Navegando por Assunto "Diagnóstico clínico"

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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)
Estudo clínico, morfológico e imuno-histoquímico de série de casos de tuberculose pleural e ganglionar
(Universidade Federal do Pará, 2011) LIMA, Edna Porfírio de; DEMACHKI, Samia; http://lattes.cnpq.br/7568391537270652; MONTEIRO, Maria Rita de Cassia Costa; http://lattes.cnpq.br/5536136455627983
The difficulty in definitive diagnosis of extra-pulmonary tuberculosis persists, mainly due to poor solutions available from conventional methods for detection of Mycobacterium tuberculosis. This study aimed to evaluate the contribution of immunohistochemical (IHC) for detection of Mycobacterium spp, in cases of pleural and lymph node tuberculosis with negative staining, as well as investigate some clinical, laboratory and morphological aspects of the disease. To obtain this sample was made in the pursuit of cases through surveillance (NVE) and Division of Medical Archives and Statistics (DAME), University Hospital João de Barros Barreto (HUJBB) and the Department of Pathology, University of Pará (UFPA), selecting those who had performed the histopathological examination for diagnosis of the case. Fifty patients were included, twenty-five with presumptive diagnosis of pleural tuberculosis and twenty-five of lymph node tuberculosis. To obtain the clinical and laboratory data were reviewed their medical records, and to confirm the morphological aspects review was performed of all selected slides. Thereafter, each sample was subjected to IHC with polyclonal Mycobacterium bovis BCG. It was found in the investigated group, more often male, whose average age was 33.8 years (SD: 14.1) with the majority coming from the city of Belem, Pará and education level of seven or fewer years of schooling. Constitutional symptoms more frequent in the whole group were fever and weight loss. In patients with pleural tuberculosis, the most frequent specific symptoms were cough, chest pain and dyspnea, and in those with lymph node involvement of the cervical alone was more frequent. Infection with human immunodeficiency virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) and alcohol consumption were the risk conditions most frequently associated. In pleural tuberculosis, 20% of cases presenting with pleural effusion associated with parenchymal injury, and 60% of the pleural fluid was exudate type. While in the lymph nodes in 50% of the cases revealed a parenchymal lesion on chest. This study was marginal participants in the amount of which has been held to direct research and culture for bacillus acid – resistant (AFB) in various clinical specimens analyzed (pleural fluid, pleural tissue and lymph node, sputum, and broncho-alveolar lavage). The predominant morphological pattern in both forms of the disease was tuberculous granulomas with caseous necrosis, regardless of serologic status for HIV. The IHC technique contributed to the diagnosis of pleural tuberculosis in 21% (4/19) samples of pleural tissue and 37.5% (9/24) of lymph node tissue. A positive immunohistochemical result defines the diagnosis of mycobacterial disease, and when associated with clinical, laboratory and morphological finds become a valuable tool to improve the diagnosis of extra-pulmonary tuberculosis.
Acesso aberto (Open Access)
Impacto da busca ativa especializada no diagnóstico da hanseníase: avaliação longitudinal e comparativa de aspectos clínicos e laboratoriais em áreas endêmicas no Pará e no Maranhão
(Universidade Federal do Pará, 2024-08) COSTA, Izabelle Laissa Viana; COSTA, Patrícia Fagundes; http://lattes.cnpq.br/6487407290759330; SALGADO, Claudio Guedes; http://lattes.cnpq.br/2310734509396125
Leprosy is a disease that represents a significant public health problem in various parts of the world, including Brazil. To improve epidemiological data, active case finding activities and longitudinal research represent a transformative approach to disease control. In this context, the present study aimed to evaluate and compare the clinical and laboratory aspects of patients with leprosy, their contacts, and schoolchildren over a one-year period in endemic areas in Pará and Maranhão. To achieve this, a longitudinal study was conducted, characterized by active case finding activities in Imperatriz-MA, São Luís-MA, and Marituba-PA, where registered leprosy cases in the Notifiable Diseases Information System (SINAN), their contacts, and school-aged children were evaluated. Participants underwent neurodermatological evaluation and blood collection for the titration of IgM anti-PGL-I antibodies, as well as intradermal scraping of the earlobes and elbows for bacilloscopy and qPCR. After one year, in 2023, participants from the municipalities of Imperatriz and São Luís were re-evaluated, and new participants were included. Among 522 individuals included in this study, 135/522 (25.9%) were clinically and/or laboratorially re-evaluated in 2023, and 387/522 (74.1%) were evaluated exclusively in 2022 or 2023. In 2022, new cases were identified among 66/221 (29.9%) contacts and 23/195 (11.8%) schoolchildren. Additionally, 9/34 (26.5%) relapses and 2/34 (5.9%) patients with therapeutic insufficiency or failure were diagnosed among index cases. In 2023, new cases were observed among 70/126 (55.5%) contacts and 10/29 (34.4%) schoolchildren. Furthermore, 7/12 (58.3%) relapses and 1/12 (8.3%) patients with therapeutic insufficiency or failure were diagnosed among index cases. In the neurodermatological evaluation, among schoolchildren and contacts who were re-evaluated, individuals with an altered superficial fibular nerve were found to be 4.3 times more likely to be in the disease case group (p < 0.05; 95% CI = 1.58- 12.74; OR = 4.32). The bacilloscopy test identified the etiological agent in 7/222 evaluated individuals (3.1%), with 4/7 (57.1%) being among individuals with a prior diagnosis of leprosy. Regarding the serological analysis of re-evaluated individuals, seropositivity was observed in 26/106 (24.5%) individuals in 2022, and 7/106 (6.6%) in 2023, a statistically significant decrease (p < 0.05). A high positivity rate for the qPCR technique was observed, including 9/10 (90%) relapses, 55/88 (62.8%) new cases, and 43/151 (48.3%) contacts. These data highlight a concerning scenario characterized by a high number of hidden leprosy cases in the analyzed regions, and a significant increase in diagnosis rates after one year of follow-up in the communities, underscoring the importance of longitudinal research and the implementation of different diagnostic and monitoring techniques for a better understanding of leprosy and its outcomes in endemic areas.