associated with an ALT level > 29 U/L. A correlation was found between ALT and AST, LDH, GGT, and ferritin. Our findings suggest that ALT and AST levels may be elevated in patients with long-term COVID-19, especially in those hospitalised during the acute phase. In addition, an ALT level > 29 U/L was associated with changes in the levels of other markers of liver injury, such as LDH, GGT, and ferritin.

Epidemiological aspects of American and visceral cutaneous leishmaniasis in the city of Cametá, Pará, Amazon / Aspectos epidemiológicos da leishmaniose tegumentar americana e visceral na cidade de Cametá, Pará, Amazônia / Aspectos epidemiológicos de la leishmaniasis cutánea americana y visceral en la ciudad de Cametá, Pará, Amazonas

Background and objectives: leishmaniases are anthropozoonosis considered a major public health problem in tropical regions and endemic in some areas of constant expansion. This study aimed to assess the main epidemiological aspects of American tegumentary leishmaniasis (ATL) and visceral leishmaniasis (VL) in the municipality of Cametá, in the state of Pará, from 2007 to 2017. Methods: this is a descriptive-exploratory analysis, of time series, with data collected in the Department of Epidemiological Surveillance of the Department of Sanitary Surveillance of Cametá. Statistical calculations were performed, and, for the coefficient of incidence of ATL and VL, the standard formula was used to obtain the indicator. Results: a total of 94 and 294 cases of ATL and VL were reported, with the highest incidence rate in 2008. The disease affected all established age groups, with high frequency in children under ten years of age for VL (n=174), and between 20 and 30 years of age, for ATL (n=71). The disease was more prevalent in males (ATL (89.4%) and VL (58.2%)), because men are more related to economic activities. Conclusion: considering the high number of rural cases, it is noteworthy that reporting in urban areas is also worrisome, in addition to the livelihood of local families, because it has made them vulnerable to the disease. Furthermore, there is concern about the possible expansion and change in the pattern of ATL in the municipality. The Municipal Department as well as the epidemiological surveillance must pay attention to promote investments and campaigns to combat and treat this important disease.(AU)

Justificativa e objetivos: as leishmanioses são antropozoonoses consideradas um grande problema para a saúde pública em regiões tropicais e endêmicas em algumas áreas de constante expansão. Este estudo teve como objetivo avaliar os principais aspectos epidemiológicos da leishmaniose tegumentar americana (LTA) e leishmaniose visceral (LV) no município de Cametá, no estado do Pará, no período de 2007 a 2017. Métodos: trata-se de uma análise descritiva-exploratória, de série temporal, com dados coletados no Departamento de Vigilância Epidemiológica da Secretaria de Vigilância Sanitária de Cametá. Realizaram-se os cálculos estatísticos, e, para o coeficiente de incidência de LTA e LV, utilizou-se a fórmula padrão para a obtenção do indicador. Resultados: foram notificados 94 e 294 casos de LTA e LV, com maior taxa de incidência em 2008. A doença atingiu todas as faixas etárias estabelecidas, com alta frequência nos menores de dez anos para LV (n=174), e, entre 20 e 30 anos de idade, para LTA (n=71). A doença foi mais prevalente no sexo masculino (LTA (89,4%) e LV (58,2%)), em virtude dos homens estarem mais relacionados com as atividades econômicas. Conclusão: em vista do alto número de casos rurais, ressalta-se que a notificação em área urbana também é preocupante, além dos meios de subsistência das famílias locais, pois vem tornando-as vulneráveis para o adoecimento. Ademais, há a preocupação com a possível expansão e mudança no padrão da LTA no município. A Secretaria Municipal, bem como de vigilância epidemiológica, deve atentar-se a promover investimentos e campanhas de combate e tratamento deste importante agravo.(AU)

