Estudo da prevalência do vírus Influenza A e B numa amostragem populacional do Arquipélago da Madeira

As infecções respiratórias de etiologia viral constituem um problema alarmante de Saúde Pública, sendo responsáveis pelo elevado e constante aumento dos índices de morbimortalidade registados no Mundo associados ao vírus influenza. O presente estudo teve como objetivo avaliar a prevalência dos anticorpos IgG e IgM em soros de utentes com requisições para análises serológicas ao vírus influenza A e B. Os utentes foram atendidos entre 1 de Abril de 2009 e 30 de Abril de 2011. Outro objectivo foi determinar a epidemiologia do vírus pandémico A (H1N1) 2009 nos indivíduos com sintomatologia de gripe durante o período entre Julho de 2009 e Julho de 2010 utilizando a técnica de RT-PCR em amostras de exsudado (ou aspirado) nasofaríngeo. Tendo por base o universo de amostragem de 981 indivíduos, constatou-se que 10,7 e 8,2% da população analisada apresenta valores positivos de anticorpos IgM e IgG indicativos de infecção pelo vírus influenza A e B, respectivamente. Constatou-se, também, que entre os 1934 indivíduos submetidos a procedimentos de diagnóstico laboratorial para a detecção de infecção pelo vírus pandémico A (H1N1) 2009, cerca de 747 (38,6%) estavam infectados. Verificou-se que, a população mais jovem foi mais susceptível à infecção pelo vírus influenza A (H1N1) 2009. Isto difere da típica época de gripe sazonal, na qual as pessoas mais idosas estão mais propensas a tornarem-se infectadas e a desenvolver doença grave por influenza A e/ou B. A prevalência de gripe na RAM é reduzida – um dos aspectos plausíveis que justifiquem esta afirmação poderá dever-se às características genéticas da população da RAM estudada. Embora seja de elevada relevância salientar que o Programa Regional de Vacinação (PRV) da RAM tem alcançado reconhecimento nacional e internacional devido às excelentes taxas de cobertura vacinal, fruto da atitude entre cidadãos e profissionais de saúde.

Estudo da incidência de doença celíaca na Região Autónoma da Madeira

A doença celíaca (DC) é um distúrbio de má absorção intestinal, causada pela ingestão de glúten e tem como único tratamento uma dieta livre de glúten (DLG). Este estudo teve como objectivo determinar a prevalência, a incidência e os melhores marcadores sorológicos de DC na Região Autónoma da Madeira (RAM), através da análise dos pedidos no serviço de Patologia Clínica do Hospital Dr. Nélio Mendonça, com marcadores de DC durante o período de Janeiro de 2002 a Dezembro de 2010. A determinação dos marcadores sorológicos (anticorpos antitransglutaminase tecidular IgA (AATA) e IgG (AATG), anticorpos anti-gliadina IgA (AAGA) e IgG (AAGG)) foi realizada no analisador automático ImmunoCAP 250, que utiliza a técnica Fluoro-Enzyme ImmunoAssay (FEIA). Dos 1004 pedidos que requereram marcadores sorológicos para a DC, 214 obtiveram um ou mais marcadores positivos, que pertencem a 130 indivíduos distintos. Quarenta e quatro (44) indivíduos realizaram biópsia intestinal e 38 foram positivas com aspectos morfológicos compatíveis com o diagnóstico de doença celíaca. A doença atingiu mais as crianças que os adultos e foi mais frequente no sexo feminino do que no masculino. A prevalência de DC na RAM de acordo com os resultados das biópsias foi de 15,3 casos por 100.000 habitantes e a incidência foi de 1,9/100.000 habitantes, com uma tendência crescente nos últimos anos. O anticorpo anti-transglutaminase tecidular IgA foi o marcador mais sensível (95,5%), correspondendo ao melhor marcador na detecção inicial de DC. Todas as amostras de crianças com idade inferior a 2 anos devem ser adicionalmente testados para anticorpos anti-gliadina, devido à sua maior sensibilidade (92,3%) em relação aos anticorpos anti-transglutaminase tecidular IgA (84,6%). Este trabalho procurou contribuir para um melhor conhecimento do perfil de doença celíaca da população da RAM.

