Dissertações em Doenças Tropicais (Mestrado) - PPGDT/NMT

URI Permanente para esta coleçãohttps://repositorio.ufpa.br/handle/2011/3559

O Mestrado Acadêmico em Doenças Tropicais iniciou em 2004 e pertence ao Programa de Pós-Graduação em Doenças Tropicais do Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará (UFPA).

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Sífilis congênita: incidência em recém-nascidos
(Universidade Federal do Pará, 1988-03-13) ARAÚJO, Eliete da Cunha; RAMOS, Francisco Lúzio de Paula; http://lattes.cnpq.br/9673476115088883; MOURA, Eloísa Flora de Arruda
Since the detection of a significant increase in the number of cases by the mid 1980s that congenital syphilis is of growing epidemiological importance worldwide. Although measures of both prevention and control are available, congenital syphilis still continues to be a major public health problem. The main objective of this study was to determine the incidence of congenital syphilis among neonates born at the maternity of a large public hospital in Belem, Brazil- Fundação Santa Casa de Misericórdia do Pará - from May to September 1996. Interviews were made with 361 mothers and physical examination was routinely performed in their newborns. Serum samples from both mothers and neonates were tested by using three methods: one non treponema I antigen test (VDRL) and two treponemal antibody tests (FTA-Abs and ELISA IgM). The diagnosis of congenital syphilis was made in 9.1% of the neonates. The main findings of the present study could be summarized as follows: a)among the infected neonates 39,4% presented with clinical symptoms compatible with syphilis; b) 36.4% of Treponema pallidum infected mothers did not undergo prenatal medical follow up; c) 12.1% of these mothers reported being drug users and, for most of them, there were reports of previous stillbirth or spontaneous abortion; d) rates of bisexuality among fathers were higher in the group of syphilitic neonates if compared to those without the disease. Further and broader investigations should be carried out, in order to better understand the epidemiological features of syphilis in the Amazon region. As a consequence, effective prevention and control measures (and possibly erradication) would be implemented.
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Plasmodium vivax: avaliação da resposta de anticorpos IgG em crianças expostas à malária
(Universidade Federal do Pará, 1997) PINTO, Ana Yecê das Neves; SOUZA, José Maria de; http://lattes.cnpq.br/6459204248879587
An improved knowledge of human antiplasmodial defense mechanisms is partof current strategies against malaria. One of the effective defense mechanisms is the relationship between cytophilic antibodies and monocytes in order to increase the phagocytosis of infected cells. Comparative studies on immunoglobulin patterns have been carried out in immune and semi-immune populations.The present work is a further contribution to the subject and has the objectiveto study the response of IgG antibodies anti-P. vivax (IgG anti-PV), and their cytophilic (lgG1 e IgG3) and non-cytophilic (lgG2) subclasses in 34 outpatient children with malaria by P.vivax. Diagnosis of malaria was established by thick blood films. IgG levels, with their respective subclasses, were identified by indirect fluorescent antibody technique in the children enrolled in the study, during the acute phase and up to ultimate established cure. Patients were divided in 2 groups according to a previous malaria history (primarily infected, n= 28) and patients with history of previous malaria attack (n=6). The geometric means of antibodies IgG anti-PV levels were demonstrated during different periods of sera assessment. The IgG anti-PV levels obtained in the days zero and seven were compared (Student's t test). IgG anti-PV levels were correlated with assexual parasitaemia and the period of sickness, (Spearman's correlation test). A description of clinical features ocurred in both subgroups. Regarding immunoglobulin subclasses, the proportion of positive and negative sera was compared (Exact Fisher's test), in the 2 subgroups with the following results: a significative statistical difference (p=0,027) ocurred in the IgG levels between day zero (D0) and day seven (07), with no correlation with previous malaria history. A descending curve was observed in IgG levels, with mean and variable values respectively of 95,2% (40-2560) on the 60th day, 62,5% (40-320) on the 120th day, and 28% (40-160) on the 180th day after treatment. There was a positive association between the time of sickness and total antibody IgG anti-PV levels in primarily infected patients. The rank order for geometric means of IgG subclasses encountered was: IgG1(598,41) > IgG3 (4,06) > IgG2 (1,42). There were no significative differences in IgG anti-PV subclasses among primarily infected patients and those without previous malaria history. The following conclusions were made: 1) An increase of IgG anti-PV levels was seen between D0 and 07; 2) During the follow up the IgG anti-PV levels showing a gradual tendency to decline: 4,76% of the patients had negative results until 060, 37,5% until 0120, and 71,42% had negative results until 180 days after treatment; 3) There was no association between assexual parasitemia in day zero and antibody levels IgG anti-PV in the first and in the eighth day of treatment; 4) In children with previous malaria attacks the time of sickness evaluation is proporcional to antibody IgG anti-PV levels, and the reverse occurs, in the primarily infected children; 5) There was no correlation between total antibodies anti-PV levels and evidence of splenomegaly;6) Cytophilic antibodies (lgG1 > IgG3) predominated over noncytophilic antibodies (lgG2) in the study sample.
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Nova proposta de tratamento para malária por Plasmodium vivax
(Universidade Federal do Pará, 1997) ABDON, Nagib Ponteira; SOUZA, José Maria de; http://lattes.cnpq.br/6459204248879587
Relapses that may occur with long standard treatment of vivax malaria might be in part due to an incomplete patient compliance. Therefore, the employment of short treatment schemes leading to a better patient compliance, and the same time having efficacy, tolerance and minimal or none adverse reactions is a matter of serious concern. In order to attain this objective, between july, 1994 to june, 1995, an open, comparative, prospective and randomized study was made in the attendance outpatient unit of Malaria Program of Evandro Chagas Institute, in Belem, Para State. Just patients aged up 12 years, from both sexes, which stayed in Belem during all the period control were enrolled. All patients were from Amazon Region, being the great majority of them from Para (85.8%). Autochthonous cases from the metropolitan area of Belem represented 39.2% of the sample. In this study, 120 patients were divided into 3 groups of 40 patients according to the following therapeutic schemes : Scheme I - chloroquine phosphate tablets with 150 mg of base substance in a total dose of 25 mg / kg / day for 3 days, that is, 10 mg / kg / day in the first day, 7.5 mg / kg / day in the second and third day, plus primaquine phosphate tablets with 15 mg of base substance in a dose of 0.25 mg / kg / day for 14 days. Scheme II - chloroquine phosphate tablets with 150 mg of base substance, 10 mg / kg in a single dose plus primaquine phosphate tablets with 15 mg of base substance in a dose of 0.50 mg / kg / day for 7 days. Scheme III - chloroquine phosphate tablets with 150 mg of base substance, 10 mg / kg in a single dose plus primaquine phosphate tablets with 15 mg of base substance in a dose of 0.50 mg / kg/ day for 5 days. Drugs were administered orally, under medical supervision to all outpatients.Clinical diagnosis was based upon history, epidemiology and physical examination of patients, while the laboratory finding of the hematozoa plasmodium in a thick blood film established the definitive malaria diagnosis. All 3 therapeutic schemes were effective, with a cure rate up to 80%. In the II therapeutic scheme, relapses were not observed. The disappearance of malarial symptoms occurred until 96 hours of treatment, while the assexual parasitaemie clearance occurred until 72 hours, considering all 3 therapeutic schemes. When present, adverse reactions were observed in a short period of time. Even in the cases of primaquine in double dose, there were no toxicity.
