Fracture Risk with Modified FRAX in Men Living with HIV.

BACKGROUND: Aging of the HIV-infected population and prolonged use of ARTs, produced metabolic alterations, including increased fracture risk. FRAX is a validated, computer-based clinical fracture risk calculator which estimates 10-year risk of major fracture, and hip fracture. However may underestimate risk in HIV-infected individuals. Several experts recommend considering HIV a cause of secondary osteoporosis. METHODOLOGY: Were included 52 men living with HIV, classified as high, moderate and low risk using ABRASSO graphic tool. RESULTS: High risk prevalence found for major fracture and hip fracture were both 2 (4.2 %) using FRAX; while 10 (20.8 %) and 14 (29.2 %) using modified FRAX, respectively. Considering bone densitometry, 5 (12.8 %) were high risk for hip fracture and was noticed an increase in high risk major fracture from 4.2 % with FRAX to 5.1 % with FRAX considering bone densitometry. As for the low risk, 19 (39.6 %) for major fracture and 23 (47.9 %) for hip fracture with FRAX. While low risk modified FRAX were 0 (0 %) for major fracture and 8 (16.7 %) for hip fracture. It was also evidenced an association of high risk for major fracture and hip fracture with modified FRAX using Fisher's exact test [p=0.0273 (bilateral)]. CONCLUSION: It was concluded is recommended using modified FRAX for people living with HIV for better control and therapeutic decision-making about osteometabolic alterations provocated for the virus and ARTs.

Analysis of malaria clinical-epidemiological predictors in individuals from Brazilian Amazon.

This research aims to determine whether the combination of epidemiological and clinical features can predict malaria. Diagnostic investigation detected 22.3% of individuals with Plasmodium vivax (P. vivax) malaria, with significant predominance of the male gender. The malaria triad (fever, chills and headache) had a more expressive frequency (81.1%) in individuals with positive thick blood than those with negative thick blood smear (65.1%), although there was no statistical significance. Among the variables analysed as predictive for positive thick blood smear, it was observed that personal history of travel to an endemic malaria area and past malaria infection (PMI) were significantly associated with malaria, even in multiple logistic regression. Fever had the higher sensitivity (94.6%) and past malaria history had the greater specificity (68.2%), with accuracy of 23.5% and 67.5%, respectively. In combined analysis, fever with chills had the highest sensitivity (91.9%), but low accuracy (38.5%). High specificity (91.5%) was found in the association of malaria triad, PMI and history of travel to endemic malaria area (which along with anorexia, was higher 94.6%), with good accuracy (80.7%), suggesting that the screening of patients for performing thick blood smear can be based on these data. The epidemiological features and the malaria triad (fever, chills and headache) can be predictors for identification of malaria patients, concurring to precocious diagnosis and immediate treatment of individuals with malaria.

An analysis of the influence of sex hormones on Balb/c mice infected with Plasmodium berghei.

Sex steroids can determine several responses in the clinical evolution of malaria. Seventy Balb-c mice were randomly distributed into 7 groups (10 mice per group): G1 to G6 corresponding to castrated females, castrated females that received estradiol cypionate, uncastrated females, castrated males, castrated males that received intramuscular testosterone decanoate and uncastrated males infected with Plasmodium berghei, and G7, the control group. The mice were evaluated with regard to survival, parasitemia, temperature, body weight, hemoglobin level (anemia) and splenic index. Castrated infected females had lower rates of survival. In the castrated male, the administration of testosterone had a negative influence on survival. There was a progressive increase in parasitemia without repercussions for survival. Castration had a significant influence on weight gain in females. Weight loss was observed in all mice, except those in groups G2 and G5, although this bore no direct relation to parasitemia. A significant and progressive decline in temperature and hemoglobin levels occurred in mice over the course of their infection, which differed from the G7 group. The weight of the spleen in relation to total body weight did not differ among the groups of infected mice, but was significantly higher than it was for the control group.

Association between vitamin D serum levels and clinical, laboratory, and parasitological parameters in patients with malaria from an endemic area of the Amazon.