Desordem coordenativa no desenvolvimento em crianças dos 3-6 Anos de idade dos Concelhos de Santarém e Rio Maior: incidência, análise dinâmica do equilíbrio e da lateralidade e influência de intervenção planeada

Identificar e analisar o comportamento motor em termos coordenativos em crianças dos 3 aos 6 anos de idade nos concelhos de Rio Maior e Santarém foi um dos nossos propósitos ao iniciar este processo científico. As crianças foram avaliadas com o teste MABC-2, exibindo os resultados do seu padrão motor coordenativo numa amostra representativa da população em causa. Com base nestes resultados analisámos o padrão motor coordenativo em função da idade, sexo, lateralidade. Observámos o comportamento das crianças com provável DCD e risco em termos da preferência e consistência da lateralidade. Posteriormente usando um teste de Midline Crossing procurámos analisar a dinâmica do uso da mão numa vertente de sistemas não lineares. Ainda nesta perspetiva teórica analisámos o equilíbrio, aspeto considerado preocupante nesta desordem para algumas crianças, através da análise de recorrência. Os instrumentos usados diferiram entre estudos em função dos objetivos de cada um: MABC-2, Midline Crossing, Questionário de Van Strien. Outro dos objetivos do nosso estudo recaiu no processo de intervenção junto de crianças em risco ou com provável desordem coordenativa no desenvolvimento. Em relação à nossa amostra encontrámos na literatura uma percentagem similar em termos de incidência de crianças com provável DCD e risco, por sexo e lateralidade. Constatámos que a percentagem de crianças com provável DCD apresenta uma representatividade percentual de acordo com a literatura. Existindo uma maior percentagem de sinistrómanos com provável DCD e do sexo masculino. Verificámos através dos sistemas não lineares que o comportamento das crianças com provável DCD se assemelha às crianças típicas, necessitando de um reforço na intervenção de forma a colmatar algumas das suas dificuldades. Verificámos que as crianças DCD são mais suscetíveis aos constrangimentos extrínsecos. Finalmente concluímos que a intervenção pode criar condições de excelência para modificar os padrões e perfis de comportamento.

Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006

NORO, Luiz Roberto Augusto et al. Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006, Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 4, p. 783-790, abr. 2009.

Incidência e fatores de risco da retinopatia diabética em pacientes do Hospital Universitário Onofre Lopes, Natal-RN

Estudar a incidência e fatores de risco (tempo de doença e presença de hipertensão arterial sistêmica) para retinopatia diabética em 1002 pacientes encaminhados pelo Programa de Diabetes do Hospital Universitário Onofre Lopes no período de 1992 – 1995. Métodos: Estudo retrospectivo de pacientes com diagnóstico de diabetes mellitus encaminhados ao Setor de Retina do Departamento de Oftalmologia pelo Programa de Diabetes do Hospital Universitário e submetido, sob a supervisão do autor, a exame oftalmológico, incluindo medida da acuidade visual corrigida (tabela de Snellen), biomicroscopia do segmento anterior e posterior, tonometria de aplanação e oftalmoscopia binocular indireta sob midríase(tropicamida 1% + fenilefrina 10%). Foi realizada análise dos prontuários referente ao tempo de doenças e diagnostico clínico de hipertensão arterial sistêmica. Resultados: Dos 1002 diabéticos examinados (em 24 deles a fundoscopia foi inviável), 978 foram separados em 4 grupos: sem retinopatia diabética (SRD), 675 casos (69,01%); com retinopatia diabética não proliferativa (RDNP), 207 casos (21,16%); com retinopatia diabética proliferativa (RDP), 70 casos (7,15%); e pacientes já fotocoagulados (JFC), 26 casos (2,65%). Do total, 291 eram do sexo masculino (29%) e 711 do sexo feminino (71%). Os 4 grupos foram ainda avaliados quanto ao sexo, a faixa etária, a acuidade visual, tempo de doença, presença de catarata e hipertensão arterial sistêmica e comparados entre si. Com relação ao tipo de diabetes, 95 eram do tipo I (9,4%), 870 pacientes eram do tipo II (86,8%), e em 37 casos(3,7%) o tipo de diabetes não foi determinado. Conclusões: Comprovou-se que os pacientes com maior tempo de doença tinham maior probabilidade de desenvolver retinopatia diabética, e que a hipertensão arterial sistêmica não constituiu fator de risco em relação à diminuição da acuidade visual nos pacientes hipertensos

Influência do vírus da hepatite G (GBV-C) na resposta imune frente à infecção por Leishmania chagasi