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Avaliação dos níveis séricos de cortisol e de hidroepiandrosterona em pacientes com malária por Plasmodium falciparum não-complicada
(Universidade Federal do Pará, 1997) LIBONATI, Rosana Maria Feio; MEDONÇA, Berenice Bilharinho de; http://lattes.cnpq.br/8356126875514076; SOUZA, José Maria de; http://lattes.cnpq.br/6459204248879587
The main purpuse of our study was to determine the levels of both cortisol and dehydroepiandrosterone (DHEA) in serum samples from patients suffering from Plamodium falciparum malaria. Since cortisol is potentially immunesupressive, and, conversely, DHEA is inherently immunopotentiating, we sought to assess the possible association between serum levels of these steroids and patient's clinical conditions. We enrolled to participate in this study 24 patients aged 12 to 47 years, of whom 18 were male and 6 female, suffering from uncomplicated P. falciparum malaria. All patients lived in areas of the Amazon were malaria is endemic. Half of them were found to be primo-infected, whereas the others were being reinfected by P. falciparum when recruited for this investigation. Blood samples were obtained from each patients as follows: at 20-minutes intervals during the pre-treatment phase (i. e. on day 0, D0), 24 hours after starting drug therapy (D1) and at the 8th day of follow-up (D7), when patients were asymptomatic. All patients at D7 presented with negative parasitemia. Serum levels of cortisol and DHEA were measured on D0, Dl and D7 and D0 and D7, respectively. In addition, the determination of IgG antibodies to both P. falciparum and P. vivax was performed only on D0. Our results indicated that levels of cortisol in serum samples collected on D0 were significantly higher than those of D1 and D7. High levels of cortisol on D0/D1 and significant parasitemia on D1 led us to postulated that this corticosteroid may interfere with the initial response of P. falciparum-infected patients to treatment. The cortisol levels did not correlate with the intensity of fever, duration of illness and the levels of IgG antibories to P. falciparum. These findings suggest that temperature does not interfere with the cortisol levels, and these, on the other land, do not significantly ralate to either antibody response or the duration of illness. The DHEA levels were found to be significantly more elevated on D0 than on D7, even though patients were already symptomatic for more than one day when first serum samples was taken. The progressive decrease in the DHEA levels is therefore likely to be mediated by a continuous stimulus from the hypothalamic-pituitary-adrenal (HPA) axis. Similarly to cortisol, the DHEA levels on D0 correlated significantly with D1 parasitemia. Thus, it is suggested that in cortisol levels paralels that for DHEA. Of interest, the DHEA serum levels seem to inversely correlate with the duration of illness, in spite of high levels of this steroid detected at the pre-treatment phase. A not significant correlation has been noted if cortisol and DHEA serum levels are compared with temperature. This clinical parameter, however, was found to directly interfere with the correlation that exist between both cortisol and DHEA levels. It is known that fever reflects the occasion when erythrocytes disrupt from the schizogony, with release of cytokines , which act as an acute stimulating factor for the HPA axis. It would therefore be proposed that liberation of both hormones has a commom mechanism. The lack of significant interrelationships between DHEA levels and IgG antibodies indicates that this hormone does not seem to interfere with the production of antibodies by P. falciparum infected patients.
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Infecção congênita pelo citomegalovírus: estudo realizado na Fundação Santa Casa de Misericórdia do Pará
(Universidade Federal do Pará, 1997-11-14) WEIRICH, Judith; SANTOS, Elisabeth Conceição de Oliveira; http://lattes.cnpq.br/2720400830437723; REZENDE, Manoel Barbosa de
Cytomegalovirus (CMV) is a DNA virus classified in the Hespesviridae family and Betaherpesvirinae subfamily. It has a worlwide distribution and may cause congenital and perinatal infection, as well acquired infection in children and adults. CMV has been associated with high rates of morbidity and mortality among immune deficient or immune suppressed patients. This investigation was carried out from November 1994 to May 1995 in the maternity of a local public hospital - ''Fundação Santa Casa de Misericórdia do Pará"- and the main objective was to assess the incidence of congenital CMV infection among neonates in Belem, Brazil. We enrolled 663 newborns and their mothers to participate in our study. The weights of neonates ranged from 900 to 5450 g (mean of 3046 g) and low birth weights were recorded in 11,4% of them. For diagnostic purposes, clinical specimens (spittle) were inoculated on to culture cell lines prepared from human foreskin fibroblasts, yielding virus isolation in 21 (3,2%) of patients. Cord blood samples have been tested for the presence of CMV -specific IgM by using ELISA, with positive results in 14 (2,1%) patients. Differences of sensitivities between these methods were analysed by using the McNemar' test (Comparing proportions in paired groups) and the X2 test of homogeneity, as appropriate. Virus isolation proved to be more sensitive than serology, with p values of 0,0233 and less than 0,01 for the former and latter statistical tests, respectively. Six (28,5%) among the 21 infected neonates were shown to be congenitally infected, presenting with typical signs and symptoms suchs as: microcephaly (4), prematurity (3), hepatosplenomegaly (2), low birth weight (2) and jaundice (1). Sera from mothers were also tested for the presence of CMV-antibody by ELISA The detection of specific IgG was recorded in 90,2% of them, whereas IgM seropositivity was detected in 4 (19,0%) of those 21 mothers of infected children. Data gathered during routine interviews with mothers revealed low social economical leve1 and indicated that 26,4% of them had no prenatal medical assistance. Their ages ranged fiom 12 to 42 years (mean age of 22,2) and all mothers of CMV-infected children were aged less than 25 years.