BACKGROUND: Some studies have suggested the importance of vitamin D [25(OH)D] in malaria clinical practice. The prevalence of 25(OH)D deficiency in the Amazon population is not well known, and there are few studies in patients with malaria. This study aimed to evaluate 25(OH)D serum levels in patients with malaria and determine their relationships with epidemiological, clinical, laboratory, and parasitemia data. METHODS: An analytical cross-sectional study of 123 patients with malaria and 122 individuals without malaria was performed in Itaituba, Pará, Brazil, from January 2018 to October 2019, by evaluating sociodemographic, clinical-epidemiological, parasitological, and laboratory data and adopting a 5% significance level. Parametric tests (Student's t-test), non-parametric tests (Mann-Whitney U), and Spearman's correlation ([rs], for non-parametric variables) were used according to the nature of the distribution of the variables. For the qualitative variables, Pearson's chi-square test, Fisher's exact test, and the G test were used. Spearman's correlation was used to compare the results of the 25(OH)D levels and blood counts performed among patients and the control group. RESULTS: Malaria patients residing in a mining area had 25(OH)D serum levels that were significantly lower than those in the control group residing in the mining area, though both were within normal levels. Red blood cell counts had an inverse correlation with parasitemia (Plasmodium falciparum), and platelet levels had an inverse correlation with parasitemia (Plasmodium vivax). 25(OH)D deficiency was evidenced in Itaituba, in the state of Pará, which is an endemic area of malaria in the Amazon region.

Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study. / Síndrome do T3 baixo como fator prognóstico em pacientes na unidade de terapia intensiva: estudo de coorte observacional.

OBJECTIVE: To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. METHODS: This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. RESULTS: Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. CONCLUSION: The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

OBJETIVO: Avaliar a síndrome do doente eutireóideo como fator prognóstico em pacientes na unidade de terapia intensiva, detectar fatores que possam influenciar a mortalidade e desenvolver uma equação para calcular a probabilidade de morte. MÉTODOS: Este foi um estudo de coorte longitudinal, observacional e não concorrente realizado na unidade de terapia intensiva da Fundação Santa Casa de Misericórdia do Pará. Realizou-se coleta de 20mL de sangue em 100 adultos sem endocrinopatia previamente documentada para a dosagem do hormônio estimulante da tireoide, da tetraiodotironina livre, da tri-iodotironina livre e da tri-iodotironina reversa. RESULTADOS: A maioria dos pacientes era do sexo feminino, com idades entre 20 e 29 anos. A maioria dos pacientes que morreram era mais velha (idade mediana de 48 anos), e 97,5% deles possuíam a síndrome do doente eutireóideo.A síndrome do doente eutireóideo esteve relacionada à morte, às comorbidades, à idade e ao tempo de internação (mediana de 7,5 dias) na unidade de terapia intensiva. A baixa dosagem de hormônio estimulante da tireoide estava associada à morte. Os pacientes com dosagem da tri-iodotironina livre menor que 2,9pg/mL tinham maior probabilidade de morrer e, naqueles que morreram, a dosagem de tri-iodotironina reversa era maior que 0,2ng/mL. A tri-iodotironina livre apresentou maior sensibilidade e acurácia, e a tri-iodotironina reversa teve maior especificidade para prever a mortalidade. Com base nos resultados e pontos de corte, desenvolveu-se uma fórmula de regressão logística múltipla para calcular a probabilidade de morte. CONCLUSÃO: Sugere-se verificar oportunamente a dosagem da triiodotironina livre e reversa em pacientes graves e aplicar a equação proposta.

Immunohistochemical evaluation of macrophage activity and its relationship with apoptotic cell death in the polar forms of leprosy.

The objective of the present study was to investigate the correlation between macrophage activity and apoptosis in the polar forms of leprosy because the immunopathological phenomena involved in these forms are still poorly understood. For this purpose, 29 skin biopsy samples obtained from patients with the polar forms of leprosy were analyzed. Macrophage activity and apoptosis were evaluated by immunohistochemistry using lysozyme, CD68, iNOS and caspase 3 as markers. The nonparametric Mann-Whitney test and Spearman's linear correlation test were used for statistical analysis. The results suggest that the apoptosis rate is under the direct influence of macrophage activity in lesions of patients with the tuberculoid form. In contrast, in lepromatous lesions other factors seem to induce programmed cell death, possibly TGF-beta. Further studies are necessary to identify additional factors involved in the immunopathogenesis of leprosy.

Macrophage and TGF-beta immunohistochemical expression in Jorge Lobo's disease.

