A COVID Longa é caracterizada por sintomas que persistem por meses após a infecção inicial pelo SARS-CoV-2, sem outra causa identificada. Dentre esses, a disfunção olfatória destaca-se por afetar significativamente a qualidade de vida dos pacientes, representando um desafio em termos de caracterização funcional, desenvolvimento de testes sensíveis para avaliação olfatória, associação com outros quadros clínicos e reabilitação dos afetados. OBJETIVO: Investigar aspectos sociodemográficos, funcionais olfatórios e a relação entre qualidade do sono e cognição em pacientes com COVID Longa que apresentam perdas olfatórias persistentes. MÉTODOS: Descrição de 5 estudos desenvolvidos com pacientes de COVID Longa com disfunção olfatória persistente acompanhadas no Programa de Atenção Clínica e Integral aos pacientes recuperados da COVID-19. O primeiro descreveu as características sociodemográficas e clínicas de pacientes de COVID Longa que desenvolveram disfunção olfatória persistente. Um segundo avaliou o poder preditivo de odores para a identificação de fenótipos olfatórios em pessoas com disfunção olfatória persistente. O terceiro estudo avaliou associação da disfunção olfatória persistente com a qualidade do sono. O quarto com aspectos cognitivos desses pacientes. E o quinto estudo avaliou a eficácia de um programa de treinamento olfatório na recuperação das perdas olfatórias persistentes. RESULTADOS: A disfunção olfatória persistente em pacientes com COVID Longa foi identificada como uma condição neurológica impactante e correlacionada a outros sintomas, como alterações cognitivas e de sono, especialmente em mulheres e adultos não hospitalizados na fase aguda. No Estudo 1, observou-se uma prevalência elevada de anosmia e hiposmia severa, associada a dificuldades nas atividades diárias, como higiene e ingestão alimentar. No Estudo 2, o teste CCCRC permitiu distinguir fenótipos olfatórios, identificando maior dificuldade em odores como canela, talco, sabonete, paçoca e chocolate no grupo hiposmia severa e anosmia. O Estudo 3 revelou uma associação significativa entre disfunção olfatória e má qualidade do sono, além de uma alta prevalência de ansiedade. Já o Estudo 4 indicou que pacientes com disfunção olfatória têm maior probabilidade de apresentar declínio cognitivo. Por fim, o Estudo 5 confirmou a eficácia do treinamento olfatório como uma intervenção viável e acessível, promovendo melhorias significativas na função olfatória dos participantes do grupo experimental. CONCLUSÃO: A disfunção olfatória é um dos sintomas neurológicos de longo prazo mais importantes da COVID-19, com maior prevalência entre mulheres, adultos e pacientes ambulatoriais. Observou-se que pacientes com disfunção olfatória podem apresentar hiposmia ou anosmia grave persistente por mais de um ano após o início dos sintomas. Destaca-se a necessidade de monitorização da taxa de recuperação da função olfatória entre indivíduos com COVID Longa, bem como as características, vantagens e fatores preditivos do teste CCCRC. Além disso, os resultados do ensaio clínico reforçam evidências anteriores da eficácia do treinamento olfatório na recuperação de perdas olfatórias pós-virais. Os estudos transversais reforçam o risco postulado de aumento de sequelas neurológicas ou distúrbios neurodegenerativos nessa população. Esses achados destacam a importância de uma abordagem multidisciplinar para o acompanhamento desses pacientes, integrando aspectos sensoriais, cognitivos e emocionais em sua reabilitação

Prostitution is known as one of the oldest paid activities in the world, legalized since 2002, many female sex workers (FSWs) still carry out their work activities without the minimum working conditions, being increasingly susceptible to exposure to the Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs). Therefore, this research aims to investigate the status of knowledge regarding HIV infection and transmission, prevention strategies and access to health services of female sex workers who work in municipalities and riverside communities of the Brazilian state of Pará, in the Amazon region. To achieve this objective, this study used four sampling methods: respondent-guided sampling, location-based sampling, total sampling and convenience sampling (non-probabilistic). Each method was used to access the largest possible number of FSWs, with a total sample of 549 FSWs (self-reported sociobehavioral data) who offered their services in 19 municipalities and 18 riverside communities in the Brazilian state of Pará. Most of the FSWs interviewed who offer their sexual services in riverside communities had their first sexual intercourse and the first exchange of sex for money before the age of 14. They have little access to medical-gynecological evaluation in health services, testing for HIV and other sexually transmitted pathogens, unlike women in municipalities/cities that have more access to health care, but both have difficulty obtaining female condoms and lubricating cream/gel (work supplies). It is worth mentioning that many of these health consultations are related to changes in the genitals such as: itching, warts and wounds. Given this scenario of economic and social vulnerability and lack of basic knowledge regarding health care, it is of utmost importance to encourage the promotion of health for these women in these locations, as they present a chain of errors susceptible to increasing the probability of contamination of STIs and HIV that the studied environment provides

Cerebral malaria is the most common clinical manifestation of infections caused by P. falciparum. This disease causes severe and irreversible neurological complications, such as visual alterations, ataxia and cognitive disorders. Therefore, the use of new therapies is necessary to reduce the damage caused by cerebral malaria. Caffeine has been widely used in several models of neurodegenerative diseases, due to its antioxidant and anti-inflammatory action. In addition, it has been described as an important modulator of BBB functions. In this sense, the objective of the present study was to evaluate the pharmacological characterization of caffeine by blocking the adenosine A2A receptor in experimental cerebral malaria (ECM). For this, we used mice of the Swiss lineage and the infection was induced through the Plasmodium berghei ANKA (PbA) strain. The animals were divided into four experimental groups: control, adenosine A2A receptor blocker (SCH-58261), group of animals infected with the strain (PbA) and the infected group treated with blocker (PbA+SCH-58261). The treated group received intraperitoneal injection of the adenosine A2A receptor blocker for 8 days. To characterize the cerebral malaria picture, cognitive impairments were analyzed by the Rapid Murine Coma and Behavior Scale protocol, survival curve, parasitemia (%), body weight and vascular permeability. We evaluated the expression of microglia (Iba-1) and astrogliosis (GFAP) markers and behavioral changes were evaluated by the open field test. Throughout the study, we can observe that the actions of caffeine on the BBB are extremely relevant, since the blockade of the adenosine A2A receptor can directly affect the integrity of the barrier. Given the above, the characterization of these pathways opens new perspectives for other preclinical trials that may contribute to the understanding and development of efficient drugs in combating malaria-induced brain damage

In the world, SARS-CoV-2 infection has been pandemic. While this impact has been well recognized in certain age groups, the effects, both direct and indirect, on the neonatal population remain largely unknown. This study assessed the clinical, epidemiological and evolutionary profile of newborns born to mothers with suspected or confirmed SARS-CoV-2 infection in the first 48 hours of life. This is a case series, descriptive, quantitative, retrospective study of pregnant women and their newborns, who tested positive for SARS-CoV-2 or with clinical, epidemiological and/or radiological evidence of COVID-19, treated at a referral hospital in the northern region of Brazil. We identified 207 medical records of pregnant women, two of whom had twin pregnancies, and 209 neonates of these pregnant women with suspected or confirmed COVID-19 in the period from April 2020 to December 2021. The pregnant women ranged in age from 14 to 45 years (mean 27.1), 68.6% came from the interior of the state, mean hospitalization of 9.3 days (SD=8.2 days), 84.5% (175) of caesarean sections and risk factors or comorbidities found in 27%, 56. SARS-CoV-2 infection was confirmed in 157 tests. Groundglass opacity was identified in 75% of the X-rays, multiple lobular or subsegmental areas of consolidation in 1.2% and in 15.2%. Of the 195 symptomatic pregnant women, there was a higher incidence of cough, fever, dyspnea, sore throat, anosmia and ageusia. In 92.3%, COVID19 improved and death occurred in 6.7%. Among the newborns, 55% were male, mean birth weight was 2758.2 g (SD=778.9, median: 2845g), mean head circumference (HC) 32.9 cm (SD=2.7), gestational age 37.4 weeks (SD=3.3). There was no breast-feeding in the delivery room in 83.2%. Length of stay between 0 and 4 days in 58.8%. Spontaneous breathing at birth occurred in 84.2%. Of the 24 NBs who required invasive ventilatory support, 50% remained for between 1 and 3 days. Only 1 NB tested positive for SARS-CoV-2, 52 were negative and 156 were not tested. Lymphopenia was documented in only 10.5% of newborns. In the clinical assessment in the first 48 (forty-eight) hours of life, we found 47 NB with clinical manifestations (22.4%), the most frequent being respiratory discomfort (76.6%) and gastrointestinal changes (19.1%). In the radiological assessment of 68 NB, two cases were found with a ground-glass pattern, 30.9% with an image pattern without changes and 66.2% with other findings. Of the NB in the study, 39 had early HAI, 13 had hospital-acquired infections, 167 had no infections and within this sample we had 10 neonates with early and late infections. We conclude from the results of the study that maternal infection with COVID-19 did not negatively influence the incidence of prematurity, the clinical evolution of the neonates, the Apgar scores and vigorous neonatal outcomes; however, there were cases of early and late healthcare-related infection (HAIs) as a neonatal complication, possibly associated with the maternal clinical condition, which contributed to an unfavorable outcome in 3.8% of the newborns

Post-COVID-19 syndrome is a multisystem condition that involves the persistence or occurrence of new symptoms, usually after 12 weeks of SARS-CoV-2 infection, lasting at least 2 months. It involves symptoms such as fatigue, anosmia, ageusia, and skin changes. Cutaneous manifestations in post-COVID-19 patients have been increasingly frequent, negatively impacting physical and mental health. The objective of this study was to describe the sociodemographic and clinical aspects of patients with dermatological alterations in PostCOVID-19 Syndrome. For this purpose, 41 patients diagnosed with post-COVID-19 syndrome who presented dermatological complaints were evaluated, referred after clinical screening by the Tropical Medicine Clinic of the Federal University of Pará. All patients were over 18 years old, had a confirmatory test for COVID-19, and resided in the metropolitan region of Belém. A structured form with sociodemographic and clinical information about each patient was used, in addition to a physical examination. The results of this study showed that the population was mostly composed of women (92.68%), and the prevalent age group (39.02%) was between 50 and 59 years. The main symptoms reported during the acute SARS-CoV-2 infection were cough (65.85%), fever (63.41%), and headache (60.98%). Among the most frequent cutaneous manifestations during the Post-COVID-19 Syndrome were hair loss (56.10%), scaly plaques (12.20%), and xerosis cutis (12.20%). Some patients reported more than one post-COVID-19 cutaneous symptom. The most prevalent diagnosis was telogen effluvium (58.53%). A greater understanding of dermatological alterations and cutaneous sequelae in post-COVID-19 syndrome is necessary for monitoring and therapeutic intervention in the follow-up of affected individuals