GB virus type C (GBV-C) appears to promote a Th1 response and is associated with prolonged survival in HIV-infected people. L. chagasi causes a spectrum of illness that varies from severe visceral leishmaniasis, a disease that in the majority of cases is fatal if not treated, to self resolution of infection and development of positive DTH response that is protective against symptomatic disease. To determine if GBV-C viremia might influence the outcome of Leishmania infection, we characterized GBV-C status in a cohort of subjects residing in a L. chagasi endemic area in Brazil. GBV-C viremia was more prevalent in blood donors from urban than in periurban regions of Natal, Brazil (16% and 7.5% respectively). Evidence of prior GBV-C (anti-E2 antibodies) was detected in 24% and 12%of these groups respectively. Anti-E2 increased with age (p= 0.0121). No difference in GBV-C viremia was found in the DTH+ and VL groups (p= 0.269); however, subjects with visceral leishmaniasis were more likely to have anti-E2 than DTH+ subjects (p=0.0012), and DTH induration was smaller in subjects with E2 antibodies (4.5 mm) compared those without (7.12 mm) (p= 0.002). Furthermore, the size of the Leishmania DTH response was greater in GBV-C viremica subjects (6.8 mm) compared to non-viremic subjects (3.3 mm; p= 0.0054). There findings suggest that GBV-C virus may promote a type 1 immune response that could influence the outcome of Leishmania infection

Co-infecção pelo vírus da hepatite G em pacientes infectados pelo Leihsmania chagasi

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Estudo do genoma do vírus causador da mionecrose infecciosa em camarões e desenvolvimento de métodos para detecção de diferentes variantes

Shrimp farming is one of the activities that contribute most to the growth of global aquaculture. However, this business has undergone significant economic losses due to the onset of viral diseases such as Infectious Myonecrosis (IMN). The IMN is already widespread throughout Northeastern Brazil and affects other countries such as Indonesia, Thailand and China. The main symptom of disease is myonecrosis, which consists of necrosis of striated muscles of the abdomen and cephalothorax of shrimp. The IMN is caused by infectious myonecrosis virus (IMNV), a non-enveloped virus which has protrusions along its capsid. The viral genome consists of a single molecule of double-stranded RNA and has two Open Reading Frames (ORFs). The ORF1 encodes the major capsid protein (MCP) and a potential RNA binding protein (RBP). ORF2 encodes a probable RNA-dependent RNA polymerase (RdRp) and classifies IMNV in Totiviridae family. Thus, the objective of this research was study the IMNV complete genome and encoded proteins in order to develop a system differentiate virus isolates based on polymorphisms presence. The phylogenetic relationship among some totivirus was investigated and showed a new group to IMNV within Totiviridae family. Two new genomes were sequenced, analyzed and compared to two other genomes already deposited in GenBank. The new genomes were more similar to each other than those already described. Conserved and variable regions of the genome were identified through similarity graphs and alignments using the four IMNV sequences. This analyze allowed mapping of polymorphic sites and revealed that the most variable region of the genome is in the first half of ORF1, which coincides with the regions that possibly encode the viral protrusion, while the most stable regions of the genome were found in conserved domains of proteins that interact with RNA. Moreover, secondary structures were predicted for all proteins using various softwares and protein structural models were calculated using threading and ab initio modeling approaches. From these analyses was possible to observe that the IMNV proteins have motifs and shapes similar to proteins of other totiviruses and new possible protein functions have been proposed. The genome and proteins study was essential for development of a PCR-based detection system able to discriminate the four IMNV isolates based on the presence of polymorphic sites

Prevalência da infecção genital pelo vírus herpes simples tipo 1 e 2 em mulheres grávidas e não grávidas de Natal/RN

Herpes simplex is a virus that can be transmitted sexually and is potentially associated with vertical transmission. This study evaluated the prevalence of genital infection by herpes simplex virus (HSV) types 1 and 2 in pregnant and nonpregnant care in the city of Natal / RN, including a total of 222 women, 92 pregnant and 130 nonpregnant. The participants answered a questionnaire to obtain data and socio-demographic characteristics, as well as potential risk factors for sexually transmitted diseases. After the interview, we collected two cervical specimens, one for the Pap test and the other for DNA extraction and analyzed by polymerase chain reaction (PCR) to detect both virus serotypes. Then the women underwent a clinical examination by colposcopy. For statistical analysis, we used the chi-square and logistic regression by SSPS 17.0 Statistic. Most women were up to 30 years of age, nonwhite ethnicity, married, elementary education, family income below the poverty level; initiated sexual activity with age up to 18 years; had more than one sexual partner lifelong and was not pregnant, but has had at least one child. The HSV-1 showed a prevalence of 26.1% among pregnant women and 30.0% in non-pregnant women. While HSV-2 prevalence was found with 10.9% and 19.2% in pregnant and nonpregnant women, respectively. The largest proportion of morphological changes of the uterine cervix was detected among nonpregnant women, both in cytology and in colposcopy. The women were nonwhite ethnicity, married, became pregnant aged less than or equal to 18 years and who had one to two pregnancies had a lower risk of acquiring genital HSV infection. There was a high prevalence of genital HSV infection, HSV-1 is more prevalent than HSV-2. No association was found between morphological changes of the uterine cervix and the presence of the virus in pregnant and nonpregnant women, nor between genital HSV infection and the classic risk factors for sexually transmitted diseases

