Navegando por Orientadores "SOUSA, Rita Catarina Medeiros"
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Item Acesso aberto (Open Access) Análise epidemiológica e caracterização parcial do gene F dos Metapneumovirus Humano detectados a partir de casos de infecção respiratória aguda na Região Norte do Brasil(Universidade Federal do Pará, 2012-10-30) FERREIRA, Luís Edilson de Azevedo; MELLO, Wyller Alencar de; http://lattes.cnpq.br/1784167608719139; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Diseases of the respiratory tract are the main complaints in health care services, and acute respiratory infections (ARI) the most common manifestations, especially in children under five years of age. In developing countries the ARI are a serious public health problem. Throughout the world is estimated to occur in approximately 2 million deaths each year by ARI. Among the causative agents of ARI, we highlight the human metapneumovirus (HMPV), especially by causing severe illness in children under 5 years. Aiming to generate data on the molecular epidemiology of this virus, we analyzed samples taken from patients with ARI in the period January 2009 to December 2011 arising from the Northern Region (Pará, Amazonas, Acre, Amapá and Roraima). It was used the technique of real time PCR (qRT-PCR) to detect the virus by the N gene and RT-PCR for the gene encoding the F protein, which was then partially sequenced. Within the study period, were tested in 2966 samples, 129 of which were positive for HMPV. The age group of 0-4 years was the one that focused more cases (n = 84, 65.89%) across the North. The identification of viruses was found to co-circulation of subgroups A2 and B2 during the three years of the study. Subgroups A1 and B1 not circulated in the region during the study period. This study represents the first report of data on molecular epidemiology of Human Metapneumovirus in northern Brazil.Item Acesso aberto (Open Access) Avaliação audiomética em pacientes tratados de meningite por Cryptococcus gattii(Universidade Federal do Pará, 2007) ALVES, Rogério Benjamim Francisco; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539This study shows the audiometric evaluation, composed by tonal audiometry and imitanciometry, in patients treated for Cryptococcus gattii meningitis. It was analyzed six patients with proven Cryptococcus gattii central nervous system infection, interned in the Hospital Universitário João de Barros Barreto, Belém, PA, Brazil, between January of 2000 and November of 2007, for antifungal treatment. The age of the analyzed patients ranged from 12 to 37 years-old. Three were men and three women. All of them originating from neighboring cities, nobody from the capital, Belém. The most common clinical findings were headache and vomiting, present in all the patients; fever and nuchal rigidity, each one absent in only one patient, not coincidents. The time of illness until the diagnosis varied from 3 to 8 weeks. Of the three evaluated men, hearing loss was presenting in two. In one of them deafness was moderate and unilateral and in the other it was bilateral and not symmetrical. Of the three women, only one presented hearing impairment. In this patient, occurred just a mild alteration in an isolated frequency, of 4.000 Hz. It is described audiometric findings in a relate of cases of patients treated for meningeal neurocryptococcosis due to Cryptococcus gattii.Item Acesso aberto (Open Access) Avaliação do programa de HIV/Aids na concepção dos usuários: o caso em um hospital de referência em Belém-PA(Universidade Federal do Pará, 2010) MENDES, Marcelo Monteiro; SOUSA, Maria do Socorro Batista de; http://lattes.cnpq.br/7985347783921988; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Study regarding the evaluation of the HIV / AIDS in a referral hospital in the design of the users. The purpose of this study was to describe the design of the users in the inpatient unit and outpatient program on HIV / AIDS in a university hospital in Belém-PA. For the study were plotted as specific objectives: to present the suggestions of users of the program to improve the development of program activities and provide minimal tools for building an evaluation model for the program. Reference was used in the landscape of HIV / AIDS, health policies in Brazil and AIDS, and evaluation of programs and services in health. The method and approach were qualitative, descriptive case study. We used a structured semi-structured interviews on the topic. The research was conducted in the dependency HUJBB, more specifically in the services of the HIV / AIDS, in which respondents were users of the NCS and hospitalized at the clinic of infectious and parasitic diseases. By analyzing the data, the lines were divided into four categories: characterization of the user as to access the service, the motivation of the user quality of service; difficulties facing the service and guidance activities, expectations for improving the program. The search result clarifies the restrictions and qualities of the program, the dissatisfaction of the user in accessing the service, the high degree of motivation and the lack of it; the main difficulties of adhering to the guidelines and program activities, such as fear to facing death, lack of resource to get the service, the prejudice faced by people with HIV / AIDS and sexual promiscuity, and user expectations for the program: fast service, better infrastructure. It concludes with the improvements that can contribute to the quality of life of users, support is enough demand for professionals to attend the program and provide comprehensive treatment to people living with HIV / AIDS seen at HUJBB program.Item Acesso aberto (Open