A infecção pelo vírus T-linfotrópico humano (HTLV) ocupa espaço entre as principais infecções sexualmente transmissíveis (IST) no mundo, sendo o público feminino mais suscetível ao contágio pela via sexual. Alguns estudos vêm demonstrando a utilização da secreção vaginal para detecção de IST, tais como por Chlamydia trachomatis e o próprio HTLV. Este estudo tem como objetivo verificar a possibilidade de detecção da infecção por HTLV em amostras de secreção vaginal, como um método auxiliar de diagnóstico. Este é um estudo observacional do tipo transversal que incluiu mulheres atendidas no ambulatório do Laboratório de Pesquisa em Epidemiologia e Doenças Endêmicas do Núcleo de Medicina Tropical da UFPA, no período de janeiro de 2019 a agosto de 2024. As participantes foram recrutadas utilizando o banco de dados do Laboratório de Biologia Molecular e Celular - LBMC/NMT. Foi usado o ensaio imunoenzimático – ELISA, como teste de triagem sorológica, e a Nested-PCR para confirmação e determinação do tipo viral, em todas as amostras de sangue e secreção vaginal. Foram investigadas 222 mulheres, das quais 198 (89,19%) foram negativas para a infecção pelo HTLV e 24 (10,81%) foram positivas, todas demonstrando correlação nos resultados de sangue e secreção vaginal. Dessas 24 mulheres, 19 (79,2%) foram positivas para o HTLV-1 e 5 (20,8%) positivas para o HTLV-2. A infecção se mostrou significativamente maior em mulheres com idades mais avançadas, naquelas que se declararam viúvas, com emprego, que residiam na região metropolitana de Belém e com pouca escolaridade. Este estudo evidenciou a viabilidade do uso da secreção vaginal na detecção da infecção por HTLV, podendo ser usado como método auxiliar no rastreio da infecção, inclusive no momento da coleta do exame preventivo do câncer do colo do útero.

The new coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus has rapidly spread around the world, becoming a public health emergency. It has high transmissibility and a varied clinical course, ranging from asymptomatic forms to severe manifestations, such as severe acute respiratory syndrome, which can lead to death. Certain groups are more susceptible to infections and have a higher risk of morbidity and mortality, such as pregnant women. Unlike what was seen with other coronavirus infections, such as SARS-CoV and MERS-CoV, pregnant women with SARS-CoV-2 do not have a higher risk of severe disease compared to non-pregnant women. Therefore, studies on the immune response in pregnant women with COVID-19 help to understand the progression of this disease in this population. This includes not only cytokines but also the transcription factors that coordinate these responses. Thus, the aim of this study was to analyze the profile of transcription factors for Th1 (Tbet), Th2 (GATA3), Th9 (PU.1), and Treg (FOXP3) in pregnant women with and without COVID-19, and to associate it with clinical outcomes. To this end, 127 pregnant women were recruited (60 COVIDpositive patients and 67 COVID-negative patients), who filled out a clinicalepidemiological form. Blood was also collected for RNA isolation and quantification. After cDNA synthesis, relative quantification of transcription factors T-bet, GATA3, PU.1, and FOXP3 was performed by qPCR. The majority of pregnant women in both groups were multigravida and in their last trimester. Most pregnant women with COVID-19 had mild to moderate forms of the disease and lung involvement between 0-25%. There was a difference in the expression of the PU.1 factor between the groups, with higher expression in pregnant women without COVID-19. Regarding the clinical form of COVID-19, there was also a difference in the gene expression of transcription factors PU.1 and FOXP3. Both were more expressed in the mild forms of COVID-19. In conclusion, PU.1 is the factor that decreases the most during COVID-19 in pregnant women, but despite this decrease, along with FOXP3, it seems to be important in preventing the worsening of COVID-19 in pregnant women

Rheumatoid Arthritis (RA) is an inflammatory, systemic, autoimmune, and progressive disease that causes inflammation and musculoskeletal dysfunctions. RA can have its impact exacerbated by infection with Parvovirus B19 (PVB19) and Epstein Barr virus (EBV), as they promote pain and increase the inflammatory process, leading to greater functional limitations and reduced quality of life. To evaluate the effects of a physiotherapeutic rehabilitation program on the functionality and quality of life of patients with Rheumatoid Arthritis and whether infection with PVB19 or EBV interferes with the effectiveness of the rehabilitation. This is a cohort study with a quantitative, descriptive, and analytical design. Inclusion criteria were: RA patients, aged between 30 and 70 years, with pain, reduced mobility, and/or reduced muscle strength in the wrist and/or hand joints, with difficulty and/or inability to perform manual functional activities. The study was divided into three stages: Rheumatological Clinical Assessment; Laboratory Tests; and Evaluation and Physiotherapeutic Rehabilitation Program in the context of pain, joint mobility, and grip strength. Results: The study involved women with an average age of 56.95 years, with a prevalence of 46.15% EBV infection and 53.85% PVB19 infection. They underwent the physiotherapy program, which showed positive and significant effects in the EBV and PVB19 groups in terms of reduced pain intensity in the right hand, and in the left hand in the EBV- and PVB19+ groups. Passive wrist joint mobility improved only in the EBV+ group after the intervention, and hand mobility improved in all groups except the PVB19+ group. However, the PVB19+ group was the only group that actively improved all wrist and hand movements after the intervention. The intervention did not show statistical significance in grip strength, measured by dynamometry. Regarding functionality and quality of life, the intervention led to significant improvements in HAQ and CHFS scores, and CIF results were better in terms of joint mobility. In light of these findings, further research is suggested to consolidate the importance of implementing physiotherapeutic programs aimed not only at functional improvement but also at understanding the therapy in response to the peripheral immune responses of RA patients. The results of this study were promising in managing the disease

Cryptococcosis is an invasive fungal infection caused by the inhalation of infectious propagules of Cryptococcus spp., ubiquitous in the environment, affecting different population strata and causing high morbidity and mortality worldwide. The objective of this study is to describe the spatial distribution and clinical outcome of patients diagnosed with the disease in the state of Pará between the years 2009 and 2018. Observational, analytical and cross-sectional research using medical records, correlating clinical-epidemiological and sociodemographic variables of patients registered and diagnosed with cryptococcosis at the regional hospital of lower Amazonas, “João de Barros Barreto” university hospital and Tucuruí regional hospital, belonging to the state of Pará, data from the Tabnet/Datasus system, cases reported in the health surveillance division and SINAN/ SESPA/ Pará, SIM/SESPA/Pará. Spatial study carried out in the epidemiology, territoriality and society laboratory of the Tropical Medicine Center/ UFPa / Pa / Brazil (LETS). Comparative analysis of the clinical - epidemiological and sociodemographic profile of patients belonging to the HRBA, HUJBB observed an increase in the number of cases of cryptococcosis during the study period and in the HRT no cases of the disease were found. In the HRBA, females prevailed (66.67%), illiterate (46.67%), aged between 18 and 59 years (60%), income of one minimum wage (73.33%), married (40%) , the outcome was death not associated with HIV (53.33%), associated comorbidities / SAH and DMII (87.50%), obvious symptoms / nausea and vomiting, sequelae / hydrocephalus, cerebral cryptococoma as the main image, low incidence, high mortality and lethality. In HUJBB, the prevalence was male (61.40%), 1st degree (52.63%), aged between 18 and 59 years old (85.53%), income of one minimum wage (87.72%), single (61 .84%), improvement after discharge as an outcome (58.77%), deaths associated with HIV stood out (74.19%), immunosuppression due to HIV as a comorbidity, CD4 values below 350 cells per mm3 of blood, tuberculosis as a co-infection , symptom found/intense headache, blindness as an observed sequel, pulmonary cryptococoma as the most evident image, high incidence, high mortality and lethality. The spatial analysis found that in HUJBB the highest rate of cases came from the municipalities of Belém (38.59%), Ananindeua (8.77%) and Marituba (4.38%) and in HRBA, Santarém (60%) . The deaths found in HUJBB came from the municipalities of Belém (49.46%), Ananindeua (10.75%) and HRBA, Santarém (66.66%). The correlation of deaths from cryptococcosis and HIV/Aids was evidenced in patients at HUJBB from the municipalities of Belém (38.70%) and Ananindeua (9.67%) and at HRBA, deaths not associated with HIV/Aids prevailed, with an emphasis on municipality of Santarém (33.33%). That said, the
study demonstrated that cryptococcosis, even after its compulsory notification in 2020 in Brazil, still has high rates of illness, deaths and demographic gaps in the state of Pará, and can be considered a “neglected tropical disease” influenced by several economic-social factors and not just considered an “outbreak disease”, thus requiring greater attention from public health bodies due to its ubiquity in human settlements.