Jorge Lobo's disease, or lacaziosis, is a chronic deep mycosis that clinically manifests as solid, variable-sized nodular parakeloidal lesions. Few studies have characterized the in situ cellular and humoral immune response, especially the involvement of cytokines with immunosuppressive effects such as TGF-beta. The objective this paper was to analyze the expression of TGF-beta in cutaneous lesions in lacaziosis and investigate its importance in the etiopathogy of the disease. The results indicate that the abundance of collagen bands, together with weak immunolabeling for CD68 seen in macrophages, indicates a concomitant effect of TGF-beta inhibiting macrophages and inducing fibrosis, which is responsible for the keloid aspect frequently acquired by these lesions. Finally, the evolution of the infection supports the hypothesis that TGF-beta plays a fundamental role in the etiopathology of Lacazia loboi infection, either by inhibiting the cellular immune response mainly mediated by macrophages or by inducing fibrosis. Further studies are necessary to better characterize the phenotype of the inflammatory infiltrate as well as the participation of other cytokines and growth factors in the tissue response of the host in Jorge Lobo's disease.

Extension project focused on health education to post-Covid-19 metabolic syndrome patients in the Amazon region / Projeto de extensão voltado a educação em saúde para pacientes com síndrome metabólica pós-infecção de Covid-19 na região Amazônica

In 2020, a new coronavirus strain led to the declaration by the World Health Organization (WHO) of a pandemic global event. With an expansion pandemic to several territories, the involvement of risk groups started to be significantly more evident than healthier patients. Categorized individuals as obese, diagnosed diabetes mellitus type 2 (DM2), and high blood pressure are shown to be more susceptible to severe cases than other individuals, reinforcing even more the greater prevalence of those diseases in our modern world. In the short period since COVID-19 onset cases, few studies could manage to address the diagnostics or even development of long-term symptoms, which sometimes take years to be noticed or start its natural clinic course. With studies showing the possibility of symptoms occurrence or serious deepening of metabolic syndrome in post-infected patients, the health education process aims to establish ways to create and raise awareness about maintaining life quality and healthy eating habits to contribute to a reduction of negative impacts long-term wise caused by a previous metabolic syndrome or started after COVID-19 infection. The extension project focused then on posterior complication development prevention caused by SARS-CoV-2 infection by encouraging a quality lifestyle. The educational booklets and attendance satisfaction questionnaires were tools for better clarification about how to make those quality life-style changes, besides the multidisciplinary attention as an aid to consolidate the health education to the patients. In this way, members of this project sought to foment research activities about this field with still few population studies, encouraging to consolidate the knowledge about the clinical course of this virus. Having contact amongst project members and patients, the construction of relations occurred bilaterally, with intercommunication between academic knowledge and cultural values, bringing a better future change to the patients (AU).

Em 2020, um novo coronavírus acarretou a declaração pela Organização Mundial da Saúde (OMS) de um evento pandêmico global. Com a expansão da pandemia para mais territórios, o acometimento dos grupos de risco passou a ser significativamente mais evidente do que em grupos previamente hígidos. Indivíduos categorizados como obesos, pacientes diagnos-ticados com Diabetes Mellitus tipo 2 (DM2) e hipertensos demonstraram ser mais suscetíveis a casos mais graves do que outras parcelas da sociedade, reforçando ainda mais a grande prevalência dessas doenças no mundo moderno. Pelo período curto desde o início dos casos de COVID-19, poucos estudos conseguem abordar o diagnóstico ou mesmo o desenvolvi-mento das sequelas a longo prazo, o que muitas vezes pode levar anos até serem percebidas ou iniciarem seu curso clínico. Com estudos apontando a possibilidade da ocorrência de sintomas ou agravamento da síndrome metabólica em pacientes pós-infectados, o processo de educação em saúde objetivou estabelecer formas de criar e conscientizar sobre como manter a qualidade de vida e a alimentação saudável, a fim de contribuir para a redução nos impactos negativos a longo prazo da síndrome metabólica prévia ou iniciada após a COVID-19. O projeto de extensão focou, assim, na prevenção do desenvolvimento a posteriori de complicações ocasionadas pela infecção do SARS-Cov-2 por meio do incentivo a um estilo de vida de qualidade. O uso de cartilhas educativas e questionários de satisfação ao atendimento foram ferramentas para o esclarecimento sobre como realizar as mudanças no estilo de vida, além da atenção multidisciplinar como auxílio na consolidação da educação em saúde para estes pacientes. Desta maneira, os integrantes deste projeto buscaram fomentar a pesquisa sobre esta área ainda com poucos estudos populacionais, incentivando a construção de conhecimento sobre o curso clínico deste vírus. Havendo o contato entre os membros do projeto e os pacientes, a construção das relações ocorre bilateralmente, com a intercomunicação entre o conhecimento acadêmico e os valores culturais, trazendo a melhoria futura para os pacientes (AU)

Clinical and immunological profiles of anaemia in children and adolescents with Plasmodium vivax malaria in the Pará state, Brazilian Amazon.