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Estudo de dose adequada da droga RO42-1611 (Arteflene) no tratamento da malária por Plasmodium falciparum
(Universidade Federal do Pará, 1997-12-04) SILVA, Rita do Socorro Uchôa; SOUZA, José Maria de; http://lattes.cnpq.br/6459204248879587
The increasing resistance of P. falciparum strains to the current antimalarial drugs makes the searching of new drugs an urgent task. The compound Ro 42-1611 is an antimalarial drug that arises from a chinese herb Artabotrys uncinatus. Since its synthesis, Ro 42-1611 was used in three different clinical trials to treat falciparum malaria in Africa, but how it works in the South America malaria patients is obscure. Althouh being an effective antimalarial, a proper therapeutic dose to achieve the supressive cure of falciparum malaria has not been established yet. The purpose of this study is to evaluate the tolerance, the toxicity and the efficacy of 3 different dose schedules of Ro 42-1611 in the treatment of falciparum malaria. It was an open, prospective and randomized trial carried out in Maraba/Para State in male patients with maximum 80 kg bodyweight. All patients had fever or another constitutional malaria symptom and had a positive thick blood smear to P. falciparum (≥ 200 and ≤ 50,000 parasites/mm³). In a hospital, they were assigned into 3 groups according to drug administration time: Group I - 1,500 mg twice a day for 24 hours; Group II - 1,500 mg twice a day for 48 hours and Group III - 1,500 mg twice a day for 72 hours. Before treatment, the following procedures were recorded from all patients: personal data, height and weight, malarial signs and symptoms, history of simultaneous drug intake, body temperature, vital functions (respiratory rate, blood pressure), parasite count, haematology and blood chemistry assesments and electrocardiogram. Ouring the treatment, all those parameters were followed, including adverse reactions to Ro 42-1611. Statistical analysis (Friedman variance test) were performed on laboratory tests results. Sixteen patients were enrolled in the study: 5 patients in Group I; 6 in Group II and 5 patients in Group III. Among patients, age ranged from 17 to 41 years old (mean 266). body weight from 44 to 72 kg (mean 54.9). The assexual parasite count ranged from 200 to 40,000 parasites/mm³ . Regarding those variables, there were homogeneity in 3 groups. According to the protocol, clinical and laboratory data were evaluated, with the following results: the minimum and the maximum fever clearence time was 9 to 48 hours respectively. The mean assexual parasite clearence was 53.6 hours, without any statistical significance among the groups (p=0.7264). There were statistical significative difference (p=0.0046) in the hematocrit values before treatment (00), and the third (02) and the eighth (07) day of the follow-up. It was observed an increase in the leukocyte count between 02 and 07, also of statistical significance (p=0.0171), as well in the platelets of 00 and 07/02 and 07 (p=0.0001). Between DO and 07, statistical significative reduction ocurred in the values of total bilirrubin (p=0.0024), alkaline phosphatase (p=0.0195) and urea (p=0.0168). There were no statistical significative difference nor in the evalution of electrocardiogram results neither in the blood pressure. Short adverse reactions were mild to moderate. In the end of the treatment, 87,5% of patients were completely free of parasites, but just 2 achieved a radical cure (12,5%), both included in Group III. Any of the schedule treatment showed efficacy. Perhaps such efficacy might be attained using Ro 42-1611 in a superior dose, for a longer period of time or in association with other antimalarial in further studies.
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Papilomavírus humano associado a lesões de cérvix uterina
(Universidade Federal do Pará, 1997-12-09) CAVALCANTE, Vânia Lúcia Noronha; LINHARES, Alexandre da Costa; VILLA, Luisa Lina; MELLO, Wyller Alencar de; http://lattes.cnpq.br/1784167608719139; BRITO, Arival Cardoso de; http://lattes.cnpq.br/0563291980190339
With the aim of improving our knowledge on the role of human papillomavirus (HPV) in the aetiopathogenesis of cervical cancer in Northern Brazil, it was studied the prevalence of HPV among 228 women with lesions of uterine cervix attending Ofir Loiola Institute, in Belem, Para, from March, 1992 to May, 1996. Histopathological examination was performed with all cervical biopsy sample obtained from these patients. In addition, specimens were analysed through different laboratory techniques to detect HPV DNA. The patients were assigned to three groups, according to the diagnosis made by histopathology, as follows: A, including women suffering from invasive epidermoid carcinoma or adenocarcinoma; B, 54 patients having either cervical intraepithelial neoplasia grade ll or lll (CIN ll or CIN lll); and C, involving 19 women with chronic cervicitis. Over all, the prevalence rates of HPV in groups A, B and C, as determine by PCR and/or dot-blot were 70.3%, 63.0% and respectively. HPV 16 predominated over other genotypes, accouting for 60.4% and 54.5% of types identified in groups A and B, respectively. Altogether HPV types 16, 18 and 33 were detected in 71.4% of positive HPV patients belonging to group C. The in situ hybridization (ISH) technique, including polyvalent HPV types 6/11, 16/18 and 31/33/35 specific probes, was used to examine 155 of the 228 samples tested by PCR, yielding HPV-positive results in 17.4% of them. Using this latter procedure, that is, PCR, the positivity rate was of much higher, 65.2%, than that of ISH. With regards to the potential HPV concurrent risck factors for the development of uterine cervical malignancies , it is noteworthy that 40% of women assigned to groups A and B reported having had first sexual intercourse when aged 15 years or less. During the interview, howewer, the number of lifetime sexual partners reported by most of them ranged from 1 to 3, suggesting lack of promiscuity among the sampled patients. In general, our data accord with those from other studies carried out throughout the world, indicating that HPV plays a significant role in the aetiology of both cervical inttraepithelial neoplasia and carcinoma of the uterine cervix. Further and broader investigations should however be carried out, in order to better understand the epidemiological features of HPV infection in the Amazon Region.