Justificación y objetivos: las leishmaniasis son antropozoonosis consideradas un importante problema de salud pública en las regiones tropicales y endémicas en algunas zonas de constante expansión. Este estudio tuvo como objetivo evaluar los principales aspectos epidemiológicos de la leishmaniasis tegumentaria americana (LTA) y la leishmaniasis visceral (LV) en el municipio de Cametá, en el estado de Pará, de 2007 a 2017. Métodos: se trata de un análisis descriptivo-exploratorio, de serie temporal, con datos recolectados en el Departamento de Vigilancia Epidemiológica de la Secretaría de Vigilancia Sanitaria de Cametá. Se realizaron cálculos estadísticos y, para el coeficiente de incidencia de LCA y LV, se utilizó la fórmula estándar para obtener el indicador. Resultados: se reportaron 94 y 294 casos de LTA y LV, con la mayor tasa de incidencia en 2008. La enfermedad afectó a todos los grupos de edad establecidos, con alta frecuencia en menores de diez años para LV (n=174), y entre 20 y 30 años. años de edad, para LTA (n=71). La enfermedad fue más prevalente en el sexo masculino (LTA (89,4%) y VL (58,2%)), debido a que los hombres están más relacionados con actividades económicas. Conclusión: dado el alto número de casos rurales, cabe señalar que la notificación en las zonas urbanas también es motivo de preocupación, además de los medios de subsistencia de las familias locales, ya que las ha vuelto vulnerables a la enfermedad. Además, existe preocupación por la posible expansión y cambio en el patrón de LTA en el municipio. La Secretaría Municipal, así como la de vigilancia epidemiológica, debe prestar atención a promover inversiones y campañas para combatir y tratar este importante problema.(AU)

Cytokine Profiles Associated With Acute COVID-19 and Long COVID-19 Syndrome.

The duration and severity of COVID-19 are related to age, comorbidities, and cytokine synthesis. This study evaluated the impact of these factors on patients with clinical presentations of COVID-19 in a Brazilian cohort. A total of 317 patients diagnosed with COVID-19 were included; cases were distributed according to clinical status as severe (n=91), moderate (n=56) and mild (n=170). Of these patients, 92 had acute COVID-19 at sample collection, 90 had already recovered from COVID-19 without sequelae, and 135 had sequelae (long COVID syndrome). In the acute COVID-19 group, patients with the severe form had higher IL-6 levels (p=0.0260). In the post-COVID-19 group, there was no significant difference in cytokine levels between groups with different clinical conditions. In the acute COVID-19 group, younger patients had higher levels of TNF-α, and patients without comorbidities had higher levels of TNF-α, IL-4 and IL-2 (p<0.05). In contrast, patients over age 60 with comorbidities had higher levels of IL-6. In the post-COVID-19 group, subjects with long COVID-19 had higher levels of IL-17 and IL-2 (p<0.05), and subjects without sequelae had higher levels of IL-10, IL-6 and IL- 4 (p<0.05). Our results suggest that advanced age, comorbidities and elevated serum IL-6 levels are associated with severe COVID-19 and are good markers to differentiate severe from mild cases. Furthermore, high serum levels of IL-17 and IL-2 and low levels of IL-4 and IL-10 appear to constitute a cytokine profile of long COVID-19, and these markers are potential targets for COVID-19 treatment and prevention strategies.

Muscle dysfunction in the long coronavirus disease 2019 syndrome: Pathogenesis and clinical approach.

In long coronavirus disease 2019 (long COVID-19), involvement of the musculoskeletal system is characterised by the persistence or appearance of symptoms such as fatigue, muscle weakness, myalgia, and decline in physical and functional performance, even at 4 weeks after the onset of acute symptoms of COVID-19. Muscle injury biomarkers are altered during the acute phase of the disease. The cellular damage and hyperinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may contribute to the persistence of symptoms, hypoxaemia, mitochondrial damage, and dysregulation of the renin-angiotensin system. In addition, the occurrence of cerebrovascular diseases, involvement of the peripheral nervous system, and harmful effects of hospitalisation, such as the use of drugs, immobility, and weakness acquired in the intensive care unit, all aggravate muscle damage. Here, we review the multifactorial mechanisms of muscle tissue injury, aggravating conditions, and associated sequelae in long COVID-19.

Cutaneous leishmaniasis in protected environmental areas in the Eastern Amazon: the case of São Félix do Xingu, Pará, Brazil.