Children and adolescents are at great risk for developing iron deficiency anaemia worldwide. In the tropical areas, malaria and intestinal parasites may also play an important role in anaemia pathogenesis. This study aimed at evaluating clinical and immunological aspects of anaemia in children and adolescents with Plasmodium vivax malaria, in the Pará State, Brazil. A longitudinal study was performed in two Reference Centers for malaria diagnosis in the Brazilian Amazon in children and adolescents with malaria (n = 81), as compared to a control group (n = 40). Patients had blood drawn three times [before treatment (D0), after treatment (D7) and at the first cure control (D30)] and hemogram, autoantibody analysis (anticardiolipin, antibodies against normal RBC membrane components) and cytokine studies (TNF and IL-10) were performed. Stool samples were collected for a parasitological examination. Malaria patients had a 2.7-fold greater chance of anaemia than the control group. At D0, 66.1% of the patients had mild anaemia, 30.5% had moderate and 3.5% had severe anaemia. Positivity to intestinal helminths and/or protozoa at stool examinations had no influence on anaemia. Patients had significantly lower levels of plasmatic TNF than control individuals at D0. Low TNF levels were more prevalent among patients with moderate/severe anaemia than in those with mild anaemia and among anaemic patients than in anaemic controls. TNF levels were positively correlated with the haemoglobin rates and negatively correlated with the interval time elapsed between the onset of symptoms and diagnosis. Both plasma TNF levels and haemoglobin rates increased during the follow-up period. The IL-10 levels were lower in patients than in the controls at day 0 and decreased thereafter up to the end of treatment. Only the anti-anticardiolipin autoantibodies were associated with moderate/severe anaemia and, possibly by reacting with the parasite glycosylphosphatidylinositol (a powerful stimulator of TNF production), may have indirectly contributed to decrease the TNF levels, which could be involved in the malarial vivax anaemia of these children and adolescents. More studies addressing this issue are necessary to confirm these findings and to add more information on the multifactorial pathogenesis of the malarial anaemia.

Níveis séricos de vitamina D e alterações hepáticas em pacientes com malária na região Amazônica / Serum levels of vitamin d and hepatic changes in patients with malaria in the Amazon region / Niveles séricos de vitamina d y alteraciones hepáticas en pacientes con malaria en la Amazonia

Vários estudos sugerem a importância da vitamina D ­ 25(OH)D ­ na evolução clínica dos pacientes com malária. Entretanto, a prevalência de deficiência de 25(OH)D na população amazônica é pouco conhecida, havendo também poucos estudos com pacientes diagnosticados com malária. Assim, o objetivo deste estudo foi avaliar os níveis séricos de 25(OH)D em pacientes com malária e sua relação com dados epidemiológicos, parasitológico e provas de função hepática. Para tanto, foi realizado um estudo transversal analítico com um grupo de pacientes com malária e um grupo controle no município de Itaituba (PA), Brasil, no período de janeiro de 2018 a outubro de 2019. Elaborou-se um protocolo para avaliação dos dados sociodemográficos, parasitológicos e laboratoriais, adotando-se o nível de significância de 5%. A prevalência de deficiência de 25(OH)D foi observada nos pacientes com malária (28,5%) e no grupo controle (24,6%), sem diferença estatística; porém, entre os residentes no garimpo, os níveis séricos foram estatisticamente menores nos pacientes com malária. Os níveis séricos de transaminase glutâmico-pirúvica (TGP) apresentaram correlação inversa com os de 25(OH)D. As provas de função hepática foram significativamente maiores no grupo com malária. Dessa forma, este estudo evidenciou a deficiência de 25(OH)D em Itaituba. Alterações hepáticas pela infecção plasmodial podem ter contribuído para a correlação inversa observada entre os níveis de TGP e 25(OH)D.