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Malária por Plasmodium vivax na infância e na adolescência - aspectos epidemiológicos, clínicos e laboratoriais
(Universidade Federal do Pará, 1997-12-16) VENTURA, Ana Maria Revorêdo da Silva; SOUZA, José Maria de
Worldwide malaria affects both children and adults, and it is known that clinical picture varies considerably in severity depending upon the immune status (particularly among children) and the infecting Plasmodium species. In the present investigation it was attempted to assess epidemiological, clinical, and laboratorial parameters of Plamodium vivax malaria during childhood and adolescence. In this study, between January, 1995 and November, 1996, it was enrolled 100 patients (both sexes), aged 0 to 14 years, who sought for medical treatment in the attendance outpacient unit of the Malaria Program of Evandro Chagas Institute, in Belem, Para State. All patients had a P. vivax-positive thick blood film. Regarding age, malaria were more frequently seen in adolescents, accounting for 37.0% of them. The fact that 34.0% of patients were identified as autochthonous cases of malaria indicates that disease is progressing in urban settings of the Amazon Region. Fever was found to be the earliest more frequent symptom in the course of illness, being recorded in 88.0% of children. At the first patients's attendance (Day 0, DO), fever, chill and headache (malarial triad) were noted in 97.0%, 91.0% and 85.0% of cases, respectively; while, hepatomegaly and splenomegaly were recorded in 29.0% and 46.0% of them, respectively. Pallor was found to be significantly associated with anaemia (p< 0.05), in that 89.2% of pale children had low haemoglobin values. It is likely that anaemia has developed mainly as a result of haemolysis; although the delay in making the malaria diagnosis (an average of 12.5 days after onset of clinical symptoms) and concurrent hookworm intestinal parasitism may also have played a role in its pathogenesis. An additional finding from this study was that malnutrition seemed not to be associated with anaemia. Once treatment had iniciated, the malarial triad began to subside and asexual parasitaemia levels tended to decrease. The former parameter, however, was shown to be more evident than the latter one. Other clinical symptoms such as pallor, weakness, arthralgia, headache and dark urine lasted longer than did malarial triad, usually persisting for up to 14 days. During or soon after finishing treatment, complications were noted in 5.0% of children including: pneumonia, bronchopneumonia, impetigo, gastroenteritis and a rash of unknown etiology. A finding of practical interest is that ultrasonography was shown to be more sensitive than abdominal palpation in the detection of hepatoesplenomegaly. The start of drug therapy was followed by a progressive increase in haemoglobin levels, reticulocyte count and mean corpuscular haemoglobin concentration (MCHC) from DO (first day of treatment) to 07 (eighth day of treatment). Conversely, the mean corpuscular haemoglobin concentration values decreased significantly from D0 to 07, probably because iron was present in bone marrow in decreased amounts.
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Descrição de outras doenças sexualmente transmissíveis em pessoas infectadas pelo vírus da imunodeficiência humana do tipo 1
(Universidade Federal do Pará, 1998) MESQUITA, Francisco Carlos Lopes de; ISHAK, Ricardo; http://lattes.cnpq.br/5621101706909450
Ninety patients seroreactive to HIV-1 were studied in order to describe the clinical manifestations of other sexually transmitted diseases as well as the demographic and behaviour factors associated to the HIV-1 infected and AIDS patients. The majority (83.3%) were males with a mean age of 31.4 years of age (range between 18 and 60 years) and a monthly family income for 79.5% of less than five mininum wages. At least one type of ilicit drug was used by 51.1% and 20.7% were intravenous drug users. Among them, 94.4% referred to a previous episode of a sexually transmitted disease. The subjects revealed that 41.6% were bisexuals, 38.2% heterosexuals and 20.2% were homosexuals. Approximately 51.1% of the bisexual subjects were intravenous drugs users and all referred to have had ano-rectal intercourse and were all positive for the presence of antibodies to Chlamydia. The mean age of the first sexual relation with penetration and the first episode of sexually transmitted disease were at 14.7% and 20.6% years of age, respectively. The vast majority (95.5%) of the subjects experienced multiple sexual partners before the knowledge of their HIV-l positive serology status. Among the 73.3% that referred a previous episode of sexually transmitted diseases, 82.2% also referred urethral discharge, syphilis and herpes simplex. At physical examination, 36.6% (33/90) presented urethral, anal and vaginal discharge and genital lesions such as discharges (51.1%), vesicles (18.1%), warts (18.1%), lymphadenopathy (18.1%), ulcers (12.1%) and papules (6%). Reaction to the VDRL and antibodies to Chlamydia were present in 13.7% and 96.4%, respectively. The vast majority referred ano-retal intercourse and previous episodes of sexually transmitted diseases.
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Infecção pelo HCV em uma unidade de diálise em Belém-Pará: desempenho de testes imunoenzimáticos em relação à técnica de biologia molecular
(Universidade Federal do Pará, 1998) CARTÁGENES, Paulo Roberto Brito; ISHAK, Ricardo; http://lattes.cnpq.br/5621101706909450; ARAÚJO, Ronaldo
The main objective of this study was to make a comparative evaluation of four 3rd generation enzyme-linked immunosorbent assay (ELISA) kits (Ortho, Ubi, BioChem and Abbott), for the detection of HCV antibody and Roche polymerase chain reaction (PCR) kit. Serum samples were obtained from 19 members of the staff (grupo A) and 66 patients (grupo B), who were undergoing either hemodialysis (n=54) or peritoneal dialisys (n=12) in a dialysis unit in Belém, Pará. Altogether, the four ELISA kits agreed in 89,5% and 81,8% when results of groups A and B were compared, respectively. Overall rates of HCV antibody ranged from 34,1% to 37,5%. These rates among the patients ranged from 42,4% to 47%. While HCV-RNA was detected by PCR in 25 (37,9%) of the patients (of whom 24 in the hemodialysis subgroup), no PCR-positive results could be yielded among the staff members. When compared with the PCR, the four ELISA kits showed sensitivity, specificity and predictive values with differences that were not statistically significant. Of interest, serum samples from 12,5% to 20% of HCV-infected patients – as diagnosed by PCR – yielded negative results when tested by the four ELISA kits. An additional finding was that increase in the aminotransferasis levels does not seem occur as a result of HCV infection, it is notable that the risk of HCV infection increases following hemodialysis procedure during six months or more, among those patients who are older than fifty years. In addition, among patients subjected to hemodialysis, a high rate (13%) of HBV carriers was found.