Access) Caracterização epidemiológica, genotípica e fenotípica da criptococose em uma unidade de referência no estado do Pará(Universidade Federal do Pará, 2012) FURTADO, Karen Cristini Yumi Ogawa; ISHIKAWA, Edna Aoba Yassui; http://lattes.cnpq.br/3074963539505872; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Cryptococcosis is a fungal infection caused by an encapsulated yeast Cryptococcus genus that affects both humans and animals, and is considered as an opportunistic infection commonly associated with immunosuppression. This is one of human fungal infections cause significant morbidity and mortality in both immunocompetent and in immunocompromised individuals and appears mainly in the form of meningoencephalitis. The aim of this study was to characterize epidemiological, genotypic and phenotypic cryptococcosis in a reference unit in the state of Pará. The target population was composed of patients treated at the University Hospital João de Barros Barreto/UFPA, January 2010 to December 2011 with laboratory confirmed diagnosis of cryptococcosis. Personal, clinical and laboratory data were collected from a review of medical records file HUJBB and the isolates were identified and characterized morphologically and biochemically. The type sexed and genotype were identified by PCR using specific primers. From January 2010 to December 2011 were identified 59 cases of cryptococcosis. Most patients were men (36/59, 61%), aged 5-70 years, mean 30.8 years. The predominant age group was 34-43 years (39% of cases). The main signs and symptoms presented by them were headache (85.5%), vomiting (80%) and fever (76.4%). All children (6/6) were HIV negative, and as the causative agent C. gattii (31.6%), while in adults 71.1% of infections were caused by C. neoformans, most HIV positive. The cases of death and recurrence were higher among patients infected with C. neoformans and the presence of sequelae was more frequent among patients infected with C. gattii. All isolates were MAT α and there was a predominance of two molecular types: VNI (64.4%) and VGII (35.6%). This study reinforces that the state of Pará is endemic to infection by Cryptococcus spp., Whose main clinical presentation, meningoencephalitis determines high rates of morbidity and mortality.Item Acesso aberto (Open Access) Caracterização genotípica do Vírus Varicela-Zoster em casos de varicela e Herpes zoster em Belém-Pará, Brasil(Universidade Federal do Pará, 2013) COSTA, Marcos Rogério Menezes da; MONTEIRO, Talita Antônia Furtado; http://lattes.cnpq.br/4592027736583434; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Varicella zoster virus (VZV) can cause chickenpox during primary infection, subsequently establishing a latent infection. In case of reactivation of the virus, the herpes zoster may occur. Analysis of the presence of IgG and IgM is critical to determine the prevalence of this virus in the Metropolitan Region of Belém. The study of specific nucleotide polymorphisms is used to define the genotypes of VZV. Analysis of ORFs 22, 38 and 54 identified genotypes of VZV according to the classification established in conference July 25, 2008 in Whitechapel, London / UK, where the strains of VZV detected and characterized by sequencing of SNPs were grouped into classes 1 through 5. To evaluate the prevalence of antibodies and describe the circulating genotypes was the aim of this study. The frequency of IgM and IgG antibodies in cases of chickenpox was 68.2% and 48.2%, respectively. Cases of herpes zoster showed prevalence of anti-VZV IgG and IgM of 87.5% and 12.5%, respectively. The genotypes 1 or 3 and 5 were present in 13 samples sequenced, and the European strain (class 1 or 3) was found in samples from all the cities studied. The identification of strains circulating VZV is extremely important because of the association of specific genotypes with clinical harshest and to assess the implementation of the vaccine in the National Immunization Program.Item Acesso aberto (Open Access) Caracterização molecular de cepas do vírus respiratório sincicial isoladas de casos de infecção respiratória aguda na cidade de Belém, Pará, Brasil nos anos de 2000 a 2006(Universidade Federal do Pará, 2006-07-03) SANTOS, Mirleide Cordeiro dos; MELLO, Wyller Alencar de; http://lattes.cnpq.br/1784167608719139; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The diseases of respiratory tract are the main complaints in the services of medical consultations, acute respiratory infections (ARI) are the most common manifestations, mainly in children under five years old. In developing countries ARI represent a serious problem of public health. Every year, ARI are responsible by about 2 million deaths all over the world. Among the infectious agents the Respiratory Syncytial virus (RSV) is the most important pathogen in infants and young children because of severe bronchiolitis and pneumonia that it may cause. With the objective to generate data on the molecular epidemiology of this virus, patients' clinical samples with ARI were analyzed during the period 2000 - 2006 in the city of Belém, Pará. Test of Indirect immunofluorescence (TIF) was used for antigenic characterization of isolated viruses and the RT-PCR for the genes encoders of the proteins G and F, that were partially sequenced. In the total period, 153 positive samples of RSV were analyzed. The age group 0-4 years showed the larger number of cases (90,19%). In relation to the seasonal profile, the pick of activity of RSV happened in the first six months of the year, being associated mainly to the period of change of the rainy season to a less rainy period. There was a co-circulation of the subgroups A and B in the years of 2001 and 2003. In 2000, 2005 