Water is the basic element for the development of any form of life. Water treatment systems may not have the desired efficiency and the presence of bacteria resistant to antimicrobials in these micro ecosystems is proven. Water sources in the Amazon region may harbor resistant bacteria, as well as sewage pipes, and the real environmental impact is unknown. Objective: to characterize the resistance of Gram-negative bacilli producing carbapenemases from hospital wastewater and water sources in the city of Belém, Amazon region. Methodology: cross-sectional study, without follow-up, with collection of a sample per point, being: sewage of Fundação Santa Casa de Misericórdia do Pará (FSCMPA), UNA Sewage Pumping Station and Guajará Bay, all collected in 2018. The samples were subjected to analysis by Vitek-II (bioMérieux) for antimicrobial susceptibility testing and genus and species characterization. Polymerase chain reactions (PCR) were performed to confirm the characterization and search for carbapenemase genes. Results: 80 Gram-negative bacteria were isolated, 34 (42.5%) from FSCMPA wastewater, 14 (17.5%) from EEE and 32 (40%) from Guajará Bay. The most common bacterial genus was Enterobacter spp. (34% - 27/80). The genus Serratia spp., Enterobacter spp. and Klebsiella spp. showed higher rates of resistance to the antibiotic colistin. The genus Klebsiella spp. (N = 5) was found in the river with the highest rate of antibiotic resistance (95.2%) and the samples of Acinetobacter spp. were also recovered in the Guajará Bay with the most frequent resistance phenotype (AMP-SAM-PITCXM-CXA-CFO-CAZ-CRO-CPM-IMP-MPM-GEN-CIP, 10/80, 13%). The MDR profile occurred in 17 (21.3%) of the samples, XDR represented 58 (72.5%) and PDR was found in 3 (3.8%) samples of the genus Serratia spp., in hospital effluent. The carbapenemases quantifying gene blaKPC had the highest prevalence (46.4%), followed by blaOXA-58 (17.5%). Only one sample of Pseudomonas spp. was not carrying a resistance gene. Conclusion: The present findings show that sewage discharge can contribute to the dissemination of antibiotic resistance genes in the Guajará Bay and the vulnerability of water sources in this region of Brazil. The application of the concepts of One Health, with a multidisciplinary approach, combined with a reformulation of legislation, for control and supervision, are essential factors to mitigate the effects of this problem in the community

Sarcopenia is an emerging problem in people living with HIV, causing worse quality of life, abnormal muscle metabolism, reduced muscle strength and mass, affecting hormones that preserve muscle function and increase longevity. Irisin, secreted by skeletal muscle and adipose tissue during physical exercise, can influence metabolic disorders and better muscle quality, mitigating sarcopenia. By reducing the effects of immunosuppression, Antiretroviral Therapy (ART) is associated with the appearance of HIV Lipodystrophic Syndrome (IVLS). To evaluate the association between sarcopenia and irisin levels with metabolic changes and body composition in patients with Lipodystrophic Syndrome secondary to antiretroviral therapy. Cross-sectional study, with a descriptive and quantitative approach, which evaluated sarcopenia and irisin levels with body composition and metabolic changes in patients with SLHIV. In 82 patients we collected the type of Lipodystrophy, lipid and glucose profiles, sarcopenia based on the SARC-CalF tool and, in 32 participants, serum irisin levels and bioimpedance. RESULTS: A mean age of 54.86 ± 13.33 years was observed; mixed dyslipidemia, BMI of 26.76 kg/m² and overweight in 39% of participants; mixed lipodystrophy, both in sarcopenic and non-sarcopenic patients; 66 participants without sarcopenia and 16 sarcopenic, with no significant association with sex; 80% without sarcopenia were sedentary, in contrast to 18.2% who were active sarcopenia, without statistical significance; related to irisin, mean of 352.96 ± 153.50 pg/mL, significant with visceral fat (p= 0.050*) and not significant with sarcopenia. We identified risk factors for sarcopenia, such as viral load, mixed lipodystrophy and physical inactivity. The correlation of irisin with visceral fat may represent a form of compensatory mechanism for the adipose abnormality found. Due to the lack of a control group and the small irisin sample, more studies are needed to evaluate sarcopenia and irisin levels in SLHIV.

In January 2020, the World Health Organization (WHO) officially declared the COVID-19 pandemic as a public health emergency of global concern. Due to the multisystemic and heterogeneous involvement both in the acute phase and in Post-COVID-19 Syndrome, otorhinolaryngological manifestations associated with Post-COVID-19 Syndrome have been the subject of great interest. The work aims to evaluate the clinical, epidemiological aspects and otorhinolaryngological sequelae of patients treated at a reference center in Belém-Pará. The sample consisted of 71 individuals, predominantly women (76.06%), with a mean age of 55.61 years, mixed race, from the city of Belém, with the most prevalent comorbidities diabetes mellitus and systemic arterial hypertension. A difference was observed between the symptoms prevalent in the acute phase and after COVID-19, with a decrease in inflammatory symptoms related to the classic symptoms of COVID-19 and an increase in persistent otorhinolaryngological complaints, especially nasal obstruction (38.03%), odynophagia (30.99%), hearing loss (23.94%), tinnitus (22.54%) and hyposmia (22.54%). The treatment indicated after the consultation mainly included the use of topical corticosteroids and nasal lavage, with a predominance of a complete vaccination schedule, with the most requested tests being pure tone audiometry and fibronasolaryngoscopy. Most patients did not have otorhinolaryngological complaints prior to the infection and there was no significant difference between vaccination and treatment instituted in the acute phase with the findings found in the physical examination

The emergence of COVID-19 has brought several challenges to global health, both in the hospital environment and in the community. The use of empiric antibiotic therapy, overcrowded health units, weaknesses in contact precautions, health professionals who are poorly trained in hand hygiene measures, among other factors, have influenced those previously announced by the World Health Organization, such as the superbugs pandemic, as the main cause of death by 2050. This objective study evaluates the impact of the COVID-19 pandemic on the profile of bacterial resistance in healthcare-associated infections of the lower tract infections (HAI/TRI), in an intensive care unit, in a private hospital, located in the city of Belém-PA. This is a retrospective and analytical cross-sectional study, in which the resistance profile of HAI/TRI bacterial isolates was evaluated over five years (2018-2022). Drug Resistance was contemporary according to the presence of resistance of bacteria to multiple antimicrobials (MS: multidrug-sensitive bacteria, MDR: multidrug-resistant, XDR: extensively drug-resistant and PDR: resistant to all drugs) and resistance was categorized by class antibiotic of the most prevalent isolates. The review of IRAS notifications prepared by Hospital Infection Control (CCIH) revealed 330 lower respiratory tract infections during the study period. The isolated bacteria had a similar distribution between female and male patients, and the clinical specimens were mostly obtained from tracheal bacterial aspirates. The bacteria with a significant change in the resistance profile between the P1 and P2 periods were P. aeruginosa (p=0.011), K. pneumoniae (p=0.0007) and A. baumannii (p=0.001), with increased profiles MDR, and XDR, and strains with PDR profile, in 2020 and 2021. In the analysis by antibiotic class, there was a significant increase in A. baumannii resistance to carbapenems and K. pneumoniae resistance to carbapenems. It is concluded that when comparing the periods, there was an emergence of K. pneumoniae resistant to aminoglycosides and carbapenems; of P. aeruginosa with tendency to resistance to aminoglycoside, carbapenem, 4th generation cephalosporin and antipseudomonal penicillin + beta-lactamase inhibitor; of A. baumannii resistant to aminoglycoside, carbapenem, quinolone, anti-pseudomonal penicillin + beta-lactamase inhibitor and penicillin + beta-lactamase inhibitor and 4th generation cephalosporin

Although the sequelae caused by the SARS-CoV-2 virus are distinct and comprehensive, there is growing evidence proposing that the imbalance in glucose parameters, which can cause hyperglycemia and diabetes, are among the outcomes induced by Post-COVID-19 Syndrome. OBJECTIVE: To analyze the glucose tolerance profile in patients with Post-COVID-19 Syndrome treated at an outpatient clinic in the metropolitan region of Belém, Northern Brazil. METHODOLOGY: This analytical cross-sectional study evaluated 158 patients with Post-COVID-19 Syndrome living in the metropolitan region of Belém, aged over 18 years, with a positive test for COVID-19 and who were already at least 4 weeks after the acute illness. Sociodemographic and clinical characteristics and self-reported symptoms were determined through a detailed questionnaire and the G test was applied for analysis. RESULTS: The study population was mostly composed of women, aged 50-59 years, with high levels of education, who were in a stable union or married, mixed race, with low monthly income, were neither smokers nor elitist. The prevalence of hyperglycemia was 66% and Diabetes 11%, the variables physical activity, family history and HbA1C were statistically significant when compared to the groups with glucose alterations and without glucose alterations. The most prevalent health complications were memory loss, fatigue, loss of concentration, hair loss, weakness, muscle pain, joint pain, headache, anxiety and depression. CONCLUSION: The findings of this study are adding knowledge to improve the organization and structuring of outpatient and hospital health services, in better targeting of clinical care and adaptations of public health strategy for the post-pandemic era.

The emergence of drug-resistant M. tuberculosis poses a serious public health problem, primarily due to the extended treatment duration, increased abandonment rates, and consequent reduction in disease cure rates. It is defined by resistance to at least two drugs, rifampicin and isoniazid. Treatment lasts for a minimum of eighteen months, divided into intensive and maintenance phases. Pyrazinamide is a drug used in the intensive phase of therapy and acts directly on the bacillus, playing an important sterilizing role. Nutritional status is a predictor of therapeutic success rates. However, there are no studies associating nutritional status with the concentrations of this drug in these patients. To evaluate the influence of nutritional status on blood concentrations of pyrazinamide in patients with multidrug-resistant tuberculosis. Patients with multidrug-resistant tuberculosis were followed up at the first, third, and sixth month of the intensive phase of treatment, of both sexes, attending the reference outpatient clinic of the João de Barros Barreto University Hospital (HUJBB) in the state of Pará, from October 2020 to August 2022. Blood samples were collected for drug dosage, a sociodemographic, epidemiological, and clinical research questionnaire was administered, and anthropometric evaluation was conducted to assess the nutritional status of the study participants. Forty-eight patients were included, with a therapeutic regimen of 18 months, using pyrazinamide in the intensive phase of treatment combined with other drugs. Six patients were excluded due to treatment abandonment and death. There was a prevalence of males (64.2%), 52.3% aged between 41 and 60 years old, self-declared as pardos (73.8%), with education level up to high school (90.3%), and family income equal to or less than one minimum wage (71.4%). Regarding entry type, 92.8% were new cases, and 71.4% had a cure outcome. Diabetes mellitus was prevalent in 33.4% of patients. As for nutritional status, the majority of adult patients were eutrophic (88.1%), and 80% of the elderly were overweight. Arthralgia and gastrointestinal disorders were the most frequent adverse reactions. Pyrazinamide concentrations were similar in the three drug collection stages and were not associated with gender; however, they were significantly lower in overweight patients. Most patients were male adults. The age group between 41 and 60 years old and education up to high school were predominant. Nutritional status for eutrophy prevailed; however, cases of malnutrition and obesity were also found. Pyrazinamide concentrations were similar at different drug collection stages and were not related to gender. Weight and BMI did not correlate with drug concentrations. However, overweight patients at the sixth month of collection showed a significant association with serum pyrazinamide concentrations