Several studies suggest the importance of vitamin D ­ 25(OH)D ­ in the clinical evolution of patients with malaria. However, the prevalence of 25(OH)D deficiency in the Amazonian population is little known, and studies with patients diagnosed with malaria are scarce. Thus the objective of this study is to evaluate the serum levels of 25(OH)D in patients with malaria and its relationship with epidemiological and parasitological data and liver function tests. To that end, an analytical cross-sectional study was carried out with a group of patients with malaria and a control group in the municipality of Itaituba (PA), Brazil, from January 2018 to October 2019. A protocol was elaborated for the evaluation of sociodemographic, parasitological, and laboratory data, adopting a significance level of 5%. Results: The prevalence of 25(OH)D deficiency was observed in patients with malaria (28.5%) and in the control group (24.6%), with no statistical difference; however, among residents in the mining, serum levels were statistically lower in patients with malaria. The glutamic-pyruvic transaminase (GPT) serum levels showed an inverse correlation with 25(OH)D levels. Liver function tests were significantly higher in the malaria group. Thus, this study evidenced 25(OH)D deficiency in Itaituba. Hepatic changes due to plasmodial infection may have contributed to the inverse correlation observed between GPT and 25(OH)D levels.

Diversos estudios sugieren la importancia de la vitamina D ­[25(OH)D]­ en la evolución clínica de pacientes con malaria. Sin embargo, la prevalencia de la deficiencia de 25(OH)D en la población amazónica es poco conocida y existen pocos estudios en pacientes con malaria. Ante esto, el objetivo de este estudio fue evaluar los niveles séricos de 25(OH)D en pacientes con malaria y su relación con datos epidemiológicos, parasitológicos y pruebas de función hepática. Para ello, se realizó un estudio transversal analítico en el grupo de pacientes con malaria y en un grupo control en el municipio de Itaituba (PA), Brasil, de enero de 2018 a octubre de 2019. Se elaboró un protocolo para la evaluación de datos sociodemográficos, parasitológicos y de laboratorio, adoptando un nivel de significancia del 5%. La prevalencia de deficiencia de 25(OH)D se observó en pacientes con malaria (28,5%) y en el grupo control (24,6%), sin diferencia estadística; sin embargo, entre los residentes en la minería, los niveles séricos fueron estadísticamente inferiores en pacientes con malaria. Los niveles séricos de transaminasa glutámico pirúvica (TGP) mostraron una correlación inversa con los niveles de 25(OH)D. Las pruebas de función hepática fueron significativamente más altas en el grupo de malaria. De esta manera, se evidenció deficiencia de 25(OH)D en la población de Itaituba. Los cambios hepáticos debido a la infección plasmodial pueden haber contribuido a la correlación inversa observada entre los niveles de TGP y 25(OH)D.

Síndrome do T3 baixo como fator prognóstico em pacientes na unidade de terapia intensiva: estudo de coorte observacional / Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study

RESUMO Objetivo: Avaliar a síndrome do doente eutireóideo como fator prognóstico em pacientes na unidade de terapia intensiva, detectar fatores que possam influenciar a mortalidade e desenvolver uma equação para calcular a probabilidade de morte. Métodos: Este foi um estudo de coorte longitudinal, observacional e não concorrente realizado na unidade de terapia intensiva da Fundação Santa Casa de Misericórdia do Pará. Realizou-se coleta de 20mL de sangue em 100 adultos sem endocrinopatia previamente documentada para a dosagem do hormônio estimulante da tireoide, da tetraiodotironina livre, da tri-iodotironina livre e da tri-iodotironina reversa. Resultados: A maioria dos pacientes era do sexo feminino, com idades entre 20 e 29 anos. A maioria dos pacientes que morreram era mais velha (idade mediana de 48 anos), e 97,5% deles possuíam a síndrome do doente eutireóideo. A síndrome do doente eutireóideo esteve relacionada à morte, às comorbidades, à idade e ao tempo de internação (mediana de 7,5 dias) na unidade de terapia intensiva. A baixa dosagem de hormônio estimulante da tireoide estava associada à morte. Os pacientes com dosagem da tri-iodotironina livre menor que 2,9pg/mL tinham maior probabilidade de morrer e, naqueles que morreram, a dosagem de tri-iodotironina reversa era maior que 0,2ng/mL. A tri-iodotironina livre apresentou maior sensibilidade e acurácia, e a tri-iodotironina reversa teve maior especificidade para prever a mortalidade. Com base nos resultados e pontos de corte, desenvolveu-se uma fórmula de regressão logística múltipla para calcular a probabilidade de morte. Conclusão: Sugere-se verificar oportunamente a dosagem da triiodotironina livre e reversa em pacientes graves e aplicar a equação proposta.

ABSTRACT Objective: To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. Methods: This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. Results: Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days). There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. Conclusion: The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

Some aspects of the behavior of the hypothalamus-pituitary-adrenal axis in patients with uncomplicated Plasmodium falciparum malaria: Cortisol and dehydroepiandrosterone levels.