and 2006 just the subgroup A was detected. However in the year of 2004 was only registered the occurrence of subgroup B. Inside the studied period, were detected different genotypes from the protein G of the subgroup A (GA2 and GA5) and of the subgroup B (SAB1 and SAB3) , indicating the first report about circulation of the genotype SAB1 in South America. In 2004, was found a differentiated cluster of the other circulating genotypes, being denominated BRB1. The analysis from gene encoder of the protein F allowed identification of mutations in the nucleotidic sequence that resulted in changes in the aminoacídica chain. This study represents the first report about the molecular epidemiology of the Respiratory Syncytial Virus in the North region of Brazil.Item Acesso aberto (Open Access) “Citomegalovírus: diversidade genética e pesquisa de resistência antiviral em pacientes imunodeficientes da cidade de Belém”(Universidade Federal do Pará, 2015-07-17) SILVA, Dorotéa de Fátima Lobato da; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Cytomegalovirus (CMV) is one of the most common cause of morbidity and mortality in immunocompromised patients because its latency and reactivation mechanism that commonly occurs in immunodeficiencies. Genetic analysis showed that the virulence of the strains may be related to genotypic diversity. The main objective of this paper was to describe the seroepidemiology profile and genetic diversity of CMV by detecting mutations that confer viral resistance to ganciclovir in immunodeficient patients from Belém city.A total of 671 samples were analyzed: 243 HIV/AIDS, 257 neoplastic patients, 112 kidney transplant and 60 people with SLE. The seroprevalence of antibodies was 96.1% and active infection and levels of 2.4% (n = 16) lower than that observed by qPCR method which corresponded to 15.63%. Differences in infection rates due to low sensitivity (5.71%) of the serological method demonstrated in screening test. The mutation research was made in 82 samples for pyrosequencing method, a 741pb segment of the UL97 gene was amplified, between 1087-1828 nucleotides. It was observed that 100% (n = 82) of samples had two mutations in amino acid in codon 596 (E596K) and another one in codon 604 (S604F). The S604F mutation was not found in other viral sequences from GenBank. Ten other mutations occurred between codons 377 and 594 in eight samples, including the A594V mutation in a renal transplant patient who ended up dying.It was concluded that the prevalence of antibodies and the epidemiological profile of the group were similar to those observed in populations of developing countries; the viral infection rates are related to viral reactivation, being underestimated by serology; sequence analysis revealed significant genetic diversity in the samples examined; detection of A594V mutation suggests circulating strains with resistance mutation.Item Acesso aberto (Open Access) Correlação entre o câncer bucal e de laringe e a presença do Papilomavírus Humano (HPV) e do vírus Epstein-Barr (EBV) no estado do Pará(Universidade Federal do Pará, 2013) ARAÚJO, Marizeli Viana de Aragão; FUZII, Hellen Thais; http://lattes.cnpq.br/0026958665547973; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The oral and laryngeal cancer represents a growing public health problem in Brazil. Smoking and alcohol are the main causes of oral cancer and larynx, but a part of the population develops the disease without being exposed to these risk factors, suggesting the existence of other causes such as genetic predisposition, alteration of tumor suppressor genes, diet and viral agents, particularly human papillomavirus (HPV) and Epstein-Barr virus (EBV). The proposition of this study was to verify prevalence of HPV and EBV in normal oral mucosa, cancer of oral cavity and larynx, and what types are most prevalent in these two situations. For this study we established two groups: one consisting of 70 specimens embedded in paraffin, with a confirmed diagnosis of oral and larynx cancer and other with 166 individuals without lesions in the oral cavity. Laboratory analysis for the viral detection and typing HPV and EBV (EBV type 1 or 2) were performed by conventional PCR (Polymerase Chain Reaction). The typing of samples positive for HPV types (6, 11, 16, 18, 33, 35, 38, 52 and 58) was performed by real time PCR using probes specific for each type. The EBV and HPV prevalence found in the oral and laryngeal cancers was 78.6% for HPV and 84.3% for EBV and 24.1% and 45.8% for EBV and HPV, respectively, in individuals without oral lesions. The most prevalent HPV types were HPV 58 (50.9%), HPV 6 (9.1%) and HPV 16 (9.1%) in cancer group and HPV 18 (12.5%), HPV 6 (7.5 %) and HPV 58 (2.5%) in the group with no lesions. The EBV 2 was more prevalent in both the cancer lesions than subjects without lesions, with a frequency of 94.9% and 82.9%, respectively. There was no association of HPV infection with EBV and sex, the prevalence being similar for men and women. Association was observed between the prevalence of HPV and EBV and its co-infections with the group that developed cancer. The prevalence of HPV and EBV and the odds ratio in the occurrence of cancer was 8.86 (p <0.0001) in individuals infected with HPV and 4.08 (p = 0.0004) in patients infected by EBV. The probability value estimated for prevalence of HPV and EBV co-infection and the occurrence of cancer has shown that individuals infected by both viruses have 65.72% likelihood of developing cancer, while infected with HPV has 31.94% and infected with EBV 17.79%. The results of this study may suggest that viral agents (HPV and EBV) are important risk factors for the development of carcinogenesis, and HPV is more