Programa de Pós-Graduação em Doenças Tropicais - PPGDT/NMT

URI Permanente desta comunidadehttps://repositorio.ufpa.br/handle/2011/3558

O Programa de Pós-Graduação em Doenças Tropicais (PPGDT) integra o Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará (UFPA), realizando atividades de ensino, pesquisa e extensão e atuando na formação de docentes-pesquisadores para o estudo e o ensino das doenças tropicais e das patologias regionais no estado do Pará e na Amazônia.

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Agora exibindo 1 - 5 de 5

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Aspectos epidemiológicos, clínicos e evolutivos da tuberculose em idosos de um hospital universitário de Belém - Pará
(Universidade Federal do Pará, 2016-02-29) CHAVES, Emanuele Cordeiro; SANTOS, Maria Izabel Penha de Oliveira; http://lattes.cnpq.br/9592128667013030; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163
Physiological changes, especially the immune, make the most vulnerable elderly to infections such as tuberculosis, a disease that this group is specific both in clinical presentation and in its therapeutic management. The objective was to evaluate the epidemiological, clinical and evolutionary aspects of tuberculosis in elderly patients at a university hospital in Belém - Para. It is a study of a retrospective cohort study, conducted at the University Hospital João de Barros Barreto, where 82 records were analyzed of cases of tuberculosis in elderly patients diagnosed from 2009 to 2013, and as a complementary way of obtaining information was obtained from the database of the National System for Notifiable Diseases of the State Department of Public Health. For statistical analysis we used the electronic program Statistical Package for Social Sciences (SPSS) version 22.0, and applied the test G, assuming level α = 0,05 (5%) and value P≤0,05. The study was approved by the Research Ethics Committee of the Tropical Medicine Center under Opinion No. 1.081.347. Most elderly were male (n = 53; 64,6%), aged 60-69 years, both among men (n = 34; 64,2%) and among women (n =13; 44,8%), with a statistically significant difference (p=0,009), new cases of tuberculosis (n = 78; 95,1%), with pulmonary clinical form (n = 62; 75,6%), associated diseases (n = 57; 69,5%) and length of stay greater than 21 days (n = 38; 46,3%). Fever (n = 55; 67,1%), dyspnea (n =53; 64,6%), weight loss (n =50; 61,0%), productive cough (n = 49; 59,8%) and chest pain (n=42; 51,2%) were the primary signs and symptoms evidenced. Regarding treatment, there was a high percentage of adverse events (n=41; 50%), especially gastrointestinal symptoms (n = 29; 70,7%). Most seniors evolved with cure (n = 49; 59,8%), but emphasizes that death from tuberculosis was considerable in the study group (n=13; 15,9%), mainly occurring during hospitalization up 7 days. As for the exposure variables and outcome for healing and death from tuberculosis, there was a statistically significant difference in the age range of variables (p = 0,017), length of stay (p = 0,000) and adverse reactions (p = 0,018). We conclude that the clinical presentation and therapeutic management of tuberculosis in the elderly is different, so it is necessary to strengthen strategies that facilitate early identification of TB suspects elderly in the community, which should take place mainly through Primary.
Acesso aberto (Open Access)
Derrame Pleural Parapneumônico: perfil e evolução de crianças internadas no Hospital Universitário João de Barros Barreto
(Universidade Federal do Pará, 2012) ARÊAS, Claudia Giselle Santos; NORMANDO, Geraldo Roger; http://lattes.cnpq.br/9822022240199044; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163
Introduction: Pneumonia is one of the most common diseases in children, and pleural effusion is a potential complication, especially in developing countries, where there are limitations in diagnostic and therapeutic resources. Objectives: The aim of this study is to know the profile of the children presenting pleural effusions complicating pneumonia analyzing their evolution regarding the clinical and surgical treatment instituted. Methods: A descriptive, transversal, prospective survey, which studied all children admitted in a Brazilian hospital which is reference in infectious diseases with diagnosis of parapneumonic effusion, submitted to surgery because of this complication, in the period between October of 2010 and October of 2011. Results: The sample was composed by 46 children, mostly younger than 3 years old (74%). A significant part of the sample (28%) had some nutritional inadequacy. The mean of disease duration until the ingress was 16,9 days, the whole sample came from other hospitals. The means of duration of hospital length and febrile state were, 26,0 and 9,8 days, respectively. It was used a media of 2,2 antibiotic schemes, and Ceftriaxone was the most drug most used. Etiological diagnosis was achieved in one single case. In 22 patients, (47,8%), it was observed empyema pleural, and they had a longer drainage duration. It was attested association between stunting and multiple surgeries (G Test = 8,40; p = 0,040). The majority of the children (80,4%) was submitted to surgery just once. The closed thoracic drainage was the most common surgery (85%). The open thoracocentesis was used in 24,0% of the children. The thoracotomy was performed in 2 patients (4,0%). All patients were clinical and radiological reestablished within 4 months after the hospital discharge, and there were not deceases in this sample. Conclusion: the sample studied has advanced disease and common nutritional disturbs, which may influence in surgical evolution. It is necessary antibiotic therapy standardization. Pleurostomy is still a valid option, and new studies are demanded in order to reconsider it, mainly in centers where videothoracoscopy is unavailable.
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Epidemiologia das infecções de corrente sanguínea por enterobactérias produtoras de betalactamase de espectro expandido: estudo caso-controle em Unidade Neonatal do Norte do Brasil
(Universidade Federal do Pará, 2012) SILVA, Danille Lima da; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163