We studied the behavior of cortisol and dehydroepiandrosterone (DHEA) in 24 patients with uncomplicated Plasmodium falciparum malaria of the Evandro Chagas Institute, Belém, Pará, Brazil. The patients were evaluated before treatment (Day 0), 24h after the beginning of medication (Day 1) and on Day 8 of follow-up (Day 7). Steroid levels were correlated with parasitemia, temperature and time of the disease. The levels of these hormones were found to be significantly higher on Day 0 than on Day 7, showing no correlation with parasitemia or temperature, but temperature had a positive effect on the correlation between cortisol and dehydroepiandrosterone. Cortisol was not correlated with the time of disease, but a significant negative correlation was observed between DHEA and time of disease on Day 7, suggesting a decline in the adrenal reserve of this steroid. In conclusion, an increase in cortisol and dehydroepiandrosterone is observed in patients with falciparum malaria, with these levels declining with decreasing parasitemia. The finding that temperature interfered with the correlation between cortisol and dehydroepiandrosterone suggests a common mechanism for the activation of these hormones in malaria.

Myocarditis associated with Plasmodium vivax malaria: a case report.

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Lipodystrophy and metabolic parameters of people living with HIV / Lipodistrofia e parâmetros metabólicos de pessoas vivendo com HIV

Introduction: Since the earliest reported cases in the United States, Acquired Immunodeficiency Syndrome (AIDS) remains one of the major challenges to global health. Objective: To evaluate the metabolic parameters and clinical manifestations of lipodystrophy in patients with lipodystrophy syndrome associated with the use of antiretroviral therapy. Methods: A cross-analytical study carried out from December 2015 to June 2016, in a public reference hospital for the care of HIV patients, in the city of Belém, state of Pará, Brazil. The sample consisted of HIV positive serology patients in treatment with antiretrovirals and lipodystrophy. Interviews were conducted and a research protocol plus laboratory analysis applied. Results: A total of 54 patients was included, 68.5% male and 31.5% female, aged 26­72 years, average of 53.07 years (standard deviation ­ SD±10.41). Among the clinical forms of lipodystrophy, the mixed one was the most prevalent (72.2%). As for dyslipidemia, 30.8% of the patients presented isolated hypertriglyceridemia, 26.9% mixed dyslipidemia, 19.2% low high-density lipoprotein (HDL-c) and 17.3% without dyslipidemia. Regarding the glycemic profile, 28.3% of the patients were diabetic, 28.3% had altered fasting glycaemia and 5.6% had altered fasting glycaemia and glucose intolerance. Conclusion: The clinical form of mixed lipodystrophy was the most prevalent. In this study, there was no association between the lipid profile and the clinical forms of lipodystrophy. However, follow-up of these patients is necessary to avoid possible complications and risks of cardiovascular events

Introdução: Desde os primeiros casos relatados nos Estados Unidos, a Acquired Immunodeficiency Syndrome (AIDS) ainda continua sendo um dos grandes desafios para a saúde global. Objetivo: Avaliar os parâmetros metabólicos e as manifestações clínicas da lipodistrofia em pacientes com síndrome lipodistrófica do HIV, associada ao uso de terapia antirretroviral. Métodos: Estudo transversal analítico realizado de dezembro de 2015 a junho de 2016 em hospital público de referência no atendimento de pacientes HIV, em Belém, Pará, Brasil. A amostra foi composta de pacientes com sorologia positiva para o HIV em tratamento com antirretrovirais e lipodistrofia. Foram realizadas entrevistas e foi aplicado um protocolo de pesquisa mais análise laboratorial. Resultados: Foram incluídos 54 pacientes, 68,5% masculinos e 31,5% femininos, com idade entre 26 e 72 anos e média de 53,07 anos (desvio padrão ­ DP±10,41). Entre as formas clínicas da lipodistrofia, a mista foi a de maior prevalência (72,2%). Quanto à dislipidemia, verificou-se que 30,8% dos pacientes apresentaram hipertrigliceridemia isolada, 26,9% dislipidemia mista, 19,2% lipoproteína de alta densidade (HDL-c) baixo e 17,3% sem dislipidemia. Quanto ao perfil glicêmico, 28,3% dos pacientes são diabéticos, 28,3% apresentaram glicemia de jejum alterada e 5,6% glicemia de jejum alterada e intolerância à glicose. Conclusão: A forma clínica da lipodistrofia mista foi a mais prevalente. Nesta pesquisa, não houve associação entre o perfil lipídico e as formas clínicas de lipodistrofia, contudo faz-se necessário o seguimento desses pacientes, para evitar possíveis complicações e riscos de eventos cardiovasculares.