effective than EBV in triggering the disease.Item Acesso aberto (Open Access) Detecção de vírus Influenza A em aves migratórias capturadas em regiões litorâneas dos estados da Bahia, Pará e Pernambuco(Universidade Federal do Pará, 2014) FERREIRA, Deimy Lima; MELLO, Wyller Alencar de; http://lattes.cnpq.br/1784167608719139; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The Influenza virus is known for its ability to infect a wide variety of animals, such as mammals (humans, pigs, horses, whales), domestic birds (chicken [Gallus gallus], goose, turkey [Meleagris ocellata]) beyond wild birds of the orders Anseriformes (duck, wild goose and swan) and Charadriiformes (seagulls, swallows, aquatic birds and sandpipers) these being its natural host. Comprehend the movement of long distance migratory wild birds is crucial to explain the movement of avian influenza viruses. This event causes movement of the birds are acting as an important means of spreading the virus along a migratory route, a fact widely accepted. During the period 2006 and 2007, samples were collected 2,252 samples from a variety of bird species captured in locations which are part of the Atlantic migration route and Mississippi, in the states of Bahia, Para and Pernambuco for epidemiological surveillance of West Nile virus and influenza. The objective of this study was to investigate the circulation of influenza virus among migratory birds that use the routes that pass the above states. For this, the samples were analyzed by means of molecular biological techniques, which comprised two main steps: a) extraction of DNA / RNA from the biological specimen; b) amplification of the gene encoding cytochrome oxidase control of by the technical Polymerase Chain Reaction (PCR) and amplification of the vRNA by Real time Reverse Transcripition polimerase chain reaction (RT-qPCR). The results obtained showed that the total samples tested, 7.2% (n = 158) were positive by RT-qPCR for Influenza A virus. We observed a difference in positivity for the virus among bird species analyzed, which is 3.58% for Charadriformes order, 26.3% among the birds of the order Anseriformes, 5.3% of birds belonging to the order Pelecaniformes and 10.9% for those order Suliformes. Among the samples of the orders Passeriformes and Columbiformes, no sample was positive for Influenza Virus. The data suggest variation among the sampling sites, and the state of Para with the lowest percentage of positivity, the second highest rate with Bahia and Pernambuco finally presenting higher prevalence of absolute value. This study shows that although rare investigations in Brazilian territory, there has been movement of Influenza A viruses among several species of migratory birds that utilize the states of Para, Bahia and Pernambuco as stopping places and reproduction of their species. These findings justify further investigations to understand the dynamics of avian influenza viruses circulating in the population of wild birds in Brazil, and its role as a potential source of infection for other animals, including humans.Item Acesso aberto (Open Access) Diversidade genética dos vírus linfotrópicos de Células T do tipo 1 na Região Metropolitana de Belém(Universidade Federal do Pará, 2015) NOBRE, Akim Felipe Santos; SOUSA, Maísa Silva de; http://lattes.cnpq.br/1775363180781218; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The human T-cell lymphotropic virus type 1 (HTLV-1) is a DELTARETROVIRUS which was first isolated from a blood sample of a patient with african american cutaneous T-cell lymphoma, in the mid 1970s; Hodgkin was later classified as leukemia / lymphoma adult T-cell (LLcTA) severe disease that affects T lymphocytes Subsequently, the virus was also associated with tropical spastic paraparesis / HTLV-associated myelopathy (HAM / TSP), character chronic and progressive causing damage mainly at the thoracic spinal cord. Their genetic diversity varies according to the region studied, and its mutation rate is very low (about 1% per thousand years) compared to other viruses. The objective of this study was to assess the genetic diversity of HTLV-1 in the metropolitan area of Belém, as well as the frequency of genotypes and the comparison of samples obtained with the sequences available in databases such as GenBank. We used blood samples collected from patients enrolled in the NMT / UFPA between the period January 2010 to December 2013. Then these samples were subjected to DNA extraction and amplification of HTLV PX region, using oligonucleotides inciciadores specific, from the PCR in two steps: internal and external (nested PCR). Positive samples then were subjected to enzymatic digestion of TaqI enzyme so that we could identify and differentiate the HTLV 1 and 2. Next, we performed amplification of the 5 'LTR region also by nested PCR positive samples, which, then were subjected to genetic sequencing. Using the method of maximum likelihood, we constructed a phylogenetic tree for the group display in clades of sequences in question. A Bayesian analysis (molecular clock) to visualize the evolutionary profile of the samples was also performed. The tests identified 78 samples positive for HTLV-1, of these, 44 were sequenced. The aa genotype was common in 100% of samples; the different subtypes had the following range rate and mutations per site per year: a- 2.10 -3; b- 2,69 . 10 -2; c- 6,23 . 10 -2; d- 3,08 . 10 -2; e- 6 . 10 -2; f- 1,78 . 10 -3; g- 2,2 . 