Leprosy is a chronic disease that represents a serious public health problem in Brazil. It manifests itself through dermatoneurological signs and symptoms. Considering the context of hyperendemicity of leprosy found in the state of Pará, primary health care makes an important contribution to interventions in the disease transmission chain. The objective was to analyze the repercussions of primary health care from the sociodemographic and spatial perspective of Leprosy in the state of Pará and its health macro-regions (MRS), from 2010 to 2022. An ecological, observational, descriptive-analytical and longitudinal study of leprosy, from 2010 to 2022, from a sociodemographic and spatial perspective, using data from epidemiological indicators from classical epidemiology and geoepidemiology, through analysis of data recorded in the Notifiable Diseases Information System, Secretariat of Primary Health Care, Fundo National Health and Brazilian Institute of Geography and statistics. A reduction in the general prevalence and detection of new cases in general and in children under 15 years of age was observed throughout the analyzed period, as well as a tendency towards a reduction in the general detection rate in the coming years, but with an increase in the proportion of multibacillary cases and grade II disability at the time of diagnosis. The increase in primary care coverage and health spending in the areas of primary care and epidemiological surveillance in the period was accompanied by a reduction in the leprosy detection rate. The human development index – municipality (IDHM) and the average number of residents per household did not influence the detection rate of new cases. The spatial distribution of cases showed a mosaic-like distribution pattern, with several foci throughout the state of Pará. Kernel analysis revealed “hot areas” with the highest concentration of the disease in the metropolitan, southeast and southwest regions of the state and identified high-risk clusters of leprosy cases through Moran's spatial correlation in the southeast and southwest. It was concluded that epidemiological indicators and spatial analysis made it possible to observe that investment in primary health care improves leprosy indicators. Furthermore, it enabled a better understanding of the epidemiology of leprosy in the region, with the identification of areas with situations of risk of illness, more efficiently directing control actions that can promote improvements in the quality of the health service offered, and by resulting in the reduction of this grievance

: The therapeutic regimen for multidrug-resistant tuberculosis must consist of at least four drugs. Levofloxacin is a fluoroquinolone used in both phases of therapy and presents a good therapeutic response. Determining serum concentrations of this drug during treatment is crucial to confirm correct follow-up of therapy and ensure adequate exposure to the medication. OBJECTIVE: To carry out follow-up and therapeutic monitoring of patients with multidrug-resistant tuberculosis undergoing treatment with levofloxacin, measuring the serum concentrations that the drug reaches after the use of therapeutic doses. In addition to associating them with biochemical markers of kidney and liver function and blood glucose and evaluating whether the incidence of adverse reactions influences the exposure of the bacillus. METHODOLOGY: A prospective and analytical case study was carried out, in which adult patients of both sexes were included, with a confirmed diagnosis of multidrugresistant tuberculosis, who underwent 18 months of treatment with levofloxacin. Socioepidemiological data and reports of adverse reactions were collected in questionnaires and serum concentrations of levofloxacin were determined by high-performance liquid chromatography. RESULTS: Of the 42 patients being monitored, 64.2% are male. The disease was more prevalent in people who self-identified as brown or black (88%), with a level of education up to high school (90.3%) and family income less than or equal to one minimum wage (71.4%). Furthermore, 71.4% of patients were cured of the disease. Arthralgia was the main adverse reaction reported both in the intensive and maintenance phases of treatment. Levofloxacin concentrations were similar in the intensive and maintenance phases. No significant difference was observed in liver function, nor was there kidney damage. CONCLUSION: It is possible to conclude that the disease is socially vulnerable and that there was adequate exposure to levofloxacin in both phases of treatment, in addition to the predominance of cure in terms of clinical outcome

Hepatitis C virus (HCV) infection has been considered an important hidden pandemic in the North region,especially in Pará- Eastern Amazon. There is a great variation in the prevalence of infection according to the geographical region studied, reflecting not only distinct epidemiological characteristics among the populations, but differences in the methodologies used to make the estimates. Within this context,the use of the geographic information system (GIS) can bring new approaches to the health process of hepatitis C in the state. The objective of this study was to understand the molecular epidemiology of HCV on the prism of spatial analysis in the six mesoregions of the state of Pará, allowing the characterization of the geographical distribution of this infection, the sociodemographic and clinical profile of the infected population. Through the observational,descriptivedesign of the ecological type of a historical series of cases with a confirmed diagnosis for HCV infection in the period from January 2018 to December 2020, based on information from the Laboratory Environment Management System(GAL) of the Central Laboratory of Public Health Laboratory of Pará (LacenPA) and the notification forms for Viral Hepatitis of the Information System of Notifiable Diseases of the Secretariat of Public Health of Pará(SESPA), the distribution of frequencies and calculation of the average rates of prevalence of infection was carried out with the use of a database in the program Excel 7.0. The statistical tests Chi square, Test G, Analysis of variance and Jurkex test were used to verify the association or comparison of sociodemographic and clinical variables in the Bigestat 5.3 program and with a significance level of 5%. The spatial distribution of the cases was carried out in the Qgis 3.22.5 software to create the coreplectic map according to the mesoregions of Pará. Of the total of 1620 cases of HCV infection detected by molecular diagnosis in the state of Pará, there was a predominance of men (47.16%), age group of 46 to 60 years (47.16%), most with elementary education (57.90%) and selfdeclared brown (53.08%). 5.8% of clothing were identified, with 3.64% cases of HCV/HB and 2.16% of HCV/HIV. The likely sources of HCV infection characterized were other risk behavior (35.58), surgical or dental intervention (17.20%), sexual intercourse (13.23%), transfusion (10.58%), use of injectable/inhaler drugs (7.73%), use of injectable drugs (6.35%), tattoo or piercings (5.43%), hemodialysis (2.12%), accident with biological material (1.19%), transplantation (0.59%) and a case of vertical transmission. The frequency of exposure to these mechanisms of HCV infection were more strongly associated with one gender than the other. The spatio-temporal analysis showed clusters of hepatitis C cases throughout the territory of Pará,and the Metropolitan region of Belém accounted for the highest prevalence rates in the period studied, with an average of 3.6 cases per 100,000 inhabitants. The genotypic frequency of HCV found in Pará from 2018 to 2020 constituted genotypes 1b,1a,3,2,4,1a/1b and 1a/3. Genotypes 1b, 1a and 3 predominated among men over the age of 46 and women over the age of 31.Genotypes 1 and sub-items showed the highest viral load values, regardless of the region in which they were diagnosed.The analyses of this study were effective in building epidemiological scenarios of hepatitis C,emphasizing the need to expand the control of hepatitis in the areas studied.

The infection by the Hepatitis C virus (HCV) represents a serious public health issue, affecting approximately 2 to 3% of the global population. The chronic form of the disease develops in over 80% of infected patients, with 20% of these cases progressing to liver cirrhosis and hepatocellular carcinoma (HCC). Hepatic lesions associated with Hepatitis C result from the body's immune response, not directly caused by the virus. The aim of this study was to evaluate the gene expression of transcription factors and cytokines related to Th1, Th2, and Treg immune responses in patients with chronic Hepatitis C at different stages of liver fibrosis. Participants were recruited from the outpatient clinic of the Núcleo de Medicina Tropical at the Universidade Federal do Pará (UFPA). Blood samples and clinical data were collected from 81 patients, and lymphomononuclear cells were separated using the Ficoll method. Total RNA was extracted from these cells using the Trizol method, and cDNA was synthesized using the SuperScript III kit (Invitrogen). The analysis of constitutive genes β-actin and GAPDH, along with selected genes, was conducted on the StepOneTM Real-time PCR System (Applied Biosystems), using the GoTaq qPCR kit (Promega). Gene expression was calculated using the 2-ΔCT method (ΔCT=CTgene-CTconstitutive). Out of the 81 patients, 36 were women and 45 were men. Among the transcription factors (FTs) and cytokines investigated, GATA-3 and TNF-α showed higher expression, respectively. Genotypes 1a, 1b, and 3 were more prevalent, and again, there was higher expression of GATA-3 and TNF-α. In the association with clinical data, an association was found between platelet decrease and elevated TNF-α expression, increased FOXP3 expression in women with normal ALT levels, and higher IL-4 expression in women with normal AST levels. Positive correlations were found in GATA-3 x T-BET, T-BET x FOXP3 among FTs, and positive correlations between IFN-γ x TNF-α, TNF-α x IL-10 among cytokines. In the correlation of FTs with their respective cytokines, a positive correlation was found between T-BET x TNF-α. Finally, when separated by fibrosis stage, a correlation was found between T-BET x FOXP3 in stage F3-F4. As this is a chronic infection, the data from this study allow us to infer that there is exhaustion of the Th1 response and an increase in Th2, and in more advanced cases of the disease, there is an increase in the Treg response

Rheumatoid Arthritis (RA) is an inflammatory, systemic, autoimmune and progressive disease, characterized by inflammation and structural damage to synovial joints, causing deformities. Its association with certain viruses, such as Parvovirus B19 (PVB19) and Epstein Barr virus (EBV), has been described in the literature. It is believed that the presence of these viruses could perpetuate the inflammatory process in RA, in addition to increasing interleukins 6 (IL-6) and Tumor Necrosis Factor alpha (TNF-α). However, there is no evidence of this relationship in the literature. Objective: To analyze the implications of PVB19 and EBV infections on the expression of IL-6 and TNF-α, and their possible association with clinical refractoriness in the treatment of patients with RA. Method: Descriptive and analytical, crosssectional study, with 116 patients with RA, belonging to the rheumatology outpatient clinic of the Fundação da Santa Casa de Misericórdia do Pará (FSCMPA). This sample was divided into two larger groups: patients treated regularly and patients not treated. The group of patients, treated regularly, was divided into two subgroups: refractory and non-refractory patients. A refractory patient was considered one who did not respond to or failed at least two classes of DMARD medication. Therapeutic failure was assessed during the consultation by the patient's clinic, associated with the Disease Activity Score values in 28 joints (DAS28-ESR). Data were collected from medical records, a questionnaire was administered and blood was collected. DNA extraction was carried out to detect the viruses, followed by RNA extraction and its quantification. Cdna was obtained through RNA, for expression of inflammatory cytokines, by real-time Polymerase Chain Reaction (qPCR). A significance level lower than 0.05 (p<0.05) was adopted. Results: The vast majority of the sample was made up of women aged 46 or over. There were 66 refractory patients, 24 non-refractory and 26 untreated. In the untreated group, there was a higher expression of IL-6, with greater statistical significance compared to the group of non-refractory patients, and a tendency towards increased expression of TNF-α, mainly in untreated and refractory patients, without statistical difference between them. An increase in IL-6 expression was found with an increase in DAS28, but it was not statistically significant. In untreated patients positive for PVB19, there was an increase in IL-6 expression, with statistical significance, when compared to non-refractory patients. Within the group of untreated patients and comparing the infected and uninfected within the group, for both viruses, there was statistical significance for the increase in TNF-α expression in the presence of PVB19. The same was not observed, for this same group, with EBV positivity. Conclusion: The profile of the studied sample was mostly female patients, aged 46 or over, with an average disease duration of more than ten years. The prevalence of PVB19 was 44.80% and of EBV was 43.37%. IL-6 was more expressed in untreated RA patients. TNF-α showed similar expression between groups. Untreated RA patients infected by PVB19 or EBV showed higher IL-6 expression compared to non-refractory and infected patients. TNF-α was more expressed in untreated RA patients infected by PVB19, compared to untreated uninfected RA patients. There was no difference in the expression of IL-6 and TNF-α in relation to the inflammatory activity of patients with RA.