Evaluation of the effects of passion fruit peel flour (Passiflora edulis fo. flavicarpa) on metabolic changes in HIV patients with lipodystrophy syndrome secondary to antiretroviral therapy

ABSTRACT This study evaluated the effects of using passion fruit peel flour together with diet therapy and counseling in 36 patients with HIV lipodystrophy who were in an ambulatory clinic in a university hospital. The patients were divided into two groups. One received 30 g of passion fruit peel flour daily for 90 days and diet therapy counseling. The other group received only diet therapy counseling. The metabolic changes were analyzed before and after the intervention, with a significance level predetermined at p ≤ 0.05. The use of passion fruit peel flour was effective in reducing total cholesterol and triacylglycerides after 30 days. The concentrations of LDL-C decreased, while HDL-C increased in the blood of lipodystrophy patients after 90 days passion fruit peel flour treatment. No significant differences in food consumption were seen between groups. The use of 30 g of passion fruit peel flour for 90 days together with diet therapy counseling was effective in improving plasma concentrations of total cholesterol, LDL-C, HDL-C and triacylglycerides.

Myocarditis associated with Plasmodium vivax malaria: a case report

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Malária falciparum com comprometimento renal (síndrome nefrótica - relato de caso / Falciparum malaria with renal impairment (nephrotic syndrome) - case report

Objetivo: apresentação de um caso de síndrome nefrótica por malária falciparum. Relato decaso: escolar, 8 anos, sexo feminino, admitida no Hospital Municipal de Tailândia, Pará, comquadro de febre alta, seguida de surgimento de edema, urina escura e oligúria.. Evoluiu comanúria e foi transferida para a Fundação Santa de Misericórdia do Pará (FSCM-PA), onderecebeu diagnóstico de síndrome nefrótica secundária à malária por Plasmodium falciparum,com base em dados de anamnese, exame físico e exames complementares. A paciente obteveboa resposta clínica e parasitológica com a terapêutica antimalárica, recebendo alta hospitalarpara controle no Programa de Ensaios Clínicos em Malária do Instituto Evandro Chagas eAmbulatório de Nefrologia. Considerações finais: o acometimento renal é uma dascomplicações graves da malária com possível evolução para insuficiência renal aguda (IRA), eque pode ser fatal. Desenvolvimento de estratégias preventivas de combate aos distúrbios renaisassociados à malária requer conhecimento dos aspectos clínicos e epidemiológicos da doença,diagnóstico precoce e correto, além de terapêutica antimalárica.

Objective: presentation of nephrotic syndrome case due to falciparum malaria. Case report:school child, 8 years old, female, admitted at Municipal Hospital of Tailândia, Pará, with historyof fever, edema, dark urine and oliguria. Because the patient evolved with anuria, she wastransferred to Fundação Santa Casa de Misericórdia do Pará (FSCM-PA), where she wasdiagnosed with nephrotic syndrome secondary to Plasmodium falciparum malaria, based onanamnesis, physical examination, and laboratory exams. The patient had clinical andparasitological response to antimalarial therapy, being discharged to control at Clinical EssayMalaria Program at Evandro Chagas Institute and in a Nephrology Outpatient Unit. Finalconsideration: renal involvement is one of the serious complications of malaria. It can progressto acute renal failure (ARF), and may be fatal. Development of preventive strategies againstkidney disorders due to malaria infection requires knowledge of epidemiological and clinicalfeatures of the disease, accurate and prompt diagnosis and antimalarial therapy.

Abordagem metabólica e nutricional da lipodistrofia em uso da terapia anti-retroviral: [revisão] / Metabolic and nutritional approach of lipodystrophy in the use of antiretroviral therapy: [review]