10 -2 changes per site per year. It was then revealed a low genotypic diversity and a high genetic stability of the samples positive for HTLV-1 in the region.Item Acesso aberto (Open Access) Doença neurológica pelo vírus linfotrópico de célula T humana - HTLV: achados clínico-funcionais e virológicos de pacientes do Núcleo de Medicina Tropical(Universidade Federal do Pará, 2008-06-26) NUNES, Ana Flávia Endres; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The Human T cells Lymphotropic Virus (HTLV-1 and HTLV-2) are retrovirus which cause the adult T cell lymphoma/leukemia (ATL) and tropical spastic paraparesis (TSP) or HTLV-associated myelopathy (HAM). Other neurologic presentations are finding include sensory disturbances and hyperactive reflexes. The prevalence of the HTLV-1 infection in Brazil is elevated (0, 8 - 1, 8%), the HTLV-1 and HTLV-2 are endemic in the Amazon region. The health care professional knows a little bit about the HTLV infection and the diseases related to these virus. This is a transversal description, case-control study with 76 patients’ carriers of the HTLV-1 and 2 admitted in the Núcleo de Medicina Tropical at Belém-Pará. The patients were submitted to clinical, functional (OMDS), neurological, laboratorial (TCD4+ lymphocytes count, proviral load quantification) evaluations and nuclear magnetic resonance (NMR). The patients HTLV-1 with abnormal neurologic findings were the cases (n=19) and the patients asymptomatic with normal neurological evaluation were the cases-control (n=40). The female sex were 66.1%, the media age was 50.7 years. The distribution of the average TCD4+ lymphocytes count in the two groups was within the normal reference values; the proviral load was more elevated in the cases group. The search of antibody anti-HTLV-1 in the cerebrospinal fluid was positive in 93, 3% of the cases. The neurological evaluation showed 16 patients (84, 2%) with TSP/HAM (p<0.0001). In fourteen cases (73, 7%) the length of the disease was between 4-9 years. The evaluation of mass muscle strength flexor and extension of the knees showed that 63.2% of the cases had 3 degree and 68.4% had 4 degree, respectively (p<0.0001). The reflexes were normal MMSS, patellar reflex and Achilles tendon reflex were hyperactive in 78.9% and 73.7%, respectively. Babinski bilateral signal was detected in 73.7% of the cases and Hoffman signal in 26.3%. Bilateral clonus was present in 13 patients. Tactual sensibility was abnormal (31.6%), mass muscle strength of legs was stronger than normal (63.2%) and the cases had also urine symptoms (89.5%). In 17 NMR done, 13 (76.47%) had abnormal image in the thoracic bone marrow. There were not associations between proviral load, OMDS, duration of the disease and NMR findings. The most of the cases with neurological disease related to the HTLV-1 were consistent with TSP/HAM; the elevated proviral load seems to be a marker of the development of the disease.Item Acesso aberto (Open Access) Fatores de risco para pneumonia associada a ventilação mecânica: estudo de caso controle(Universidade Federal do Pará, 2005) MARSOLA, Lourival Rodrigues; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care unit (ICU) patients. Understanding the risk factors for VAP can help to assess prognosis and devise and test preventive strategies. To identify the factors associated with development of VAP and its incidence, a restrospective non-matched case-control study was conducted in a 10-bed surgical-medical intensive care unit at a university hospital in Belém city, Brazil, from January 2003 to July 2004. The primary outcome measured was risk factors associated with VAP, which was defined according to The Centers for Diseases Control and Prevention. Demographic and time-dependent variables reflecting ventilation, nutrition, drug exposure, associated morbidities and invasive devices were analyzed. Twenty seven VAP patients and 27 controls were studied. Crude rate of pneumonia and incidence of VAP were, respectively, 10.6% and 12.3 episodes/1000 VM-days. The mean time for the onset of VAP was 14.29 ± 9.16 days. Mean ICU length of stay in patients with and without VAP were 34.2 ± 27.7 and 15.4 ± 13.6 days, respectively (p=0.003). Crude mortality was similar in both groups, 66.7% for cases and 55.6% for controls (OR=1.60; 95% confidence interval [CI] 0.53- 4.82; p=0.576). Univariate analysis demonstrated aerosol therapy (OR=4.75; p=0.01) and neuromuscular blockade (OR=8.61; p=0.003) associated with higher risk of VAP. In summary, neuromuscular blockade and aerosol therapy were associated with an increased risk for the development of ventilator-associated pneumonia and both are potentially modifiable risk factors.Item Acesso aberto (Open Access) Função pulmonar dos pacientes com fibrose cística colonizados por Pseudomonas aeruginosa no Pará(Universidade Federal do Pará, 2008) FALCÃO, Edilene do Socorro Nascimento; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Pseudomonas aeruginosa is an opportunistic pathogen in cystic fibrosis becoming the most frequent cause of lung infection; it is responsible for high mortality rates in patients who present this disease. The goal of this study is to showing spirometric and clinic characteristics of patients who present cystic fibrosis and who are attended at João de Barros Barreto University Hospital (HUJBB), in the State of Pará. A retrospective study was performed with 44 patients´ notes record who were attended at HUJBB during the 1997 to 2007 time frame; these patients fit into inclusion criteria, in which 14 presented P. aeruginosa bacteria colony, nine patients died. The significance rate presented was of 5%. Within the group who was colonized by P. aeruginosa, ten patients were women and the median age for their initial symptoms was of 0.3 ± 0.6 year which was significantly different when compared with patients who didn´t present the bacteria colony (p<0.05). The median age for diagnosis was of 13.1 ± 10.8 in colonized patients and all of them