Tuberculosis is an infectious disease transmitted by interpersonal contact. The social determinants related to the disease are mainly socioeconomic factors, leading to a high incidence of cases in low-income communities that live in precarious conditions of basic sanitation, housing and nutritional deficits. OBJECTIVE: To investigate the influence of large enterprises on the temporal distribution of tuberculosis cases between the years 2005-2019 in municipalities in the state of Pará. METHODOLOGY: Retrospective casecontrol was carried out between municipalities in which large industrial enterprises (cases) and municipalities in the same mesoregion and with the same MHDI that maintained their economic base over the years (controls). Data relating to tuberculosis cases, forms of entry and outcome, extension of the health network, access to basic sanitation and the relationship with changes in health determinants resulting from the project were analyzed. RESULTS: All municipalities showed increasing rates of tuberculosis in the period, with the population of Altamira having a higher odds ratio. The main form of entry was new cases, and the outcome was cure. When analyzing socioeconomic data, it was observed that all municipalities experienced population growth over time, which resulted in a reduction in access to basic sanitation (sewage system, garbage collection and public lighting). The health network was mainly made up of Basic Health Units. CONCLUSION: The findings indicate little influence of enterprises on the incidence of tuberculosis as changes occurring in municipalities are often similar between cases and controls

The COVID-19 pandemic solidifies itself as one of the biggest public health emergencies, affecting everyone, yet with different intensities and forms. In this study, we sought to evaluate the health level of patients‘ family members who were hospitalized with COVID-19, in a hospital located in the northeast of Pará, considering the influence of psychosocial factors triggered by the pandemic. Faced with this, the question arises: how did hospitalization affect the mental health of family members of hospitalized patients? To respond to the issues raised, as well as achieve the proposed objective, a methodological path of bibliographic and field research was outlined. In the bibliographical research, sources of reading articles published on the CAPES platform, emphasis on the Federated Academic Community (CaFe) portal, were used, using the following keywords: hospitalization; COVID-19; pandemic; family; caregiver; mental health. Furthermore, articles, books and booklets from FIOCRUZ were used, as this institution has been a pioneer in studies regarding COVID-19 in Brazil, especially with regard to mental health. Regarding field research, two research instruments were used, one being qualitative (four open questions that deal with the family member's experiences during the hospitalization period) which was analyzed based on Bardin's content analysis and the other quantitative (Questionnaire of Goldberg Health which deals with the level of general health) which was evaluated using the chi-square test. Therefore, the main discoveries refer to the singularity and subjectivity of the Amazonian subject, emphasizing the massive presence of women in this place of care. Thus, depressive, and anxious symptoms, sleep disorders, death wish, and factors related to employment and income were predominant in the narratives. That said, it is essential to deepen the aspects related to hospitalization due to COVID-19, thus seeking to create parameters and protocols for public health cases that go beyond the need for isolation, also considering the subjectivity of the Amazon‘s subject.

O Brasil está entre os 20 países que apresentam alta incidência de tuberculose, sendo notificados na pessoa idosa 14.112(2019), 10.449 (2020), 11.469 (2021) e 13.225 (2022) casos novos da doença. No estado do Pará foram 675 (2019), 580 (2020), 675 (2021) e 779 (2022) casos. O idoso apresenta particularidades específicas e problemas de saúde, como a tuberculose. O aumento do número de casos evidencia a complexidade de monitoramento, por esta razão, estratégias têm sido utilizadas para o mapeamento das regiões como o georreferenciamento e geoprocessamento. Objetivo: Analisar a disposição cronológica e geográfica de casos novos de tuberculose e a relação espacial com os Determinantes Sociais em Saúde em idosos, entre 2010 a 2020, notificados no estado do Pará e nos Centros Regionais de Saúde. Material e métodos: Estudo descritivo e analítico, de caráter exploratório, do tipo ecológico, com abordagem quantitativa, realizada no estado e nos Centros Regionais de Saúde, sendo analisados 6.135 casos, registrados no Sistema de informação de Agravo de Notificação (SINAN), disponibilizados pela Secretaria de Saúde do Estado do Pará. A análise espacial foi realizada por Índice de Moran Global e Local, modelagem espacial a partir da Regressão Linear Múltipla e Regressão Geograficamente Ponderada e varredura espacial e espaço-temporal, por meio do software SaTScan. Resultados: Identificou-se homens jovens, raça parda, ensino fundamental, residente da zona urbana, predominância da forma pulmonar, sorologia HIV negativa e ausência de Diabetes Mellitus, baciloscopia positiva, baixa adesão quanto a cultura de escarro, radiografia de tórax de caso suspeito, não realização do Tratamento Diretamente Observado e situação de encerramento do tratamento por cura. Na análise espacial os centros regionais de saúde com maior incidência foram o 9º, 4º e 11º CRS, presença de clusters alto-alto na região Sudoeste do Pará. Na modelagem de regressão espacial o 9º e 10º CRS com maior risco de TB em municípios com menor população ocupada vulnerável à pobreza que retorna diariamente ao trabalho. E o 9º CRS, 12º CRS, 13º CRS, 11º CRS, 7º CRS e 5º CRS apresentaram maiores riscos para TB, ainda que tenham baixo desflorestamento acumulado. Na varredura espacial identificou aglomerado de risco em Belém, Ananindeua e Marituba e no município de Barcarena e Jacareacanga. Na varredura espaço-temporal, verifica-se o município de Belém. Conclusão: As técnicas robustas de análise espacial utilizadas mostraram as regiões mais vulneráveis e expostas à TB em idosos, identificando os principais municípios e Centros Regionais de Saúde o que pode estar relacionado a fragilidade na rede assistencial, capacitações dos profissionais, municípios pobres, com baixa escolaridade, moradia inadequada e crescimento acelerado de algumas regiões. A identificação dos principais Centros Regionais e os Determinantes Sociais de Saúde pode fortalecer as ações de controle para estas regiões, sendo necessário um planejamento, monitoramento e avaliação no controle da TB em idosos

Human papillomavirus (HPV) is the main infectious agent associated with the development of cervical cancer and is the most common and prevalent sexually transmitted infection in women. The estimate of cervical cancer in the state of Pará in 2022 was 19.48/100,000 inhabitants. HPV infections and the advancement of lesions is associated, among other factors, with the persistence of viral DNA in infected cells, mainly by oncogenic types. Another important factor is the genetic variations of the host that may be associated with susceptibility to the development of this neoplasm. Several single nucleotide polymorphisms (SNPs) in DNA repair genes have been associated with persistence of infection and development of cervical cancer. XRCC1 (x-ray Repair cross-complementing group 1) and XRCC3 (x-ray Repair cross-complementing group 3) genes are important components of several pathways of the DNA repair system, which plays a role in protecting the genome from damage caused by carcinogenic agents being, essential in preserving genomic stability. Therefore, the objective of the research is to determine whether there is an association between the polymorphisms XRCC1 Arg399Gln (rs25487) and XRCC3 Thr241Met (rs861539) with cervical cancer. This study included 368 samples of patients with invasive cervical cancer and 153 patients without cancer as control of the study attended at the gynecology service of Ophir Loyola Hospital. DNA extraction from cervical cells was performed and then, for the detection of HPV, the nested-PCR technique was used with the primer oligonucleotides My9/11 and GP5/6; genotyping was determined with TaqMan probes by allelic discrimination method. As a result, no statistically significant association between XRCC1 and XRCC3 SNPs with cervical cancer was identified, with p= 0.3761 and p= 0.2043, respectively. The frequency of the C allele of XRCC1 was 0.67, while that of the T allele was 0.33. The most frequent genotype was the wild homozygous CC. Regarding XRCC3, the frequency of allele G was 0.81, while allele A was 0.19. The most common genotype was wild homozygote GG. The SNPs studied do not increase the risk of developing cervical cancer.

This study determined the prevalence and factors associated with HIV-1 infection in MPS who work in the State of Pará, north of Brazil. This study was composed of biological samples and information from MPS that operate alongside rivers and highways in Pará, north of Brazil. Several sampling methods were used. Information was collected through face-to-face interviews, using a structured form. All samples were tested for the presence of anti-HIV-1/2 antibodies by ELISA. Seroreactive samples were tested for the presence of cDNA-HIV-1 by real-time PCR. Chi-square, Odds Ratio and logistic regression statistical tests were used to establish factors associated with HIV-1 infection. In total, 549 MPS participated in this study. Most participants reported being born in the State of Pará (75%), most declared themselves to be single, heterosexual, non-white, with a mean age of approximately 27 ± 7.5 years (range 18 to 47 years), low level of education. All stated that they practiced oral, vaginal and anal sex, as long as the client paid for the sexual services, the majority (70.4%) reported a monthly income of approximately one minimum wage, the monthly income ranged from 400 to 2100 reais, reported that the value of the sex program cost between R$ 20 and 150, with an average price of around R$ 40.00. In MPS, (16.06%) were identified with anti-HIV-1/2 antibodies. All seroreactive samples showed cDNA-HIV-1. After the bivariate and multivariate analysis, factors were associated with HIV infection: “use of illicit drugs”, “dispensing a condom during sexual intercourse”, “performing anal sex” “dispensing a condom if the client pays more (29.4 %) and with regular clients (16.1%)”, “time in prostitution for more than seven years (50.4%)”, and having suffered episodes of violence, 35 of these MPS suffered from physical violence (60.0%), sexual (8%) violence in the sex trade, and “not having a regular gynecological consultation/exam” and (19.2%) verbalized their displacement from riverside communities in the municipalities of Marajó Arquipélago to others in the state of Pará, to offer sexual services, especially during summer holidays and traditional festivals in the cities of Belém, Bragança, Breves, Marapanim (district of Marudá), Salinópolis and Soure. In short, this study identified relevant information for directing strategies for control, care and prevention of HIV infection in female sex workers who work in the state of Pará.