INTRODUCTION: Cutaneous Leishmaniasis is a disease transmitted to men and animals by infected female phlebotomine sandflies and is considered a great environmental and public health problem in the Amazon region. Thus, the study aimed to analyze the spatial distribution of this disease in São Félix do Xingu, in the state of Pará, Brazil, and its relationship with epidemiological and environmental variables, in the period from 2012 to 2016. METHODOLOGY: The data used were from the Information System of the Pará State Secretariat of Health, the National Institute for Space Research and the Brazilian Institute of Geography and Statistics. The statistical and spatial analysis of the variables were done using non-parametric chi-square statistical test, kernel interpolation technique and the Bivariate Global Moran Index. RESULTS: The municipality had 183 confirmed cases, non-homogeneously distributed in 5 administrative districts. The individuals most affected were adult males with brown skin, an elementary level of education and rural area residents. In the case series, a direct relationship was observed between the increase of the number of cases and deforestation in the study area. The spatial analysis showed different types of land use and cover related to case clusters in the municipality. Additionally, there was a presence of cases in protected areas and a great epidemiological silence in indigenous lands. CONCLUSIONS: Thus, this disease is a large and complex public health problem in the municipality, related to social and environmental risk factors.

Assessment of Anti-SARS-CoV-2 Antibodies Post-Coronavac Vaccination in the Amazon Region of Brazil.

The present study evaluated the frequency of seropositivity for anti-SARS-CoV-2 (S1 and S2) total antibodies and anti-SARS-CoV-2 (receptor binding domain-RBD-S1) neutralizing antibodies in individuals vaccinated with the immunizing agent Coronavac. This was a cross-sectional study involving 358 individuals divided into two groups. Group 1 consisted of 205 volunteers who were tested for anti-SARS-CoV-2 total antibodies; group 2 consisted of 153 individuals tested for the presence of anti-SARS-CoV-2 neutralizing antibodies. Seropositivity was greater than 70% in both groups, although 17.6% and 20.9% of individuals showed no neutralizing or total antibody reactivity, respectively. The frequency of anti-SARS-CoV-2 total antibodies displayed a significantly different distribution between the sexes but not according to age. The frequency of anti-SARS-CoV-2 neutralizing antibodies was 93.3% (95% CI 68.1-99.8) in the age group from 21 to 40 years but significantly decreased with advancing age, and was 76.2% (95% CI 52.8-91.8) for 41 to 60 years, 72.5% (95% CI 62.8-80.9) for 61 to 80 years, and 46.7% (95% CI 21.3-73.4) for >80 years. Our results reveal a high prevalence of anti-SARS-CoV-2 total antibodies and anti-SARS-CoV-2 neutralizing antibodies in individuals who received both doses of the Coronavac vaccine, suggesting a lower effectiveness of the humoral immune response among those older than 60 years of age, which might be associated with senescence of the immune system.

Dynamics of anti-SARS-CoV-2 IgG antibodies post-COVID-19 in a Brazilian Amazon population.

BACKGROUND: In this study, the prevalence and persistence of anti-SARS-CoV-2 (severe acute respiratory syndrome-coronavirus) IgG was evaluated in volunteers 90 days after COVID-19 (coronavirus disease 2019) diagnosis by correlating response dynamics with clinical conditions, epidemiological characteristics, and disease severity. METHODS: The study recruited 200 volunteers aged 18 years or older of both sexes diagnosed with COVID-19. Of the 200 volunteers initially selected, the 135 individuals who underwent serological testing for anti-SARS-CoV-2 antibodies on the first visit to the laboratory, were invited to return, after 90 days, and provide a new blood sample for a second assessment of the presence of anti-SARS-CoV-2 IgG antibody. Disease severity and longevity of symptoms were evaluated for each individual and associated with the serological profile. RESULTS: Among the 135 individuals who underwent a previous serological test for anti-SARS-CoV-2 antibody, 125 showed reactivity to IgG (92.6%). Of the 125 individuals with detectable IgG in the first test, 87 (69.6%) showed persistence of this antibody after 90 days and 38 (30.4%) lost IgG reactivity in the second evaluation. The frequency of all reported symptoms was higher in individuals who maintained IgG persistence after 90 days of symptoms. Symptom manifestations lasted ≥21 days in the group with a persistent IgG response (39.6%) and ≤ 7 days in the group with a nonpersistent IgG response (50.0%). The length of hospital stay and supplemental oxygen use were higher in individuals with a persistent IgG response. CONCLUSIONS: The results of the present study show a high frequency of loss of anti-SARS-CoV-2 IgG antibodies within 3 months after COVID-19 diagnosis in the Brazilian Amazon.

Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil. / Conhecimento e comportamento preventivo de gestantes sobre Toxoplasmose no município de Imperatriz, Maranhão, Brasil.

The aim of this study was to assess toxoplasmosis knowledge and preventive behavior, and relate these to socioeconomic, pre-natal and environmental issues among pregnant women served by the Family Health Strategy in the municipality of Imperatriz, Maranhão, Brazil. This is a cross-sectional study performed by applying a structured and pre-tested questionnaire to a sample of 239 pregnant women. Only 23.4% of the pregnant women had good knowledge of the disease, primarily in the area of prevention, and 58.9% adopted suitable preventive behaviors. The results obtained show a significant association of various toxoplasmosis risk factors, such as drinking untreated water (OR = 2.1245; IC95% = 1.20-3.73; p = 0.0128), contact with cats (OR = 7.6875; IC95% = 4.22-13.97; p < 0,0001), cleaning cat feces (OR = 6.8738; IC95% = 3.02-15.60; p < 0.0001), eating raw meat (OR = 5.7405; IC95% = 3.21-10.24 and handling sand/cat litter OR = 10.7376; IC95% = 4.64-24.85; p < 0.0001). This shows a need for continued education on toxoplasmosis for the pregnant women seen by the Imperatriz FHS, and for more comprehensive preventive measures, with public health and education policies that take into consideration economic, social, environmental and cultural issues.

O objetivo desse estudo foi avaliar o conhecimento e o comportamento preventivo sobre a toxoplasmose e relacionar com as condições socioeconômicas, do pré-natal e ambientais entre as gestantes da Estratégia Saúde da Família (ESF), do município de Imperatriz, Maranhão, Brasil. Neste estudo transversal foi aplicado um questionário estruturado e pré-testado, com amostra de 239 gestantes. Somente 23,4% das gestantes apresentaram bom conhecimento sobre a doença, com ênfase no domínio prevenção; 58,9% adotaram adequadamente os comportamentos preventivos. Os resultados obtidos chamam a atenção pela associação significativa a vários fatores de risco para a toxoplasmose, como: consumo de água sem tratamento (OR = 2,1245; IC95% = 1,20-3,73; p = 0,0128), contato com gatos (OR = 7,6875; IC95% = 4,22-13,97; p < 0,0001), limpeza das fezes do gato (OR = 6,8738; IC95% = 3,02-15,60; p < 0,0001), consumo de carne crua (OR = 5,7405; IC95% = 3,21-10,24; p < 0,0001) e mexer com areia (OR = 10,7376; IC95% = 4,64-24,85; p < 0,0001), gerando a necessidade de uma educação continuada sobre a toxoplasmose para as gestantes atendidas na ESF de Imperatriz, e o estabelecimento de medidas preventivas mais integrais, com políticas públicas de saúde e educação que levem em consideração questões econômicas, sociais, ambientais e culturais.

Conhecimento e comportamento preventivo de gestantes sobre Toxoplasmose no município de Imperatriz, Maranhão, Brasil / Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil

Resumo O objetivo desse estudo foi avaliar o conhecimento e o comportamento preventivo sobre a toxoplasmose e relacionar com as condições socioeconômicas, do pré-natal e ambientais entre as gestantes da Estratégia Saúde da Família (ESF), do município de Imperatriz, Maranhão, Brasil. Neste estudo transversal foi aplicado um questionário estruturado e pré-testado, com amostra de 239 gestantes. Somente 23,4% das gestantes apresentaram bom conhecimento sobre a doença, com ênfase no domínio prevenção; 58,9% adotaram adequadamente os comportamentos preventivos. Os resultados obtidos chamam a atenção pela associação significativa a vários fatores de risco para a toxoplasmose, como: consumo de água sem tratamento (OR = 2,1245; IC95% = 1,20-3,73; p = 0,0128), contato com gatos (OR = 7,6875; IC95% = 4,22-13,97; p < 0,0001), limpeza das fezes do gato (OR = 6,8738; IC95% = 3,02-15,60; p < 0,0001), consumo de carne crua (OR = 5,7405; IC95% = 3,21-10,24; p < 0,0001) e mexer com areia (OR = 10,7376; IC95% = 4,64-24,85; p < 0,0001), gerando a necessidade de uma educação continuada sobre a toxoplasmose para as gestantes atendidas na ESF de Imperatriz, e o estabelecimento de medidas preventivas mais integrais, com políticas públicas de saúde e educação que levem em consideração questões econômicas, sociais, ambientais e culturais.