presented respiratory symptoms pertaining to the diagnosis. The median of the predicted percentage values of spirometries for initial and final evaluation of the colonized group was VEF1 (60.0 ± 25.0%) and (47,82 ± 16.1%) and FEF25-75% (42.5 ± 22.9%) and (26.5 ± 17.9%), and in the non-colonized group, the median was VEF1 (79.2 ± 21.0%) and (79,6 ± 18.0%) and FEF25-75% (69.2 ± 26.7%) and (68.9 ± 26.8%), respectively (p<0.005). The median initial Shwachman score in the colonized patients was 42.9 ± 13.5 and in the non-colonized patients it was 68.4 ± 15.1 (p<0.0001), and at the final evaluation the median was 36.6 ± 18.7 and 73.6 ± 12.3 (p<0.0001), respectively, showing important difference between the two groups. Factors related to deaths found in the study were related to P. aeruginosa colonization, inadequate nutritional status and reduced VEF1. In the studied casuistry, a larger damage to respiratory function and older median age for diagnosis were found in the State of Pará when compared to other Brazilian States. These data reinforce the need for action towards precocious diagnosis in the State of Pará so that an efficient and guided therapeutic approach is put into practice guiding to survival increase and quality of life improvement for these individuals, which is the main goal of professionals involved in the assistance practice area.Item Acesso aberto (Open Access) Impacto na incidência de infecção relacionada a cateter vascular central após medidas de educação na unidade de terapia intensiva do Hospital Universitário João de Barros Barreto(Universidade Federal do Pará, 2007) COSTA, Maria Heliana Alencar da; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Central venous catheters are commonly employed in the management of critically ill patients in intensive care units (ICU). Primary bloodstream infections resulting from central venous catheterization (CVC-BSI) are a common cause of excess morbidity, mortality, and medicalcare costs associated in the ICU setting. Many strategies have been used to decrease the risk of CVC-BSI and educational initiatives aimed at improving CVC insertion and care has been demonstrated successful results. The purpose of the study was to determine the impact of an educational program targeted to specific points observed during CVC care practices on decreasing CVC-BSI rates in ICU setting. This was a preintervention and postintervention study. Barros Barreto Hospital is a 260-bed university urban teaching hospital located in Belém city, Pará, Brazil and its ICU is a 10-bed surgical-medical unit. In this ICU, reported CVC-BSI from January 2003 to December 2005 was 11.8 episodes of CVC-BSI per 1000 CVC-days. Between January 2006 and July 2007 this study was carried in this setting. An educational program based on CDC Guidelines for Prevention of Intravascular Catheter- Related Infection directed to nurses and physicians was developed by a multidisciplinary task force to highlight correct practices for CVC care. Posters concerning CVC-BSI pathogenesis and prevention, tips about importance of handwashing were available in the unit. BSI-CVC rates were monitored in the following 12-months period after educational intervention. Twenty episodes of catheter-associated bloodstream infections (11.8 per 1,000 catheter-days) occurred in the 36 months before the introduction of the education program. Following implementation of the intervention, the rate of catheter-associated bloodstream infection decreased to four episodes in 1667 catheter-days (2.4 per 1,000 catheter-days), a decrease of 78%. Behavior changes such as adherence to hand hygiene before manipulating CVC and CVC dressing was dramatically enhanced after the educational intervention (49.5% to 98.5% and 15.4% to 96.9%, respectively) [p < .0001]. A multiple approach included a focused educational strategy targeted to specific problems observed during a careful evaluation of CVC care practices, and policy changes can lead to decrease in the incidence of bloodstream infections associated to CVC. Educational programs directed to healthcare professionals may lead to decrease in cost, morbidity, and mortality associated to healthcare-related infections.Item Acesso aberto (Open Access) Incidência de infecção hospitalar em portadores do HIV: estudo comparativo com pacientes não-HIV(Universidade Federal do Pará, 2008) SARAIVA, Danielle de Lima; NEVES, Dilma Costa de Oliveira; http://lattes.cnpq.br/7230812534416350; MARSOLA, Lourival Rodrigues; http://lattes.cnpq.br/9393259046010911; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539HIV/AIDS patients may be exposed to the same risks for acquisition of nosocomial infections than non-HIV/AIDS patients, however, factors related to the immune suppression of former patients represent important paper in the pathogenesis for the development of nosocomial infections. This study investigated and compared the incidence of infections between HIV infected inpatients and non-infected inpatients in the Infectious Diseases Service of Hospital Universitário João de Barros Barreto. Nosocomial infections were related to invasive procedures (mechanical ventilation, urinary and central vascular catheter). It was an analytical, observational and prospective study, accomplished from February to December, 2007. Daily visits were performed by infection control team and the researcher from the first day in the Hospital to his discharge. There were reported 1.130 exits and 20.276 patients-day; 40 patients developed nosocomial infections and 17 (42,5%) non-HIV patients had 19 (39,6%) infections and 23 (57,5%) HIV patients developed 29 (60,4%) infections; eleven (55%) of these 23 patients had T4 cells counts less than 100cells/mm3 and 15 (65,22%) deaths