While 89.3 million people were forced to move around the world in 2020, 2021 saw this number surprisingly increase to 100 million, which corresponds to more than 1% of the world's population. Never in history has such high levels of population displacements been recorded. In this scenario, a group of refugees – the Warao indigenous people – has drawn the attention of Brazilian public health authorities, specifically in the city of Belém, State of Pará. The reasons for this include the high number of migrants of this ethnic group, their cultural singularities, and the poor healthcare access they had in their country of origin, Venezuela. Furthermore, these disorderly migrations of population groups have contributed to the resurgence of vaccine-preventable diseases such as measles. In 2022, Brazil reported 3,061 confirmed cases of measles; 225 of those were reported in the state of Pará. To validate a mobile application to strengthen measles surveillance among Warao indigenous refugees. METHOD: to develop the application, we chose the Human-Centered Design (HCD) method. The HCD is a solution design process based on user empathy. It involves prototyping a healthcare application that offers quick and successive interaction with users. This method consists of three phases: Listening, Creating, and Delivery. In the “Listening” phase, the needs of the Warao indigenous people were examined in terms of cell phone use and vaccine information management. The “Creating” phase consisted of applying different techniques of brainstorming, visual layouting, and synthesizing statements of need to guide rapid prototyping and receive feedback from end-users. In the last phase, the “Delivery”, we applied the System Usability Scale (SUS), which corresponds to a Likert scale, that helped us carry out a preliminary validation of the application and understand the efficiency and reception of the prototype by users. RESULTS: in the first phase – Listening –, 21 Warao individuals were interviewed. The interviews revealed that 91% (n=20) of them lost their vaccination certificate more than 3 times. And these 91% said they would like an app where they could save their vaccination information. After collecting information on how they would like the application to be, we moved on to the second phase – Creating –, in which we thought of all the details regarding the application's system and ran tests to avoid its instability. After that, the application was made available on the Play Store to be tested with a usability scale that corresponds to the third phase – Delivery. The SUS results obtained through the participants was 78.6 points, which is considered excellent. This means the application was usable by the participants. WaraoMedI was the first application designed for the self-management of information by Warao individuals. We expect the WaraoMedI 1.0 application to provide selfmanagement of healthcare and measles information.

The human cell lymphotropic virus (HTLV-1) can cause HTLVassociated myelopathy or tropical spastic paraparesis (PET/MAH) is considered an inflammatory demyelinating disease of the central nervous system, and clinically impairing the cardiac dysautonomia observed by changes in the Heart Rate Variability (HRV). To evaluate HRV in patients infected with human T-cell lymphotropic virus. Quantitative, observational, cross-sectional study with a control group and not randomized. Participants were divided into three groups: HTLV patients with PTS/HAM symptoms (SG); HTLV without symptomatology of PTS/HAM (AG) and the control patients, without the virus (CG). HRV was captured using a POLAR® heart rate monitor, model RS800cx. The distribution of data normality was through the Shapiro-Wilk test. The Kruskal-Wallis test was used to compare the group, and a confidence level of 5%. There were total of 37 volunteers evaluated. The CG had a higher mean age and BMI. At the supine and lying position, AG had a higher mean value of SDNN, RMSSD; as well as the variables: LF, SD1 and SD2; however, comparisons between groups showed no statistical difference. As for the nonlinear variables, close averages were observed with no statistical difference.  In present study, there was no statistical difference in comparison between groups in relation to linear and non-linear variables, both the supine position and the sitting position.

Cervical cancer (CC), also called cervical cancer, starts in your lining tissue and develops slowly, with some normal cells becoming precancerous and later cancerous. It is believed that analyzing the geographic distribution and epidemiological profile of CC cases in the mesoregions of the state of Pará, from January 2016 to December 2021, may contribute with information to strengthen practices and public policies to improve prevention actions. prevention and control of cervical cancer in the State of Pará, aiming to minimize the incidence of cases. This study aims to analyze the geographic distribution and epidemiological profile of Cervical Cancer cases in the mesoregions of the state of Pará, from January 2016 to December 2021. This is an ecological, descriptive, retrospective study, with a quantitative approach, carried out through a survey of secondary data in the Hospital Records of Cancer, installed in Oncological Hospitals, concentrated in the Information DATASUS System, Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE). The study will consider the female population aged 25 to 64 years old with CC in the state of Pará, involving the six mesoregions (Baixo Amazonas, Marajó, Metropolitana de Belém, Northeast Pará, Southwest Pará and Southeast Pará), in the period of 2016 to 2021. The results show that during the years 2016 to 2021, 2,408 cases of malignant neoplasia of the cervix were reported in the state of Pará. Among the investigated mesoregions, Metropolitana de Belém (n:1160; 48.17%), Northeast Pará (n:479; 19.9%) and Southeast Pará (n:307; 12.7%) stood out. The Lower Amazon mesoregion reached the highest rate in 2019 (11.33 cases/100 inhabitants). The Marajó mesoregion deserves special attention, since the incidence of reported cases of the disease has been increasing since 2017. Regarding women affected by the neoplasm, those in the 45-54 age group prevailed in Baixo Amazonas and Marajó, those aged 35 to 44 years in Northeast Pará, Southeast Pará and Metropolitana de Belém. A total of 736,505 cervical cytology exams were performed during the period investigated in the mesoregions. It was observed that the performance of notified tests increased until 2019 and declined by almost half in 2020. It was observed that the number of hospitalizations, deaths and mortality rate are concentrated in the Metropolitan Region of Belém (1785 hospitalizations, 391 deaths and 22 .47% mortality rate). It is concluded that the disease still represents an important public health problem in the mesoregions, mainly in Marajó, where its incidence is increasing. Also, a drop in the performance of cytopathological exams of the cervix was identified, making informational advertisements and the use of strategies about the importance of this exam for the female population, especially for the target age group, essential.

Despite being one of the oldest diseases known to humanity (SANTOS, 2003), leprosy continues to be a globally significant health issue, classified by the World Health Organization as one of the twenty Neglected Tropical Diseases (NTDs). This disease affects individuals of both genders and all age groups, often exhibiting a slow and progressive course. When left untreated, it can lead to deformities and physical disabilities, often irreversible. Muscle strength and mobility alterations in leprosy patients are poorly studied, representing a knowledge gap. In this context, this study aimed to investigate lower limb muscle strength alterations using a portable dynamometer and mobility using the Timed Up And Go Test (TUG) in leprosy patients, while also examining their relationships with demographic and clinical characteristics.This was a crosssectional analytical study conducted on leprosy patients recruited by convenience sampling at the outpatient clinic of the Tropical Medicine Center of the Federal University of Pará in Belém, Pará, Brazil. Muscle strength assessment in these patients was performed using a portable dynamometer, measuring the strength of eight movements on both sides. The TUG test was then conducted on these patients, with test data captured using inertial sensors. After data collection, statistical analysis was carried out using Bioestat 5.3 to generate results that would confirm the association of relevant study variables, considering a 95% confidence interval (CI) and a significance level (α) of 5% (p-value ≤ 0.05). Results were presented in tables and graphs.It was observed that for hip adduction movement on both sides, more than 50% of individuals exhibited strength below the median. The means and medians of lower limb muscle strength assessed by dynamometry were lower in the presence of neuritis for all analyzed movements, with statistical significance for right and left hip flexion and right tibial posterior strength. Analysis of the relationships between strength assessed through the simplified form and clinical-demographic variables showed statistical significance for the presence of neuritis in the right hallux and tactile sensitivity on both sides of the dorsiflexor of the foot. In general, dynamometryderived strength values (Z-scores) were lower when the simplified assessment was altered, with statistical significance for various movements.The average total time for the TUG test (performed on 18 patients) was 11.36 seconds, with 61.11% demonstrating reduced mobility (10 to 20 seconds) and 38.88% displaying normal mobility (up to 10 seconds), according to standard classification. The presence of neuritis resulted in longer test times in the analyzed sample. Leprosy alters patterns of strength and mobility in patients, and strategies to prevent these alterations are necessary

Leprosy is a disease of mainly dermatological and neurological involvement, and neural involvement, called leprosy neuropathy, is closely linked to the cause of the appearance of impairments and physical disabilities, predominantly in the upper and lower limbs. Early detection of leprosy neuropathy is fundamental for the control of injuries and prevention of disabilities in leprosy and therefore, developing accurate instruments for this purpose is fundamental for clinical practice. In view of this, the objective of this study was to develop and validate an instrument for assessing/diagnosing upper and lower limb impairment in leprosy neuropathy, based on the conceptual model of the International Classification of Functioning, Disability and Health (ICF). For this, a study was carried out with the development of health technology, divided into four moments: 1) Development and validation of the instrument, based on a panel of specialists, using the Delphi method; 2) Evaluation of the tool's accuracy, through the establishment of the ROC curve (Receiver Operating Characteristic) and calculation of sensitivity, specificity, positive and negative predictive value. The agreement between the proposed instrument and the degree of disability, considered the gold standard in this study, was also calculated using the kappa coefficient. To assess accuracy and concordance, the proportion of the ICF cut-off point was considered and also estimated using Liu's method. 3) Cross-sectional study to investigate the correlation between the presence and severity of disabilities with activity limitations and participation restriction 4) Exploratory study describing two cases. For all studies with statistical inference, p≤0.05 was considered. It was possible to create an evaluation/diagnosis instrument in multidimensional leprosy neuropathy, of the clinical index type, validated by specialists with six evaluation domains: without disability, mild, moderate, severe and complete. The instrument's performance was better for the cutoff score estimated by the Liu method than by the ICF. When it identifies deficiencies in general through the cutoff score of 10.75, it is accurate and specific, but with poor agreement. The instrument seems to better discriminate mild disabilities, but for severe ones it is not very accurate. By disregarding the most severe deficiencies (GI 2), it showed greater accuracy, sensitivity, specificity and moderate agreement with GI. The two cases studied had GI 0, but one with mild and the other with moderate deficiency. A correlation was observed between impairments and activity limitations and GI; but not with restriction on participation. In general, it can be concluded that the instruments presented can be useful for clinical practice, especially for discriminating incipient and more discreet deficiencies. However, further studies are needed to evaluate other properties of the instrument, as well as better calibrate it to identify serious deficiencies.