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Adenopatia cervical tuberculosa em crianças: aspectos epidemiológicos, clínicos e laboratoriais
(Universidade Federal do Pará, 1998-03-22) FIGUEIREDO, Erika Maria Riebisch de; AYRES, Manuel; http://lattes.cnpq.br/1649810738276000
Tuberculosis remains a serious public health problem, and in Brazil, the principal agent for this disease is the Mycobacterium tuberculosis. In infancy, among extrapulmonary forms, one of the most frequent and less studied is that involves the superficial lymph nodes. In order to determine the incidence and to know the epidemiologic, clinical and laboratory features of lymph nodes tuberculosis, between January, 1995 to December, 1996, in the attendance outpatient unit of Hospital Ofir Loiola, it was enrolled 73 children from both sexes, aged 0 to 14 years, with enlargement of the cervical lymph nodes. The samplewas divided in 2 groups: in the first group, it was located 61 patients with adenopathy from etiologies other than tuberculosis, while 12 patients with cervical tuberculosis adenopathy took part in the second group. In this study, concerning tuberculosis adenopathy, for one hundred thousand in habitants,in the metropolitan area of Belem, it was observed an year rate incidence of 1.03 . Regarding adenopathy from other etiologies, the incidence was 4.27 and 6.15, in 1995 and 1996, respectively. The great majority of childhood adenopathy (64.4%) was nonspecific, although, when it was considered just those of known etiology, the relative risk of being tuberculosis was1.17. In both groups, the greatest incidence of cervical adenopathy was observed among preschool male children. However, when it was made a comparative analysis between the groups, there were no statistic significative differences toward age, sex, nutritional status, clinical symptom onset, type and characteristics of the affected lymph nodes. Disturbance in the nutritional status may have played a role to enhance the morbidity in 41.7% of the tuberculosis cases. The evidence of a cervical mass was the main symptom in the 2 studied groups, though, 75.1% of children with lymph node tuberculosis also had a general involvement of other lymph nodes chains. All children with cervical lymph node enlargement, which proved later to be of tuberculosis etiology had at least one month of illness course, and in such circumstances, a cold abscess represented the main symptom in 25% of them. It was possible to identify the sourceof infection in 1/3 of patients. Among children with tuberculosis, 63.6% had a positive tuberculin skin test, with a reaction 210 mm. Considering all bacteriologic procedures performed, culture turned to be the main element to tuberculosis diagnosis, with 100% positive results; while baciloscopy had little importance. Histopatologic exams showed granulomatosis lesions suggesting tuberculosis, in 88.9% of the sample. Concomitant pulmonary involvement was observed in 27.3% of children with lymph node tuberculosis. A good therapeutic response was seen using the pattern scheme adopted by Health Ministery, with out adverse reactions.
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Eficácia clínica da vacina tetravalente (RRV-TV) contra rotavírus em Belém, Pará
(Universidade Federal do Pará, 1999-06-17) OLIVEIRA, Consuelo Silva de; LINHARES, Alexandre da Costa; http://lattes.cnpq.br/3316632173870389; BATISTA, Nildo Alves; http://lattes.cnpq.br/9347541615414055
There is currently growing evidence that infantile rotavirus gastroenteritis will be controlled only through the development of an effective vaccine targeted for use in early childhood. This study was conducted with the aim of assessing the protective efficacy of the lower-titer rhesus-human reassortant rotavirus tetravalent vaccine (RRV-TV, 4 x 104 ) against the major clinical indicators of severity cases of rotavirus diarrhoea; for this, were re-examined 91 rotavirus-associated diarrhoeal episodes that were recorded during an efficacy trial carried out previously in Belem, Para, Brazil. The source of information for study were the data recorded in field forms used to perform the routine surveillance for diarrhoeal episodes, as well as those forms in which daily clinical records were made while diarrhoea persisted. Relative efficacy was specifically against the following clinical parameters: a) duration of diarrhoea; b) maximum number of liquid /semiliquid stools per day; c) duration of vomiting episodes/24h; d) maximum number of vomiting episodes / 24h; e) fever (rectal temperature); f) dehydration; and g) need for treatment. The overall clinical severity of rotavirus gastroenteritis has been graded using a numerical twenty-point scoring system (i.e., maximum of 20 points) which allowed the classification of diarrhoeal cases in mild (0-6 scoring interval), moderate/severe (9- 14) and very severe (>14). A significant (p<0.05) protection conferred by RRV-TV was observed in five of the seven clinical parameters under analysis, as follows: a) duration of diarrhoea (52%, pure rotavirus diarrhoea; b) maximum number of liquid/semi-liquid stools per day (42% and 53% against all- and- pure diarrhoeal episodes, respectively); c) maximum number of vomiting (56% and 62% for all-andpure diarrhoeal cases, respectively); d) dehydration (42% and 48% against all-andpure cases of diarrhoea, respectively); and e) the need for rehidration (42% and 46% for all-and-pure cases, respectively). High protective efficacy levels were achieved against rotavirus type G2-related diarrhoea during the second year of follow-up, if considered both the number-and-the maximum number vomiting episodes: 90% and 100%, respectively. Also for G2 type, the overall cumulative protection of 100% against those episodes scored greater than 14. Similar rates of protection against mixed - (35%) and - pure (37%) rotavirus gastroenteritis were yielded after two years of follow-up. While no efficacy was achieved against mild (0- 8 scored) diarrhoea, RRV-TV was 75% (p = 0.02) efficacious against the very severe cases of rotavirus gastroenteritis; there was a tendency for protection against alland- pure diarrhoeal episodes with clinical scores ranging from 9 to 14: 44% (p = 0.06) and 45% (p = 0.08), respectively. The results of study support the view that RRV-TV appears to selectively protect against the most severe rotavirus disease.