Abstract The aim of this study was to assess toxoplasmosis knowledge and preventive behavior, and relate these to socioeconomic, pre-natal and environmental issues among pregnant women served by the Family Health Strategy in the municipality of Imperatriz, Maranhão, Brazil. This is a cross-sectional study performed by applying a structured and pre-tested questionnaire to a sample of 239 pregnant women. Only 23.4% of the pregnant women had good knowledge of the disease, primarily in the area of prevention, and 58.9% adopted suitable preventive behaviors. The results obtained show a significant association of various toxoplasmosis risk factors, such as drinking untreated water (OR = 2.1245; IC95% = 1.20-3.73; p = 0.0128), contact with cats (OR = 7.6875; IC95% = 4.22-13.97; p < 0,0001), cleaning cat feces (OR = 6.8738; IC95% = 3.02-15.60; p < 0.0001), eating raw meat (OR = 5.7405; IC95% = 3.21-10.24 and handling sand/cat litter OR = 10.7376; IC95% = 4.64-24.85; p < 0.0001). This shows a need for continued education on toxoplasmosis for the pregnant women seen by the Imperatriz FHS, and for more comprehensive preventive measures, with public health and education policies that take into consideration economic, social, environmental and cultural issues.

Detection of pain with neuropathic characteristics in patients with diabetes mellitus assisted in primary care units / Detecção de dor com características neuropáticas em pacientes com diabetes mellitus atendidos na atenção básica

ABSTRACT BACKGROUND AND OBJECTIVES: There is a lack of epidemiological data on neuropathic pain in Brazil. Thus, the present study aimed to detect the presence of pain with neuropathic characteristics in people with diabetes mellitus, assisted by the Hiperdia program in Santarém-Pará. METHODS: A cross-sectional study was carried out between April and November of 2016 in seven Primary Care Units of Santarém. Patients with types 1 and 2 diabetes mellitus enrolled in the Hiperdia program, who answered a clinical and sociodemographic questionnaire were included. All those who reported pain responded the Douleur Neuropathique 4 questions and the visual analog pain scale. Data were tabulated and statistically analyzed using the software Bioestat® 5.0. RESULTS: The sample consisted of 129 patients, all of whom with type 2 diabetes mellitus. Of these, 67 (51.9%) reported pain. Of these, 34.1% were detected with pain of neuropathic characteristics, with a predominance of pain in lower limbs and moderate intensity. The most reported symptoms were: tingling, pinching/needling and numbness. CONCLUSION: An expressive prevalence of people with neuropathic pain was obtained through the application of the Douleur Neuropathique 4 questions questionnaire, which proved to be an effective and easily applied tool. It is suggested that the neuropathic pain should be identified in the primary care unit and that studies with greater population coverage be performed in Santarém-Pará and in the Northern region, due to the scarcity of data in Brazil.

RESUMO JUSTIFICATIVA E OBJETIVOS: Há uma carência de dados epidemiológicos sobre dor neuropática no Brasil. Assim, o presente estudo teve por objetivo detectar a presença de dor com características neuropáticas em pessoas com diabetes mellitus, atendidos pelo programa Hiperdia, em Santarém-Pará. MÉTODOS: Estudo transversal, realizado no período de abril a novembro de 2016, em sete Unidades Básicas de Saúde de Santarém. Foram incluídos pacientes com diabetes mellitus tipos 1 e 2, cadastrados no programa Hiperdia, que responderam a um questionário clínico e sociodemográfico. Todos que relataram dor responderam aos questionários Douleur Neuropathique4 questions e a escala analógica visual. Os dados foram tabelados e analisados estatisticamente através do software Bioestat® 5.0. RESULTADOS: A amostra foi composta por 129 pacientes, os quais todos possuíam diabetesmellitus tipo 2. Dentre eles, 67 (51,9%) referiram dor. Desses, 34,1% foram detectados com dor de características neuropáticas, com seu predomínio nos membros inferiores e de intensidade moderada. Os sintomas mais relatados foram formigamento, alfinetada/agulhada e adormecimento. CONCLUSÃO: Obteve-se uma prevalência expressiva de pessoas com dor de características neuropáticas, por meio da aplicação do questionário Douleur Neuropathique4 questions, que demonstrou ser um instrumento eficaz e de fácil aplicação. Sugere-se que seja feita a identificação da dor neuropática na atenção básica e que sejam realizados estudos de maior abrangência populacional em Santarém-Pará e na região norte, em razão da escassez de dados no Brasil.