were related to nosocomial infections. Hospital infections rates in HIV patients were higher than in non-HIV patients (3.09 versus 1.74 infections by 1000 patients-day). Pneumonia was the most frequent infection site an its incidence was 1,6 episodes for 1000 patients-day. Urinary tract infection in non-HIV patients was 12,11 episodes by 1000 urinary catheters-day compared to 4,41 episodes by 1000 urinary catheters-day in HIV positive patients. In conclusion, HIV patients are more susceptible to acquire nosocomial infections probably because of immune suppression related to HIV infection and invasive procedures and preventive and control measures should be directed to this patient population.Item Acesso aberto (Open Access) Infecções da corrente sanguínea por Klebsiella spp. produtora de Betalactamase de espectro expandido em unidades de terapia intensiva neonatal de hospital de ensino no estado do Pará: fatores de risco para letalidade(Universidade Federal do Pará, 2010) ESPÍNOLA, Débora Consuelo Santos Macêdo; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Extended-spectrum beta-lactamase-producing Klebsiella spp. has emerged as a common problem globally. However, data relative to the clinical and epidemiologic characteristics outcome in infected newborns due to for this ESBL-producing gram-negative bacterium of ESBL are still they are limited. A retrospective descriptive study that examined risk factors associated to letality for examined the analytical epidemiology of ESBL-producing Klebsiella spp. bloodstream infections (BSI) in the NICU of a teaching hospital in the state of Pará. A sample of 27 neonates were studied, most of the neonates were premature (77.8%), with mean gestational age 34 weeks, from 27 to 41 weeks. The BSI episodes were more common with infants weighing ≤ 1500 g (40.7%), and 14.8% below 1000g. The mean length of hospital stay was 40.51 days ranging from 5 to 101 days (SD = ± 29.61). The average time of onset of BSI was 12.2 days ranging from 5 to 24 days after the date of admission. Most infections were caused by bacteria of the species Klebsiella pneumoniae (52%). The overall mortality was found 66.7%, as for mortality related to BSI (up to 14 days of bacteremia), the fatality rate was 51.8% (14/27). The central vascular catheter (CVC) was present in about 60% of the RN and all the patients presented under mechanics ventilation at the moment of the episode of the BSI. Regarding the variables studied until the 14th day after the bacteremia episode, only the inappropriate treatment presented significance statistics (P < 0.0017), since all the newborn that had received inappropriate treatment had an unfavorable evolution. The nosocomial BSI due to caused ESBL-producing Klebsiella if have become a common problem in premature neonates RN with high raised mortality in those who that they received inappropriate antimicrobial treatment.Item Acesso aberto (Open Access) Ocorrência do metapneumovírus humano nas infecções respiratórias agudas em estados da região nordeste do Brasil(Universidade Federal do Pará, 2012-05-31) SILVA, Allan Kaio; MELLO, Wyller Alencar de; http://lattes.cnpq.br/1784167608719139; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The respiratory tract illnesses are responsible by a significant rate of laborer absenteeism as well like by elevated indices of morbidity and death, between which the acute respiratory infections (ARI) represent the bigger complaints in the medical-ambulatory service in world. The viruses are considered the main etiologic agents of ARI, acting is like main pathogen or prepossess the secondary bacterial infections, among them finds the Human Metapneumovirus (HMPV). This virus was identified in 2001 presenting as an important causal agent of ARI acquired in the community. It is a cosmopolitan virus that causes similar respiratory illnesses to the Respiratory Syncytial Virus. In Brazil, reports are relatively scarce about the occurrence of the HMPV in the population. The objective of this study is to investigate the occurrence of Human Metapneumovírus (HMPV) in patients with clinical diagnosis of acute respiratory infection (ARI) in the Northeast Region of Brazil. Between the period of June 2009 to September 2010, patients from basic attention unit or hospital units services of five states of Northeast Region, were submitted the collection of specimens for detection from techniques of molecular biology. Statistical analyses were utilized for sample choice (545) and handling of the results obtained. The study showed a positivity of 4,7% for HMPV, without the existence of a specific age group for the occurrence of infection. A predominance of the female sex between the positive cases occurred, however, without statistical meaning. The peak of positivity for the virus (n=16) happen in the third quarter of the year in all States investigated. In this study, was possible describe the occurrence of HMPV in the Northeast Region, affecting patients with acute respiratory infection like accompanied in basic attention as hospitalized, that filled clinical criterion for Severe Acute Respiratory Syndrome.Item Acesso aberto (Open Access) Perfil clínico-epidemiológico da Criptococose em pacientes HIV positivos atendidos em uma unidade de referência em Belém do Pará(Universidade Federal do Pará, 2012) ALMEIDA, Jairo Cunha de; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539Cryptococcosis among residents of the state of Pará presents as severe endemic disease, occurring in different mesoregions state end the metropolitan area of Belém occurscausing cryptococcal meningitis, with a mortality rate above 40%. To try to elucidate the clinical end epidemiological study of cryptococcosis