Acesso aberto (Open Access)
Carcinoma hepatocelular e as infecções pelos vírus das hepatites B e C na Amazônia Oriental: estudo clínico-sorológico e de biologia molecular
(Universidade Federal do Pará, 1999-08-06) MIRANDA, Esther Castello Branco Mello; BENSABATH, Gilberta; http://lattes.cnpq.br/0818254462635138; CRUZ, Ermelinda do Rosário Moutinho da; http://lattes.cnpq.br/6061358867607317
In order to contribute to a better understanding of the possible role of hepatitis B and C in the etiopathogenis of hepatocellular carcínoma (HCC) in the East Amazon, there were studied 36 patients admited in three public hospitais in Belém/PA, from January,1992 to March,1999. The criteria to be enrolled in the study were the association of clinical and image procedures, alpha-fetoprotein (AFP) above 400nglml in the serum and/or histopathology examination compatible to hepatocellular carcinoma. Clinical aspects, biochemical and histological examination, serum levei of AFP and serological B and C hepatitis markers were evaluated. Polymerase chain reaction assays were used to detect serum virus nucleic acids, HBV DNA and HCV RNA. There was a predominance for male sex in the prevalence of HCC (p<0.01 ) in a ratio of 6.2 to 1 (male/female). Regarding age, the Mean and the Median were 50.8 and 53.0 years respectively, and the Amptitude was 6 to 81 years. Most patients (52.7%) carne from rural regions. Farmer was the main occupation referred (p<0.01). Alcohol abuse was observed in 33.3%. Abdominal pain and hepatomegaly were the most recorded sign and symptoms in 94.4% of patients. Cirrhosis was detected in 83.3%. The majority of it belonged to class B or class C of Child-Pugh classification. During diagnosis, 50% of patients had some kind of complication, specially portal-systemic encephalopathy and gastro-intestinal hemorrhage (upper digestive bleeding) related to the originai chronic liver disease. In 88,9% of the sample, one or more hepatitis B markers were positive. Also, 8,3% those patients had anti-HCV simultaneously positive. There were no serological markers in 11,1% of the casuistic. 58.3% had HBsAg serological positive test. Coinfection was detected in 2.8%. Antibodies to HBc were positive in 86%, being present in 25% of cases in association with the anti-HBs. Among patients positive to HBsAg, anti-HBe was observed in 85.7%, anti-HBe in 9.5% and IgM anti-HBc in 57.1%. There were no positive anti-HD in any sample case. The HBV DNA was found in 37.7% of ali patients and in 65% of the HBsAg positive. The HCV RNA was detected in 8.5% of the sample but in 100% of the patients positive to anti-HCV. Sera from patients negative to HBsAg or to anti- HCV had any evidence of HBV DNA or HCV RNA. The AFP was above the normal value in 88.9% of patients, with levels up to 400ng/ml in 75% of them and in 27.8% high titers superior to 70000 ng/ml were observed. The abdominal ultrasonography identified liver tumors with nodules, multiple or single, present respectively in 63.9% and 36.1% of the sample. The predominant histological tumor was trabecular well differentiated carcinoma (p<0.05). The least Mean age and the highest AFP serum levei (p<0.01 ) were recorded among patients HBsAg posítive. Most of patients had advanced illness. A death rate of 38.9% were recorded. In conclusion, hepatitis B virus infection seems to be important in the etiology of HCC in the East Amazon. Improving preventive measures such immunization and screening for early diagnosis of liver tumors in the risk population should be emphasyzed. Further control or direct studies need to be done to elucidate important possible cofactors in the region that may contribute to a better understanding of the mechanisms enrolled in hepatocarcinogenesis.
Acesso aberto (Open Access)
Prevalência de anticorpos para HTLV em indivíduos atendidos em um centro de diagnóstico para Anti-HIV
(Universidade Federal do Pará, 2000) BRÍGIDO, Helena Andrade Zeferino; REZENDE, Manoel Barbosa de
The researches are about the occurency of HTLV I and II infections increased after Acquired Immunodeficiency Syndrome (AIDS). In case of coinfection the AIDS has higher precocity in its development with modifications of its parameters control and the antiretroviral begining. This study presents the prevalence of HTLV IIII among patients attending the AIDS Reference Unit (URE-DIPE). A group of 588 patients from the URE-DIPE, 292 from Institute Evandro Chagas (IEC) and 295 of blood donors from HEMOPA was tested for the presence of antibodies to HTLV IIII using double ELISA and Western Blot. In the URE-DIPE the heterosexual population was the predominant, in both sexs, with 499 persons (84,9%). Although after the Anti-HIV result analysis, there is no significative difference in the sexual option. Seven patients (1,2%) were positive to HTL V I. The coinfection HTL V/HIV occurred in 3 cases, corresponding for 0,5% from the total. In the IEC, the serum positivity was detected in two cases (0,7%) to Anti-HTLV I and II. Comparing these 2 groups (URE-DIPE and IEC), the results didn't disagree with p=0,2345 and 0,4691, respectivitly. The population thats presents a higher sexual activity is the most and lEC do not permit to determine that in the first, the HTL V infection is the most incidence. Also, there is no significative difference between the heterosexual and homosexual infections. Therefore, the sexual contact is the dominant factor. The most afected ages are favourable the perinatal transmission. The serum positivity absent in the blood donors is compatible with the low prevalence of this group. It is agrees on the literature. Further studies are necessary in order to inform the health professionals and the whole population about prevention and controls.
Acesso aberto (Open Access)
Arbovírus Morumbi (Phlebovirus : Bunnyaviridae) - estudo histopatológico e imuno-histoquímico do fígado na infecção experimental em camundongos: comparação entre as vias cerebral, intraperitoneal e subcutânea
(Universidade Federal do Pará, 2000) BARROS, Vera Lúcia Reis Souza de; ROSA, Amélia Paes de Andrade Travassos da; ALVES, Venâncio Avancini Ferreira; http://lattes.cnpq.br/8923271345704795
Morumbi virus is a member of Phlebotomus Fever serogroup (Bunyaviridae family, Phlebovirus genus), native from the Brazilian Amazon region. It'svector is unknown, but is supposed to be, transmitted by phlebotomine sandflies. It was isolated in 1988 from a human presenting an acute febrile illness. When inoculated in the brain of Newborn Swiss mice, this arbovirus showed visceral tropism, including liver damage. In order to establish the anatomopathological and immunohistochemical characteristics in the liver of albino Swiss suckling mice experimentally infected with Morumbi virus; to assess the differences of tropism of the virus in the liver following the intra cerebral, intra peritoneal or subcutaneous routes of inoculation; to detail the sequence of anatomical and pathological events in the liver; to demonstrate the location of the viral antigen in the hepatic tissue during the experimental assay; and to study the possible relationship between the anatomopathological and immunohistochemical findings, an experimental study was conducted with 71 Newborn Swiss mice (two or three days of age), distributed as follows: 21 received intra cerebral inoculation (IC), 21 received intraperitoneal inoculation (IP) and 29 received subcutaneous inoculation (SC). 