Gram-negative bacilli, especially Enterobacteriacea, are frequently associated with neonatal sepsis. A retrospective case-control study was performed to study bloodstream infections (BSI) caused by extended-spectrum beta-lactamase-producing (ESBL) enterobacteria in a neonatal unit the northern region of Brazil. This research was undertaken of all neonates admitted between 1st January 2007 and 31st December 2011 to the neonatal care unit, who had late-onset sepsis with blood cultures positive for Klebsiella sp., Enterobacter sp., Serratia sp. and Escherichia coli, performed according to National Committee for Clinical Laboratory Standards criteria. There were 153 neonates with gram-negative septicaemia, 87 newborns were infected with ESBL-producing enterobacteria, with incidence of 8.63 cases per 1000 newborns admitted. These were studied 132 patients, divided in two groups, cases (ESBL +) and controls (ESBL -), of 66 each (1:1). Most cases were affected in the first days of life (34,8% vs. 9,1%, p=0,001), especially in 2007 (19,7%), and made use two antibiotics (59,1% vs. 33,3%, p=0,01). The control group made more use of central venous catheter (62,1% vs. 45,4%, p=0,037) and parenteral nutrition (75,7% vs. 48,5%, p=0,001). The distribution curve of enterobacteria in accordance with the production of ESBL throughout the study period showed a greater number of cases in 2007 and 2008 (56,05%), with a higher chance of acquiring ESBL-producing enterobacteria these years (78% e 72%, respectively), and a higher number of controls for 2010 and 2011 (72,7%). The evolution to more deaths occurred among the cases (40,9% vs. 24,2%, p=0,031) and the majority died within 30 days of the episode of ICS (92,6% vs. 50,0%, p=0,002). In multivariate analysis, the evolution to death by ESBL-producing remained as an independent variable (OR=3,47 IC 1,33 – 9,06). It was concluded that there was a higher incidence of ESBL-producing enterobacteria BSI for the first two years of the study (2007 - 2008), with probability of acquiring this type of infection of up to 78%. The neonatal mortality was high, being three times greater when compared to infections by non-ESBL-producing enterobacteria. The change of the resistance profile of BSI by enterobacteria, reducing the number of cases of ESBL over time was a result of the implementation of control measures for dissemination and selection of bacterial resistance in the neonatal unit, and coinciding with the revision of care protocols as increased use of PICC and parenteral nutrition protocol in the period from 2010 to 2011.
Acesso aberto (Open Access)
Fatores associados a letalidade na fungemia neonatal em UTI de hospital de ensino na Região Norte do Brasil
(Universidade Federal do Pará, 2011) MATTOS, Wardie Atallah de; BICHARA, Cléa Nazaré Carneiro; http://lattes.cnpq.br/2161704040280760; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163
Candidemia is one of the most common nosocomial infections in intensive care units. In newborns, especially premature very low birth weight (1500 g <) and extremely low birth weight (1000g <) with candidemia is an important cause of morbidity and mortality. This study aimed to evaluate the risk factors for candidemia-related mortality, set the overall mortality and mortality attributed to candidemia in neonates hospitalized in a referral hospital maternal and child health in northern Brazil during the observation period January 2008 to December 2010. In order retrospective study was conducted nested case-control study for risk factors associated with death and case-control analysis of mortality attributed to, by reviewing the microbiology and corresponding clinical records of neonates with a confirmed diagnosis of candidemia by blood culture. The Blood Stream Infection by Candida spp occurred in 34 neonates, of which about 58.8% with weight equal to or less than 1,500 g and 41.2% over 1500 g. Gestational age was equal to or below 32 weeks in 38.2% of newborns and approximately 61.8% over 32 weeks. Candida albicans was identified in 9 patients (26.5%), Candida parapsilosis in 9 patients (26.5%), Candida glabrata in one patient (2.9%) and 15 patients (44.1%) there was no identifying the species of Candida. As a risk factor associated with lethality venous dissection was present in 8 patients (23.5%) p = 0.0331. Patients with fungemia had a chance of approximately 12 times more likely to evolve to death compared to controls without fungemia. Mortality attributed to fungemia was 26.4% and overall mortality for candidemia was 52.9%. The data showed that the venous dissection was a significant risk factor for mortality in neonates with candidemia. Other risk factors were not associated with mortality. The occurrence of fungemia significantly increases the chance of a premature newborn hospitalized in the intensive care unit death evolve independent of any other clinical variable.
Acesso aberto (Open Access)
Pneumopatias infecciosas em pacientes com HIV/AIDS: abordagem histórica em um hospital de referência na Região Norte, Brasil
(Universidade Federal do Pará, 2016-06-07) SANTOS, Milene Cardoso Salgado dos; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163
Pulmonary infectious diseases frequently are identified in patients with the human immunodeficiency virus (HIV). The objective of this study was to describe the clinical, epidemiological aspects and techniques used in the diagnosis of infectious lung disease in patients with HIV/AIDS. We evaluated 830 medical records of patients admitted to the University Hospital João de Barros Barreto (HUJBB) - Belém - Pará, in the period 2005-2014, diagnosed with infectious pulmonary diseases, positive HIV/AIDS and over the age of 18. The mean age of subjects was 37.7 years with higher age among those with greater sexual activity and productivity, most men (64.4%), however it was observed a significant increase in women over the years increasing the number of women in hospital beds. Most origin was from the state capital (46.6%). Infectious lung diseases manifested themselves through productive cough, weight loss and dyspnea. The vast majority of patients had their diagnosis presumptively through epidemiological, clinical and radiological data and perform empirical treatment. In patients who had the diagnosis established this was done by sputum analysis, bronchoalveolar lavage and transbronchial biopsy and the most frequent diagnoses were bacterial pneumonia, tuberculosis and pneumocystis pneumonia, with a significant increase in tuberculosis cases in the period between 2011 and 2014.The outcome, in-hospital mortality occurred in most cases due to bacterial pneumonia and there was a considerable increase in the number of high over the years, even with the increased length of stay and the limitations on the diagnostic tools.

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