in HIV-positive patients, we conducted a retrospective study, analytical case series with chart review of the last 05 year (2006 – 2010), with HIV-positive patients in a referral hospital in Belém- Pará. The disease is still one of the most frequent causes of death in HIV-positive patients in our region and due to C. neoformans the largest number of cases, accouting for 57 (60,6%) ot a total of 94 cases. Regarding the clinical form of cryptococcosis, developed by the HIV-positive patients, we observed that the nervous system is present in 46,8% of patients and the spred of disease in 27,7% of cases. The relationship between the cause of deathand the presence of Cryptococcus occurs by a complex set of factors that must be clarified and correlated with patient death end most importantly, establisn qua strong in this relationship once detected.Item Acesso aberto (Open Access) Perfil de abdome agudo cirúrgico em pacientes com HIV/AIDS em um hospital de referência no estado do Pará(Universidade Federal do Pará, 2012-10-26) PASCOAL, Giselly de Fátima Mendes; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The Acquired Immunodeficiency Syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). HIV attacks human cells responsible for defending the body from diseases, and the CD4 + T cells most affected. Abdominal pain in immunocompromised patients with difficult management evolves diagnosis is mandatory for the surgeon to be familiar with the various differential diagnoses and secondary complications of AIDS. This study aimed to describe the clinical and epidemiological aspects of AIDS patients who developed acute abdomen and received surgical treatment from January 2001 to January 2011 at the University Hospital João de Barros Barreto. It was an observational, retrospective, case-control, where the case group consisted of patients with HIV / AIDS who developed acute abdomen and the control group of patients who have progressed to acute abdomen, but no immunosuppressive condition associated. Patients were predominantly male ratio 4.5 men for every woman in the group with AIDS, but with similar proportion in controls. Most patients (87%) of the control group had a laboratory abnormality, unlike the group with HIV / AIDS, where 38.5% of patients had normal results. Anemia was present in 75% of patients with HIV / AIDS and leukocytosis in 80% of the control group. The most frequent cause of acute abdomen in the population with HIV / AIDS was intestinal perforation (82.1%), while the control group was intestinal obstruction (39.1%). Only the clinical picture of abdominal defense and decreased bowel sounds showed statistically significant (p <0.01). Radiological changes occurred in 87.2% of patients with HIV / AIDS showed distension and 65.2% of control patients showed air-fluid levels. The main surgery performed in the group HIV / AIDS was a bowel resection with primary reconstruction of traffic (65.5%). Surgical complications were more frequent in the group with HIV / AIDS (87.2% with wound infection) and the predominant cause of death in both groups was sepsis from abdominal focus (81% in cases and 87.5% controls ), including in patients ostomates. The probability of death in patients with HIV / AIDS was higher by about 2-fold compared to controls. The length of hospital stay and postoperative time to death was lower in AIDS patients compared to controls. Being fundamental to the study to improve the management and survival of patients with HIV / AIDS.Item Acesso aberto (Open Access) Perfil epidemiológico dos usuários do Centro de Testagem e Aconselhamento no município de Belém, Pará com sorologia positiva para HIV(Universidade Federal do Pará, 2011) NASCIMENTO, Rodolfo Gomes do; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The pandemic of HIV and aids represent a global phenomenon, dynamic and unstable. One of the main achievements in controlling the epidemic was the creation and expansion of Counseling and Testing Centers (CTC) in several regions of the country. These centres represent the input port of the individual is infected in the health system and provide specialist services in diagnosis, guidance on HIV transmission and prevention. The overall objective of the survey was to describe the epidemiological profile, as well as the risk of users behaviors that were serviced in CTA-Belém, between January 2008 and December 2010 with positive serology for HIV. For this purpose was held an active pursuit and confidentially in medical records archived respecting the anonymity of users and all ethical precepts that involve the manipulation of information. Were analyzed the data of 547 users with HIV of CTA-Belém during the study period (prevalence 6,09%). The results of the survey clarified the profile of users with AIDS, who were in the majority of the general population and were not part of any group more vulnerable to viral infection and sought service have been exposed to some risk and forwarded by other services/health professionals. Regarding the risky behavior, 98.5% reported sexual exposure and results warn not to use condoms in sex with both fixed and with possible partners, being the main reasons for this behavior trust in partnerthe non-availability of condoms during sexual intercourse and others. It is concluded that although there are similarities in relation to other studies developed in the country and with the current trend of HIV/AIDS epidemic, there are peculiarities in our region who deserve better targeting of preventive intervention on the part of public health such as providing free condoms and guidance campaigns for use in stable relationships, including in the population with higher education and professional situation stable.