Correlação entre a infecção genital pelo vírus do papiloma humano, a resposta imune e os achados colpocitológicos em mulheres grávidas e não grávidas

The genital HPV infection is very common between men and women worldwide, affecting particularly young women, constituting a serious public health problem in less developed regions, favored by the poor living conditions of population. The cytology and colposcopy have notorious importance in the diagnosis of precursor lesions of cervical cancer and therefore its prevention. However, even with such diagnostic tools, the number of women who develop cervical cancer is still high. This study aims to assess the prevalence of genital tract infection by HPV in pregnant and nonpregnant women, evaluating the profile of the immune response presented by the women of these two groups in order to establish correlations among profile of immune response, presence of virus and occurrence of lesions of the uterine cervix. We analyzed specimens obtained from the cervix of 221 patients, 91 pregnant and 130 non-pregnant, aged 14-72 years. The women were subjected to colposcopic and cytologic evaluation detect possible changes in the cervix and then samples were collected in order to perform HPV detection by PCR and real-time PCR for detection of mRNA of pro-inflammatory and anti-inflammatory cytokines. In the present study, the overall prevalence of HPV genital infection was 28.1%; of which 31.9% were pregnant patients and 25.4% in non-pregnant women. Young women under 30 years and those with low educational level education showed a higher risk of HPV infection. Colposcopy showed better correlation with detection of HPV DNA by PCR, when compared to cytology. Generally, HPV infected patients, pregnant or not, exhibited reduced mRNA expression of both pro-inflammatory (IFN-γ, TNF-α) and anti-inflammatory (IL -10) cytokines, when compared to patients not infected by HPV. Nonpregnant patients infected presented increase mRNA expression of IL-17 in patients without injury, whereas those with lesion showed higher mRNA expression of TGF-β. Pregnant women without injury infected exhibited increased mRNA expression of TGF-β. There was no difference in HPV prevalence between pregnant and nonpregnant women. There was a reduction of pro-inflammatory cytokines, except IL-17, in all women infected by HPV. Moreover, we observed an increase of TGF-β in HPV-infected women who are pregnant or not. The results suggest that, in women in this study, HPV infection promoted changes in the profile of cytokines necessary for activation of effective immune response, possibly favoring viral persistence

Acesso aos serviços odontológicos e incidência de cárie em adolescentes e fatores de risco em município do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

Hiperidrose compensatória após simpatectomia toracoscópica: características, incidência e influência na satisfação do paciente

Hyperhidrosis is an idiopathic condition characterized by excessive sweating. Symptoms generally begin in childhood or early adolescence, and rarely improve with age. The excessive localized sweating generally occurs either spontaneously, or in association with stressful or emotionally charged situations. This prospective study aimed to investigate predictive factors for compensatory hyperhidrosis after thoracoscopic sympathicotomy. From 2000 to 2002, 80 patients (53 female and 27 male) underwent hyperhidrosis surgery. The patients, ranging from 12 to 56 years old, were studied and followed-up for 42.51 ±5.98 months. A satisfaction grading using a visual analogue scale -VAS (0 = not at all satisfied, and 10 = fully satisfied) was used. The surgical procedure was performed bilaterally on the second ganglion (T2) for facial hyperhidrosis, on the third and fourth ganglia (T3 and T4) for axillary hyperhidrosis, and on the third ganglion (T3) for palmar hyperhidrosis. The results showed that, 68 patients (85%) presented with compensatory sweating (CS), which was classified as mild (33.8%), moderate (33.8%) and severe (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, while 10 patients (12.5%) were dissatisfied. Degrees of satisfaction varied according to sex, age, BMI and extent of denervation. Moreover, the compensatory hyperhidrosis was more severe in abdomen and back than in legs. In conclusion, although CS is a frequent adverse effect of sympathicotomy, the degree of patient satisfaction was high. Some factors were related to the occurrence and severity of CS and the most adequate patients to be submitted to this operation are young adult women whose BMI is less than 24.9