0.02ml of virus suspension was used as the infectious dose. The control was comprised of 30 mice that were not inoculated. Subgroups of 8 mice (6 inoculated, 2 controls) were euthanized daily, at intervals of 24 - 96 hours in the IC and IP groups, and until 120 hours in the SC group. Liver specimens from all mice were fixed in a 10% neutral formalin solution, then embedded in paraffin wax to obtain 5f.lm sections that were stained with haematoxylin/eosin for morphological analysis. Immunohistochemical technique (Envision System, DAKO, USA) was employed in additional sections, using alkaline phosphatase and hyper-immune anti-Morumbi virus serum prepared into suckling mice, to detect the viral antigen. 6 patterns of portal lesion and 9 patterns of lobule lesion were studied in a scale from zero (0) to three (+++), where zero represented absence of lesion and three represented severe lesion. Light microscopy examination revealed that Morumbi virus was able to produce hepatic lesions in the portal and lobular areas when inoculated in mice in three different routes, raising an acute hepatitis, in which bodies similar to Councilman - Rocha Lima bodies were observed, irregularly distributed in the lobules. The appearance of those bodies occurred 24 hours post-inoculation (pi), with a peak at 72 hours pi in miceis inoculated. The immunohistochemical technique showed mild presence of viral antigen from 24 hours after inoculation in IC group and from 48 hours after in IP and SC groups, showing a certain parallelism between the detection of viral antigens and the morphological lesions. Maximum detection of the viral antigen was observed in IP rout, specially those mice euthanized at 72 hours pi. General distribution of the antigen was concentrated in the hepatic lobules, in the cytoplasm of normal and necrotic hepatocytes, as well as inside the Kupffer cells, without any preference for the three lobule areas. The following conclusions are made: i) experimentally infected mice model was excellent to study the Morumbi virus-induced lesions, with preference to IP rout; ii) in all inoculated routes (IP, IC and SC) there were evidence of Morumbi virus infection, with a remarkable detection of its antigen in the hepatic tissue of Swiss mice; iii) Morumbi virus antigen detected in the liver of Swiss mice was associated with acute hepatitis and with focal necrosis; iv) an intense acute hepatitis occurred in the liver of euthanized mice 72 hours pi with Morumbi virus by the intraperitoneal route but was not observed in the other two used routes; v) in this experiment, acute hepatitis was limited, showing a clear tendency to disappear in the follow up in the majority of inoculated animals; vi) cholestasis was not very often observed in the experimental hepatitis due to Morumbi virus; vii) Morumbi virus antigen was detected predominantly in the cytoplasma and was exhibiting a granular pattern in hepatocytes and Kupffer cells; viii) Morumbi viral antigen was detected as early as 24 hours in hepatic tissue in IC route and 48 hours after IP and SC routes.
Acesso aberto (Open Access)
Correlação clínico-laboratorial na amebíase intestinal
(Universidade Federal do Pará, 2001) ESTEVES, Paulo Sérgio Cardoso; PÓVOA, Marinete Marins; http://lattes.cnpq.br/2256328599939923
Intestinal amoebiasis clinical diagnosis remains presumable and the correct diagnosis always need laboratorial confirmation. A hundred-five patients, of both sexes, age between 13 - 80 years-old, from passive demand of "Serviço Ambulatorial de Clínica Medica da Polícia Militar", were selected for this study in order to correlate the clinical findings and imunoenzimatic E. histolytica GIAP stool antigen search. The prevalence of intestinal amoebiasis was 13,33% (14/105) for single stool examination and 24,76% (26/105) for ELISA. When the two methods were compared, diference statistically significant it was found (p < 0,05 - McNemar). Among detected parasites by single stool examination: Endolimax. nana with 61,90% (65/105), Blastocystis hominis 28,57% (30/105). Entamoeba coli 18,10% (19/105) and Giardia lamblia 5,71% (6/105) were the most prevalent. Trichiuris trichiura with 4.76% (5/105) and A lumbricoides 3,81% (4/105) had the highest prevalence among helminths. The prevalence of such parasitic infections at the studied population was according to local casuistic. In the analysis of the symptomatology of ELISA positive patients, 73,08% (19/26) had reported one or more disease suggestive symptoms, and was observed abdominal pain in 46,15% (12/26) patients, diarrhoea with no abnormal elements in 42,31 % (11/26), tenesmus in 3,85% (1/26) and intestinal constipation 11,54% (3/26). The presence of such symptons when compared with clinical similar cases ELISA negative, were not significative (p > 0,05 - McNermar). In 4,76% patients (5/105), diarrhoea with mucosus and blood was refered. This association with ELISA positive test were observed in 3,84% (1/26), and was statistically significative when compared with ELISA negative ones. The results of this work shows the difficulties in establishing the clinics and laboratory correlation in intestinal amoebiasis. It occurs because of clinical syndroms are not so specifie and the need of different diagnosis, together to the error possibility in routine diagnosis methods. Its is suggested the inclusion of ELISA test in intestinal amoebiasis diagnosis as a necessary clinical resource although, it does not exclude the single stool examination to others parasites, due to be able to identify only the pathogen, Entamoeba histolytica.
Acesso aberto (Open Access)
Neurocriptococose pediátrica no Estado do Pará: espectro de achados tomográficos na infecção por Cryptococcus neoformans var. gattii
(Universidade Federal do Pará, 2001-09-05) CORRÊA, Maria do Perpétuo Socorro Costa; MAGALHÃES, Luiz Marconi Fortes; http://lattes.cnpq.br/6032076996211936; SEVERO, Luiz Carlos; http://lattes.cnpq.br/8729316807859951
This study shows the spectrum of computed tomography (CT) findings in children's neurocryptococcosis due to Cryptococcus neoformans var. gatfii, in the State of Para. We analysed the cranial CT scan appearance of eleven children (younger than 13 years of age) with proven central nervous Cryptococcus neoformans var. gattii infection, between January 1992 and December 2000, who were horizontalized were referred to Hospital universitário João de Barros Barreto, Belém, PA, Brazil. Intracranial cryptococcosis was defined by identification of encapsulated yeast by microscopic examination and isolation of Cryptococcus neoforman from cerebrospinal fluid and positive identification of the var. gattii with use of canavanine-glycine-bromothymol blue agar media, with at least a cranial CT study obtained at the time of the diagnosis. The age range was 6 years to 12 years, with a mean age of 8,8 years. Six were girls and five were boys. The most common clinical findings were headache, fever and nuchal rigidity (n=11 ); nausea and vomiting (n=10). The mean time from onset of symptoms to diagnosis was 4.2 weeks (range, 2 to 8 weeks). No normal cranial CT was detected in any patient. In all patients were observed hypodense nodules. The remaning scan abnomalities were as follows: six had hydrocephalus, nine had diffuse atrophy, and five had hydrocephalus coexistant with diffuse atrophy. We described by the first time cranial CT scan findings in series of case of neurocryptococcosis due Cryptococcus neoformans var. gaftii in immunocompetent children. This study shows that this infection most commonly develops multiple hypodense nodules, mainly in the basal ganglia region and in the cerebral white matter. These lesions apparently progress to important atrophy of the cerebral white matter, with ventricular dilatation and prominence of cerebral sulci, consequent of a presumable compensatory hydrocephalus. In general, these patients present mild changes in cerebral cortex.