Prevalence of autoantibodies against cellular antigens in patients with HIV and leprosy coinfection in the Amazon region.

BACKGROUND: Infectious agents can activate self-reactive T cells. In general, infections trigger various mechanisms, including a lack of auto-tolerance, induction of costimulatory molecules on antigen presenting cells, and molecular simulation, in addition to cross-reactions between microbial antigens and self-antigens. HIV and leprosy coinfections lead to self-immunity with the production of autoantibodies. However, not enough data on the immune behaviour associated with this coinfection are available. Therefore, this study focused on the detection of autoantibodies against cellular antigens (AACA) in individuals with HIV and leprosy coinfection in the Amazon region. METHODS: Patients were distributed into four groups according to their infections: (i) coinfection with HIV and leprosy (n = 23), (ii) infection with leprosy (n = 33), (iii) infection with HIV/AIDS (n = 25), and (iv) healthy blood donor controls (n = 100). AACA were identified by indirect immunofluorescence and the samples were tested using a commercial diagnosis kit containing the antinuclear antibody HEp-2. RESULTS: Morphologically, all stages of cell division were assessed in addition to the morphological features associated with the nuclear matrix, nucleolus, mitotic spindle, and cytoplasm. There was a high prevalence of AACA in the coinfection group (47.8%, n = 11) when compared with the control group of healthy blood donors (2.0%). The results showed predominantly cytoplasmic staining in all groups analysed, and no difference was observed between the presence or absence of AACA and the leprosy forms (paucibacillary and multibacillary) in the coinfection group. CONCLUSIONS: The results of this study show that despite the tendency of coinfected patients to have higher levels of autoantibodies, no correlation was observed between clinical and laboratorial variables and morbidity associated with HIV and leprosy coinfections or the levels of AACA in the serum of coinfected patients. These data are important to elucidate this complex relationship between HIV and leprosy and thus improve the follow-up of these patients.

Infecção congênita em pacientes matriculados em Programa de referência materno infantil / Congenital infection in patients enrolled in mother child preference program

Objetivo: Caracterizar o perfil epidemiológico dos recém-nascidos de risco com infecção congênita atendidos naUnidade de Referência Materno Infantil e Adolescente/URE-MIA, em Belém/PA. Método: estudo retrospectivo noqual foram analisados os prontuários de todos os pacientes matriculados no Programa de RN de Risco da URE-MIAcom diagnóstico de infecção congênita, entre 2008 e 2013, a partir de protocolo elaborado pelos pesquisadores,totalizando casuística de 186 (cento e oitenta e seis) indivíduos. Resultados: Observou-se a sífilis congênita comoinfecção mais frequente, totalizando 147 casos, dentre os 186 pacientes; seguida por toxoplasmose e citomegalovirose,respectivamente. A maioria (66,6%) das mães realizou pré-natal completo, sugerindo baixa qualidade do serviçoofertado às gestantes, principalmente no que diz respeito à triagem das infecções congênitas. Conclusão: Constatouseque o alarmante recrudescimento da sífilis congênita na população estudada, bem como as demais infecções quefiguraram nesta pesquisa, podem ser relacionadas a um pré-natal ineficiente, suscitando, portanto, maior investimentoe olhar crítico dos agentes de saúde para a necessidade de um sistema pré-natal efetivo na prevenção de doençaspassíveis de tratamento, durante a gestação.