A terapia anti-retroviral altamente ativa, usada contra o Vírus da Imunodeficiência Humana, vem possibilitando a melhora do quadro clínico-laboratorial de portadores da Síndrome da Imunodeficiência Adquirida. Contudo, alterações metabólicas e complicações morfológicas, associadas ao uso da terapia, vêm sendo investigadas. A utilização prolongada desta terapia tem um impacto importante sobre o estado nutricional dos pacientes. Antes da sua utilização, a perda de peso e a desnutrição, conseqüências das infecções oportunistas, eram os maiores problemas nutricionais. Atualmente, o foco principal das discussões têm sido as complicações metabólicas e morfológicas, dentre elas a lipodistrofia, com a dislipidemia, a resistência à insulina, a osteopenia, e a distribuição alterada da gordura corporal, aumentando assim os riscos de doenças cardiovasculares. A nutrição desempenha um papel fundamental no suporte da saúde desses pacientes, integrando as equipes multiprofissionais, promovendo a melhora da adesão à terapia anti-retroviral e do prognóstico da doença. No entanto, para que se tenha mais conhecimento sobre a terapia, as proporções de seus efeitos adversos, e o perfil nutricional desses pacientes, a curto e a longo prazos, é de suma importância que se estude mais sobre este assunto, a fim de permitir perspectivas de um regime terapêutico mais seguro dentro de seus alcances metodológicos, proporcionando uma melhor qualidade de vida aos pacientes.

The highly active antiretroviral therapy used against Human Immunodeficiency Virus provides an improvement in laboratory and clinical findings of patients with Acquired Immunodeficiency Syndrome. However, metabolic and morphologic disturbances associated with the therapy are being investigated. The drawn out use of these therapy has an important impact on the nutritional status of the patients. Before the use of this therapy, weight loss and malnutrition caused by opportunistic infections were the biggest nutritional problems. Nowadays the main discussion points are the resulting metabolic and morphologic complications, among them lipodystrophy with dyslipidemia, insulin resistance, osteopenia and altered distribution of body fat, thus increasing the risk of cardiovascular diseases. Nutrition plays an essential role in supporting the health of these patients, integrating the multidisciplinary teams, improving antiretroviral therapy adherence rates and disease prognosis. However, in order to better understand the therapy, the side effect rates and the nutritional profile of these patients on the short and long run, it is vital to study this subject more deeply to obtain perspectives of a safer therapeutic regimen within its methodological scope, improving the quality of life of these patients.

Preditores de mortalidade na cirurgia de revascularizção do miocárdio / Mortality predictors in coronary artery bypass grafting surgery

Fundamentos: A alta morbidade pós-operatória e os elevados índices de mortalidade dos pacientes submetidos à revascularização cirúrgica (RM) na fase aguda do infarto do miocárdio podem induzir o adiamento do procedimento. Objetivos: Identificar variáveis relacionadas à mortalidade, bem como os fatores de risco para o óbito de pacientes submetidos à cirurgia de revascularização do miocárdio. Métodos: A pesquisa foi realizada no período de setembro 2011 a maio 2012, no Hospital de Clínicas Gaspar Vianna, Belém, PA, Brasil. Foram utilizados prontuários de 240 pacientes, tendo sido aproveitados 223 (17 excluídos), referentes a pacientes internados no período de janeiro 2008 até dezembro 2011. Inicialmente foi calculada a frequência dos óbitos e, em seguida, a frequência das variáveis pré, intra e pós-operatórias e respectivos intervalos de confiança para caracterizar a população de estudo. Resultados: Dos 223 pacientes, 12 (5,4 %) foram a óbito. A variável no período pré-operatório mais significativa para o estudo foi a idade. No período intraoperatório, são os procedimentos cirúrgicos de urgência/emergência e, no pós-operatório, a transfusão sanguínea.Conclusão: No pós-operatório, as complicações cardiovasculares e as transfusões são fatores de risco, e a UTI se tornou um fator de proteção contra o óbito.

Background: High postoperative morbidity and mortality rates among patients undergoing coronary artery bypass surgery (CABG) during the acute phase of myocardial infarction may lead to the post ponement of these procedures.Objectives: To identify variables linked to o mortality and risk factors related to death among patients undergoing coronary artery bypass grafting surgery.Methods: The survey was conducted from September 2011 to May 2012 at the Hospital de Clinicas Gaspar Vianna in Belém, Pará State, Brazil, using the medical records of 240 patients (223 assessed and 17 excluded) admitted from January 2008 through December 2011. Initially, the death frequency was caculated, followed by the pre-, intra- and post-operative variable frequencies and their respective confidence intervals, in order to characterize the study population. Results: Among all 223 patients, 12 (5,4%) died, with age being the most significant varible in the pre-operative period. During the intra-operative stage, this was urgente or emergency surgical procedures, followed by post-operative blood transfusions. Conclusion: During the post-operative stage, cardiovascular complications and transfusions are risk factors, with the ICU constituting a protection fator against death.