Acesso aberto (Open Access)
Análise higiênico-sanitária da carne do caranguejo-uçá (Ucides cordatus) beneficiada em dois municípios litorâneos do Estado do Pará
(Universidade Federal do Pará, 2002) CÉSAR, Kátia Lamarão Vieira; REZENDE, Manoel Barbosa de
Among the products of animal origin, the crab is held as one of the victuals more susceptible to the deterioration process due to is specific chemical composition, activities of autoliticas enzyme and to the close pH of the neutrality. Beyond of those intrinsic factors related to the crustacean, the process of extraction of its meats is accomplished, in the great majority of the times, in unsatisfactory hygienic-sanitary condition, causing, like this, a high text of contamination of these. With the objective of analyzing the microbiologic, microscopic and parasitical quality of the crabmeat traded in two municipal districts of Pani (Sao Caetano de Odivelas and Braganya), 30 samples were researched, acquired from the meat collectors, in its points of collection. In the microbiologic analysis, presence was observed, in high levels, of fecal coliforms and S. aureus, in both municipal districts, however Salmonella (s. panama: sorogrupo D) was only detected in Braganya/Vila de Caratateua. It is stood out that, great part of collection points presented their samples out of the effective legal patterns in the current Brazilian legislation. The microscopic analysis revealed constant dirt presence (fragments and stick chips, seed, fibber and chips of vegetable origin, for the human, excrement and insect larva). However, the parasitical analysis was negative for the detection of cysts of protozoarius (E. histolytica/E. dispar and G. lamblia). The results reveal the precariousness of the hygienic-sanitary conditions of the researched samples, indicating this way the need of being created, on the part of the competent authorities, a registration of the Ministerio da Agricultura e Secretaria da Agricultura do Estado, so that the manufacturing and the commercialization of this product are made in agreement with Brazilian and state sanitary rules.
Acesso aberto (Open Access)
Malária no Pará: estudo do quadro clínico e laboratorial nas infecções causadas pelo Plasmodium vivax, na atualidade
(Universidade Federal do Pará, 2002) NEVES, José Joaquim de Oliveira; SOUZA, José Maria de
Nowadays malaria is considered one of the most iInportant problem of public health the World Health Organization. Recent studies showed changes in clinical and laboratory pattern. The aim of this work was to study the clinical manifestations and laboratory pattern of malaria infection due to Plasmodium vivax. This longitudinal and prospective study was carried out in Evandro Chagas Institute, in Belem City, from November 2001 to June 2002. The methodology was: diagnosis, treatment and follow-up of P. vivax parasites carries diagnosed by thick smear during all period of the treatment. Were evaluated the epidemiologycal, clinical and laboratory aspects including sex, skin color, profession, origin of infection, period of incubation and persistence of headache, chills and fever, and another symptoms during the treatment. Laboratory investigation included the parasite count and data related to blood exmnination (coagulation tests, hemoglobin rates, erythrocytes, leukocytes), aminotransferases, bilirrubin, alcaline phosphatase, urea and creatinine. Preliminary data of the present study showed changes in epidemiologycal aspects related to the kind of occupation of malaria-infected patients living in urban area. The incidence of malaria cases was higher aIllong students and housewives. This study corroborates the fonner studies related to chloroquine schizonticide action in an average time of 48/72 hours and also it showed significant thrombocytopenia that still now is not very well studied in malaria due to P. vivax. Plateletes fall do not change the blood coagulation tests. On day seven, 124 patients among 127, showed paleness, but as wek now, it has not a good correlation with anelnia occurrence.
Acesso aberto (Open Access)
Aspectos clínicos e epidemiológicos dos acidentes por arraias nos distritos de Mosqueiro e Outeiro, Belém-Pará-Brasil
(Universidade Federal do Pará, 2002) PARDAL, Pedro Pereira de Oliveira; FRANÇA, Francisco Oscar de Siqueira; http://lattes.cnpq.br/7343707037851377; REZENDE, Manoel Barbosa de
The Marajó Bay waters become fresh waters during the months when the pluviometric precipitation is high. They also become brackish waters in the other period what makes possible to find stingrays of the Potamotrygonidae family and other seawater species. These stingrays have retrossered and sharp stings that once got into the victims they injure the skin which recovers the glandurar cells with venon, exposing the tissues to the toxin, leading them to clinical manifestations. It has been used an observational and descriptive model of prevalence in order to estimate the clinical and epidemiological aspects of 116 stingrays accidents occurend in the Mosqueiro and Outeiro beaches, around Belem, Para, from July 1999 to August 2001. These accidents happened specially in the Mosqueiro beaches (80,2%) with more frequency in the male sex (63,8%) while in the teenager and adult groups it occurs (38,8% and 50,0%) respectively, and during the month of July (37,9%). In all tides there were victims but with less frequency in the high tide (4,3%). The most accidents ocurred in the bottom of a river with sand (49,1 %) and during the afternoon period (62,1 %). The major part of the stingrays caught in the Mosqueiro beaches belongs to the Potamotrygonidae family. The victims helped in the first hour were 79,3% of the cases being the lowest members the part the most affected in 84,5%specially the feet in 75,0%. All the patients appeared with local clinical manifestations, the pain with 99,1% and the cianosis with 42,2% of the cases. The systemic symptoms were present in 14,6% being the dizziness (6,0%) and the sudoresis (5,2%) the most ones found. The blood pressure above the normal was present in 6,0% and the taquicardiac was in 9,5%. The debridment has been the cirurgic behaviour the most used (94,5). Only 18,1% came back to a revaluation whose 33,4% of them evolved to necrosis 28,6% with local infection. There has been no statistic signifecance in the correlationamong the clinical evolution, the treatments used and the time between the accidents and the beginning of the medical service. We concluded that the stingray accidents are an important health injury for the population who despite the local complications and difficulties, the victims don't display a serious healthy state. The brackish waters period seems to have a great influence to increase the number of these accidents.