Objective: characterize the epidemiological profile of newborns with congenital infection risk treated at the MaternalChild and Adolescent Reference / URE-MIA in Belém / PA. Method: retrospective and cross-sectional study inwhich the medical records of all patients enrolled in the URE-MIA Program NB Risk with congenital infectionbetween 2008 and 2013, from protocol developed by the researchers analyzed a total sample of 186 (one hundredand eighty-six) individuals. Results: Syphilis was observed as the most frequent congenital infection, totalizing 147cases among 186 patients; followed by congenital toxoplasmosis and cytomegalovirus, respectively. The majority of(66.6%) mothers held complete prenatal, suggesting poor quality of the service offered to pregnant women, especiallywith regard to the screening of congenital infections. Conclusion: This study concludes that alarming resurgenceof congenital syphilis in this population, as well as other infections that figured in this research, may be related toan inefficient prenatal, thus posing greater investment and critical eye from health workers to the necessity of aneffective system in prenatal prevention of diseases susceptible to treatment during pregnancy.

Leprosy and pregnancy: detection coefficient and proposal for a new index.

INTRODUCTION: Our study presents a method to generate a novel detection coefficient for the association between leprosy and pregnancy (DCLP). Methods The DCLP was calculated for women from the State of Pará (2007-2009), Brazil. Data were ordered, divided into five equal parts (corresponding to the P20, P40, P60, and P80 percentiles), and classified as low, medium, high, very high, or hyperendemic. RESULTS: Using the new index, we established the DCLP parameters for low (<0.36), medium (0.36-0.69), high (0.70-1.09), very high (1.10-1.50), and hyperendemic (>1.50). CONCLUSIONS: The new DCLP is more appropriate than the overall detection coefficient (DC), which does not take into account the particularities of the interaction between a disease and a specific physiological state.

Analysis of the detection coefficient for the association between leprosy and pregnancy in the integration region of Carajas, State of Para, Brazil

Introduction The association between leprosy and pregnancy is currently poorly understood and has been linked to serious clinical consequences. Methods A retrospective study between 2007 and 2009 was performed in the integration region of Carajás, Brazil on a population of pregnant lepers, with non-lepers of ages 12-49 years serving as the reference population. Results Twenty-nine pregnant lepers were studied during the study period. The detection rates (DRs) for the studied association were 4.7 in 2007, 9.4 in 2008, and 4.3 in 2009. Conclusions The Carajás region presented a medium pattern of endemicity during most of the study period, with a high DR found in 2008. .

Analysis of the detection coefficient for the association between leprosy and pregnancy in the integration region of Carajás, State of Pará, Brazil.

INTRODUCTION: The association between leprosy and pregnancy is currently poorly understood and has been linked to serious clinical consequences. METHODS: A retrospective study between 2007 and 2009 was performed in the integration region of Carajás, Brazil on a population of pregnant lepers, with non-lepers of ages 12-49 years serving as the reference population. RESULTS: Twenty-nine pregnant lepers were studied during the study period. The detection rates (DRs) for the studied association were 4.7 in 2007, 9.4 in 2008, and 4.3 in 2009. CONCLUSIONS: The Carajás region presented a medium pattern of endemicity during most of the study period, with a high DR found in 2008.

Leprosy and pregnancy in the State of Pará: an epidemiological perspective.

INTRODUCTION: A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of socio demographic, epidemiological and operational indices. METHODS: This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. RESULTS: During the study period,149 associations were detected, with 14 hyperendemic counties: seven in 2007, fi ve in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index(5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However,most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. CONCLUSIONS: The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification.

Leprosy and pregnancy in the State of Para: an epidemiological perspective

Introduction A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of sociodemographic, epidemiological and operational indices. Methods This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. Results During the study period, 149 associations were detected, with 14 hyperendemic counties: seven in 2007, five in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index (5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However, most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. Conclusions The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification. .

Perfil epidemiológico de grávidas HIV positivas atendidas em maternidade pública de referência / Profile of pregnant epidemiological answered in HIV positive maternity public reference

Objetivo: descrever o perfil epidemiológico de grávidas infectadas pelo HIV na maior maternidade pública do Norte do Brasil. Método: estudo descritivo, retrospectivo, envolvendo 770 grávidas atendidas na triagem obstétrica da Fundação Santa Casa de Misericórdia do Pará, o período de 2004 a 2010, após análise dos dados obtidos a partir de prontuários, sob os preceitos éticos recomendados. Resultados: a prevalência e a incidência no período foram de 1,87% e 0,40%, respectivamente; a faixa etária predominante entre 18 e 23 anos (42,1%), sendo que 50,4% tinham ensino fundamental incompleto, 68,2% exerciam atividades do lar, 89% eram solteiras e a maioria procedia de municípios com mais de 50 mil habitantes - Belém, 53,9%; Ananindeua, 13,0%; Castanhal 4,8%; Paragominas, 3,6%; Tailândia, 3,5%; Barcarena 3,1%; Marituba, 2,9%; Abaetetuba, 1,8% e São Miguel do Guamá, 0,6%. Conclusão: o conhecimento das variáveis epidemiológicas da maior casuística de grávidas infectadas pelo HIV da Amazônia brasileira, que chegaram à maternidade, permitiu concluir que o perfil de faixa etária, escolaridade, estado civil e ocupação está compatível com os dados nacionais; entretanto, a maior procedência de grávidas de municípios de médio e grande porte opõem-se ao fenômeno da interiorização da epidemia a municípios menores, como se observa no país. Os resultados obtidos vêm reforçar que o Estado do Pará mostrou alta taxa de prevalência da infecção pelo HIV na gravidez, contrapondo-se as demais regiões do país onde há um decréscimo

Objective: to describe the epidemiological profile of HIV-infected pregnant largest public hospital in northern Brazil. Method: a descriptive, retrospective study involving 770 pregnant women attending the obstetrics triage Foundation of Santa Casa de Misericordia of Pará, in the period between 2004 to 2010. After analyzing the data obtained from medical records, under the ethical recommended. Results: the prevalence and incidence in the period were 1.87% and 0.40% respectively, the predominant age group between 18 and 23 years (42.1%), while 50.4% had incomplete primary education, 68 , 2% had home activities, 89% were single and most came from municipalities with over 50,000 inhabitants (Belém, 53.9%; Ananindeua, 13.0%; Castanhal 4.8%; Paragominas, 3.6% ; Thailand, 3.5%, 3.1% Barcarena; Marituba, 2.9%; Abaetetuba, 1.8% and São Miguel do Guama, 0.6%.Conclusion: the knowledge of epidemiological variables of the largest sample of pregnant HIV-infected Brazilian Amazon, which arrived motherhood, concluded that the profile of age, education, marital status and occupation is consistent with national data, however, most merits of pregnant municipalities of medium and large oppose the phenomenon of internalization of the smaller municipalities like epidemic is being observed in país.Os results reinforces the state of Pará, showed high prevalence rate of HIV infection in pregnancy, as opposed to other regions of the country where there is a decrease.

Medicina tropical e infectologia na Amazônia. v.1 / Tropical Medicine and infectious diseases in the Amazon. v.1

O livro contém 83 capítulos totalizando 1.762 páginas, a obra reúne trabalhos de 174 autores de diversas instituições de assistência, ensino e pesquisa na área de Saúde do Brasil, abordando de maneira didática as principais doenças infecciosas e tropicais prevalentes no País e, especialmente, na Amazônia brasileira. E está dividido em dois volumes e contempla, além dos temas gerais e síndromes infecciosas, as doenças causadas por vírus, bactérias, protozoários, helmintos, fungos tais como tuberculose, hepatite, leishmaniose e dengue e os acidentes por artrópodes e animais peçonhentos e venenosos

Medicina tropical e infectologia na Amazônia. v.2 / Tropical Medicine and infectious diseases in the Amazon. v.2

O livro contém 83 capítulos totalizando 1.762 páginas, a obra reúne trabalhos de 174 autores de diversas instituições de assistência, ensino e pesquisa na área de Saúde do Brasil, abordando de maneira didática as principais doenças infecciosas e tropicais prevalentes no País e, especialmente, na Amazônia brasileira. E está dividido em dois volumes e contempla, além dos temas gerais e síndromes infecciosas, as doenças causadas por vírus, bactérias, protozoários, helmintos, fungos tais como tuberculose, hepatite, leishmaniose e dengue e os acidentes por artrópodes e animais peçonhentos e venenosos