The repositioning of drugs was a strategy used to reduce morbidity and mortality attributed to COVID-19. Several drugs were tested in vitro and in clinical studies, such as chloroquine, hydroxychloroquine, ivermectin, and nitazoxanide. These studies used varying doses and treatment frequencies, some of which proved ineffective, while others caused serious adverse reactions. Ivermectin is a low-cost drug used in the treatment of various parasitic infections. In vitro studies characterized the minimum inhibitory concentration for SARS-CoV-2, and the drug was predominantly selfadministered for prophylaxis of the infection. No standardized clinical protocols were followed, and there are no estimates of the number of individuals that used the drug and the doses used. In this context, the present study aimed to estimate whether the plasma concentrations of the drug is within those reported for the therapeutic use of the drug. Patients from the municipality of Altamira with a positive molecular test diagnosis for COVID-19 were recruited, and demographic data and blood samples were collected for ivermectin measurement using high-performance liquid chromatography. A total of 91 patients were included in the study, of which 56% were male. The prophylactic use of non-pharmacological measures was high and similar between sexes. However, the use of ivermectin and other drugs was higher among men. The number of patients with measurable plasma concentrations of ivermectin was 21 (23%). The median concentration was 57.1 ng/ml, ranging from 20.77 ng/ml to 169.6 ng/ml. In male patients, the total number of samples with measurable plasma concentrations was 17 and the median concentration was 65.41 (21.5-169) ng/ml, and in females, it was 45.67 (20.7-100.3) ng/ml. There was no significant difference in drug concentrations between the sexes of the patients. In most of patients, the plasma concentrations of the drug were similar to those reported after its therapeutic use, but four patients presented high plasma levels of the drug. Therefore, it cannot be stated that all patients used the drug safely

The Brazilian Amazon is one of the regions with the highest incidence of leprosy, being a public health pathology and where the individuals with multibacillary type of disease are at increased risk of infection with M. Leprae, presenting physical disabilities and morbidities that directly interferes in maintenance of postural balance. Thus, there is a need to research the association of postural sway with center of pressure through the force platform and inertial sensor to evaluate the balance in leprosy patients. To evaluate the static balance in participants with multibacillary leprosy and health participants through the force platform and inertial sensor and realize clinical and concurrent validation of inertial sensor. This is an observational and transverse study with 30 participants with Leprosy and 30 health participants submitted to evaluation of static balance through inertial sensor and force platform. The participants performed the evaluation though 3 conditions (open eyes, closed eyes and unipodal) and the information of force platform and sensor were processed by Matlab computational routines that were quantified by 4 parameters: Total Displacement, Area, anteroposterior axis and mid-lateral axis.  The parameters obtained a correlation classified as very high between the platform and the sensor. The two instruments showed a significant difference between the unipodal condition and the others in the 4 evaluated parameters and in both groups. The records on the platform indicated that the OF condition presented TD, AP and ML values significantly higher than the hansen group when compared to the control group and the same occurred in the AP parameter in the OA condition. The sensor was able to discriminate most differences between groups or conditions, except for the TD and ML parameters. Not all the differences between the groups found in the COP measurements performed by the platform were confirmed by the COM measurements recorded by the inertial sensor, where the APdisp parameter was the only one that the sensor was able to detect difference between the groups in the OA and OF. In the force platform assessments, participants with multibacillary leprosy showed greater oscillations in all variables, in OA and FO, when compared to the control group, except for Area and parameters TD and MLdisp, which showed different values between groups only when measured with the force platform. This research confirmed the concurrent validity of the inertial sensor with the platform and its clinical validation, demonstrating that this instrument can be applied in clinical environments because it is low cost and easy to use and partially confirmed the clinical validation. The results found may contribute to public health through the identification of postural control instruments in patients with multibacillary leprosy.

American cutaneous leishmaniasis (ACL) is an infectious, non-contagious, chronic disease caused by about fifteen protozoa species of the genus Leishmania, widely distributed in Latin America and allocated in three subgenera: Leishmania, Vannia and Mundinia. In Brazil, seven species that cause ACL are recognized, six of which belong to the subgenus Viannia [L. braziliensis, L. guyanensis, L. lainsoni, L. shawi, L. naiffi and L. lindenbergi] and one in the subgenus Leishmania [L. amazonensis], which are responsible for a broad clinical and immunopathological spectrum represented by four clinical forms: localized cutaneous leishmaniasis (LCL), borderline disseminated cutaneous leishmaniasis (BDCL), mucocutaneous leishmaniasis or mucosal leishmaniasis (MCL/ML) and anergic diffuse cutaneous leishmaniasis (ADCL). Ulcerated skin lesion is the most common clinical manifestation of the LCL, which is also the most common clinical form of ACL and which can be caused by any of the seven known species. In the BDCL, which can also be caused by any of the seven known species, the infectious condition spreads from the primary cutaneous lesion, giving rise to dozens or hundreds of ulcerated lesions of the ecthymatoid type or infiltrated lesions. The MCL/ML and ADCL forms are the most serious, caused specifically by L. (V.) braziliensis and L. (L.) amazonensis, respectively; the first causes ulcerativegranulomatous nasobuccopharyngeal mucosal lesions, and the second causes cutaneous lesions, mainly nodule-infiltrated, diffusely distributed in the tegument (sparing only the scalp, palms of hands and soles of feet). The ACL pathogenesis is strongly influenced by the immune-genetic system of the host and by the species-specific antigens of the parasites of the subgenera Viannia and Leishmania, with L. (V.) braziliensis and L. (L.) amazonensis having the greatest pathogenic potential in Brazil. The laboratory diagnosis of the disease is based mainly on direct parasitological examination of material collected from skin and/or mucosal lesion, however, its sensitivity is low, 60% on average, while the molecular method is very expensive. For this reason, the immunological, cellular and humoral methods are also applied, however, the one that was used to investigate the cellular delay-type hypersensitivity response, the Montenegro intradermal reaction (“DTH”), is out of use for technical reasons, while the methods that investigating the humoral response can be done mainly through the indirect immunofluorescence antibody reaction (IFAT) and the immunoenzymatic assay (ELISA). In the present work, we used IFAT-IgG to comparatively evaluate the competence (reactivity) of two crude antigens, stage-specific, from axenic culture amastigote of L. (L.) amazonensis and L. (V.) lainsoni in the serodiagnosis of the four clinical forms of ACL; the first, from L. (L.) amazonensis, was already being used in the leishmaniasis laboratory “Prof. Dr. Ralph Lainson” from Instituto Evandro Chagas (“SVSA, MS”) to serve the Unified Health System (“SUS, MS”), while the second, by L. (V.) lainsoni, is a new proposal, aiming to broaden the spectrum of the specificity of the ACL serodiagnosis by IFAT-IgG with an antigen representing the subgenus Leishhamnia [L. (L.) amazonensis] and another representing the subgenus Viannia [L. (V.) lainsoni]. For this purpose, 147 serum samples were used from patients treated at the mentioned laboratory, whose diagnosis was based only on parasitological or immunological (DTH) examination, or on the two associated methods: LCL (132), BDCL (11), MCL/ML (24) and ADCL (7). The main results were as following: 1) the overall reactivity rates of the antigens from L. (L.) amazonensis and L. (V.) lainsoni showed similar results (P> 0,05), 92% and 93,7%, respectively, indicating that both are equivalent from the antigenic point of view; 2) 100% reactivity in the serodiagnosis of the BDCL, MCL/ML and ADCL forms; however, in the LCL form, reactivity revealed less expressive results, 89,4% with L. (L.) amazonensis antigen and 91,6% with L. (V.) lainsoni; the overall means of the serological titers in the 174 serum samples of the four clinical forms also revealed similar values (P> 0,05), such as 386-IgG for the L. (L.) amazonensis antigen and 331-IgG for L. (V.) lainsoni; the mean serological titers in the serodiagnosis of each clinical form showed similar values (P> 0,05) in three clinical forms: LCL (239 x 205), BDCL (960 x 1,105), and MCL/ML (603 x 607), while in the ADCL the observed values (1,280 x 777) revealed that the average of the serological titers of the L. (L.) amazonensis antigen was higher (P< 0,05) than that of the L. (V .) lainsoni; the antibody genesis of the ADCL, BDCL and MCL/ML forms was more reactive than that of the LCL, which was the one that presented the lowest antibody genesis in the clinical and immunopathological spectrum of ACL; reactivity rates in the LCL diagnosed only by parasitological or immunological examination (“DTH”), or by the association of these diagnostic methods revealed that the reactivity of these two antigens is independent of the diagnosis method of the LCL form; finally, neither the duration of the disease nor the number of skin lesions interfered with the reactivity of the studied antigens. Based on these results, we conclude that both axenic culture amastigote antigen of L. (L.) amazonensis or L. (V.) lainsoni can be used in the serodiagnosis of ACL.

HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a chronic inflammatory disease that causes lower extremities spasticity and/or hyperreflexia and its pathophysiology has not been completely elucidated, but it is known that there is a great immune response participation. Recently, the existence of an intermediate group between asymptomatic patients and HAM/TSP patients, who have an incomplete myelopathy, was observed. This new group confirmation and integration study of the different immune response profiles will help in determining the prognosis and specific care for these patients. To study the integration between gene expression of Th1, Th2, Th17, Th9, Th22 and Treg immune response profiles with the development of neurological signs and symptoms in patients infected with HTLV-1 and the development of clinical conditions. Analytical cross-sectional study with clinical evaluation of Asymptomatic Carrier (AC), Mono/oligosymptomatic (MOS) and HAM/TSP (HAM) patients, blood collection, lymphomononuclear cells isolation, RNA isolation and quantification, cDNA synthesis, gene expression quantification of cytokines and transcription factors for Th1, Th2, Th17, Th 9, Th22 and Treg immune response profiles and data analysis with R Programming Language, to perform Factor Analysis of Mixed Data (FAMD) and cluster analysis. With the FAMD, of the 41 variables, 22 are the most important in the separation of the three groups AC, MOS and HAM. HAM is isolated from the others, with great variables influence, MOS approaches the PA group, but presents differences. The AC group is separated from the MOS by the influence of reflex, EDSS and cytokines and transcription factors decrease. MOS separates from PET by changing strength, gait, EDSS, and increased IRF4. There is a distinct patients group infected with HTLV-1 who are not asymptomatic or HAM/TSP, distinguished by clinical features and cytokines and transcription factors gene expression

Coronaviruses are zoonotic RNA viruses of the order Nidovirales of the Coronaviridae family. Severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) was first identified in Wuhan Province, China, as the causative agent of the COVID-19 pandemic. To describe the circulation profile of SARS-CoV-2 strains in the State of Pará, from 2020 to February 2022, in order to identify the variants of interest (VOI) and of concern (VOC) in the proposed period. 178 samples from respiratory secretions - combined swab (nose and throat) or sputum, positive for SARS-CoV-2, received by the Respiratory Virus Laboratory - LVR/IEC, from the state of Pará, were processed. From these samples, the viral RNA extraction process was performed sequentially using the QIAamp® Viral RNA Mini Kit (Qiagen); RT-qPCR with specific targets using the SARSCoV-2 kit (E/RP) - Bio-Manguinhos (Fiocruz); sequencing on new generation platforms (Ion and Illumina) and Bioinformatics analysis. Of the 178 samples, the presence of 6 clades (19B; 20A; 20B; 20J_Gamma_V3; 21J_Delta and 21K_omicron) and 18 genetic variants, including the three VOCs of (Gamma and Delta and Omicron), and two previous VOIs (N.9; Zeta/P.2), in addition to two variants of national importance (B.1.1.28 and B.1.1.33). In the year 2020, the B.1.1.28 lineage was present in 34 samples (19%); the P.2 (Zeta) strain in 39 samples (21%) and the B.1.1.33 strain in 13 samples (7%) analyzed. In the year 2021, the predominant circulation lineage in Pará was P.1 (Gamma) with 40 (22.5%) sequenced samples, it was still possible to detect the Delta variant in three samples they (AY.43; AY.99.2). In early 2022, of the 28 sequences analyzed, all belonged to the Omicron variant (BA.1 n=4; BA.1.1 n=8; BA.1.14 n= 1; BA.1.1.14 n=1; BA.1.14. 1 n=12; BA.1.22 n=2). The Gamma VOCs and their predecessors have in common their origin in Brazil and within the national scenario they promoted a great epidemiological impact, being responsible for the significant increase in the number of cases of COVID19 in Brazil in 2021. It is also notable the circulation of Delta that has a significant global importance, being the most transmissible VOC, representing a large number of infections in 2021. As in the first half of 2022, the predominance of circulation of Omicron classified as a VOC, responsible for the third wave of COVID-19 in the world

To understand, through the application of questionnaires, unknown variables related to the exposure of pregnant women to people infected with Covid19, observing its impact and relationship with the sociodemographic characteristics of the individuals interviewed. Methodology: This is an epidemiological, observational research of the cross-sectional type, of exploratory nature with a quali-quantitative approach, conducted with pregnant women in the year 2021. The research was conducted digitally through social networks (Twitter, WhatsApp, Facebook, Instagram) and professional organizations. Pregnant women over 18 years old participated in the study. Results: São Paulo (SP) was the state with the highest number of pregnant women (n = 106). The Southeast (n = 175) and South (n = 119) regions were the most prevalent. The most common age groups were 30 to 39 years (n age group (n = 175) and from 21 to 29 years old (n = 132). The majority (n = 272) reported living at home with their family, followed by an apartment (n = 51). Participants reported having children and elderly people in their household. Most said they did not need to be tested (n = 38) and that they had not been tested but would like to be tested (n = 35). The symptoms most commonly reported when infected were dry cough, headache, and sore throat; however, many participants reported being asymptomatic (n = 315). Most have hypertension (n = 49) as a risk factor for COVID-19, in addition to smoking (n = 42) and respiratory disease (n = 39) and diabetes. The data on mental health showed that in 2020, most pregnant women pointed to anxiety (n = 90), technology abuse (n = 83), and stress (n = 69). Most were satisfied with government measures (n = 254) and respondents in favor of a new lockdown. Prevention involved wearing a mask (n = 82 and 206), avoiding crowding (n = 82 and 212), and doing hand hygiene (n = 77 and 197). It is concluded that although pregnant women during the pandemic experienced several moments of mental and emotional stress, social and health service access, and dissatisfaction with government measures, it was possible to observe important preventive measures regarding contact with infected and/or uninfected people: demonstrating a very evident preventive behavior

This study aimed to investigate the factors interfering in the occurrence, severity, treatment adherence and time to clinical improvement of leprosy reactions in cohorts of leprosy patients coinfected with HIV and not coinfected. This is a comparative, longitudinal research between two historical clinical cohorts of leprosy patients followed at the outpatient clinic of the Núcleo de Medicina Tropical of the Universidade Federal do Pará (Federal University of Pará), being cohort 1 formed by 74 leprosy patients coinfected with HIV and cohort 2 formed by 81 leprosy patients not infected by the HIV virus. The results showed homogeneity between the socioeconomic aspects in both groups, with a prevalence of males, age 31 to 59 years, coming from the capital, single, with complete elementary education and family income of up to 1 minimum wage in both groups. Multibacillary cases prevailed in both groups, in group 1 the tuberculoid boderline form prevailed and in group 2 most developed the boderline boderline form. The occurrence of leprosy reactions, in group 1, was more significant in patients aged 31 to 59 years, with the presence of neuritis, drug users, smokers, who lived alone and with no family support network. In group 2, the development of reactions was significant in the age group 16 to 30 years, in the BL and LL clinical form, in multibacillary patients, with positive bacilloscopy, with the presence of neuritis and who denied drug use and smoking. Reaction episodes of moderate severity prevailed in both groups. Adherence to treatment of leprosy reactions was higher among the non coinfected individuals, while in group 1 non-adherence was associated with drug use and living alone. The longest time to clinical improvement in group 1 was associated with smoking and longer reaction episodes. In group 2, the longest time to clinical improvement was associated with cases that developed type I and II reactions, with moderate severity and longer-lasting reaction episodes. The duration of reactions and time to clinical improvement was shorter in patients coinfected with leprosy and HIV than in those not coinfected. This study demonstrated the importance of drug use, smoking, living alone and the absence of a family support network in the occurrence of leprosy reactions in patients coinfected with leprosy/HIV, as well as in the non-adherence to treatment of reaction episodes.

The study was based on the public health scenario experienced during the new coronavirus (COVID-19) pandemic, caused by SARS-CoV-2, which presents a varied clinical spectrum from asymptomatic infection to severe cases. According to the World Health Organization (WHO), about 81% of cases have mild or moderate disease, 14% progress to severe disease and 5% are critical. Some important examples of comorbidities that can worsen the development of the disease are components of MS, such as hypertension, DM and obesity, which can significantly increase the risk of hospitalization and mortality in patients with COVID-19. The research aimed to evaluate the relationship between MS and the clinical picture in COVID-19 infection. This is a cross-sectional analytical study, where the existence of MS is the exposure variable that was related to the clinical outcome of COVID-19 (mild to moderate and severe), based on sample data (n=245) from individuals treated at UEPA's Comprehensive Health Care Program for Post-Covid-19 Patients and at NMT's Project for Epidemiological, Clinical and Laboratory Assessment of Patients Post-Infection with SARSCoV-2. The results demonstrate that the association of MS and the clinical picture of COVID19 demonstrate a significant result for the NCEP criteria with p < 0.02, with 34.9% of patients with MS developing COVID-19 in the severe form and 65 .1% were mild to moderate. However, for the classification of MS using the IDF, the results were not significant (p- >0.05). In the multiple logistic regression, it was observed that the variables that were independently associated with the severity of the clinical condition were male gender, age (years) and MS according to the NCEP classification. The data acquired and analyzed allowed us to conclude that patients with MS have a higher risk of developing severe COVID-19

The advent of high potency antiretroviral therapy (ART) increased the life expectancy of people living with HIV/AIDS, and with that an increase in pathologies and complications inherent to aging, to the ART side effects and the action of the virus itself. Among these, several metabolic alterations are observed, highlighting alterations in bone metabolism. Therefore, this study evaluated the activity of metalloproteinases type 2 and 9 (MMP-2 and MMP-9) in people living with HIV/AIDS using antiretroviral therapy and who had reduced bone mineral density (BMD), compared to PLWHA without changes in BMD. Tissue inhibitor TIMP-1 expression and its correlation with MMP-2 and MMP-9 and oxidative stress were also evaluated. This work was carried out at the lipodystrophy outpatient clinic of the Jean Bitar Hospital, in male patients with the HIV virus, and who were using ART, with and without BMD reduction, who were submitted to a questionnaire, laboratory tests with biochemistry and hormone dosages, bone densitometry and collection of 1ml of plasma for metalloproteinases, TIMP-1 and oxidant enzymes evaluation. It was observed that 60.4% of the sample had reduced BMD, the majority being osteopenia, with a predominance of lumbar spine reduction. Regarding traditional risk factors, there was no statistical significance, except when age associated with stratification of hypogonadism was evaluated. No statistical difference was observed between the groups regarding the assessment of oxidative stress. An increase in MMP-2 and TIMP-1 in the study group was observed in the sample, with statistical significance, being considered independent risk factors in relation to the reduction of BMD. As for MMP-9, there was no difference between the groups. Therefore, both conditions, osteopenia/osteoporosis, regarding HIV infection and its treatment interfere in the behavior of metalloproteinases and TIMP-1 , but there are other factors that can influence the osteogenesis of these individuals.

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), emerged in late 2019, causing coronavirus disease 2019 (covid-19), which has a wide spectrum of clinical expression, ranging from asymptomatic to severe illness. SARS-CoV-2 can infect individuals of any age group, but pregnant women represent a susceptible population because they have altered immune responses so as not to reject the fetus. In the SARS outbreak in 2003, and MERS in 2012, pregnant women had worse outcomes compared to non-pregnant women. The immune response in covid-19 is an important point in the development of the severe disease pictures, mainly related to the cytokine storm. Cytokines such as IL-2, IL-4, IL-6, IL-10, and chemokines such as CCL12, CCL13, CCL10, IP-10, MCP-1 and MIPs are highly expressed in patients after SARS-CoV-2 infection. Focusing on chemokines, which are responsible for immune system cell traffic, their role in covid-19 is not yet well clarified, especially in pregnant women. With this, this study evaluated the importance of chemokines, in particular MCP-1, MIP-1β and IL8, in the clinical pictures of covid-19 in pregnant women. Therefore, we conducted a crosssectional analytical study at the Santa Casa de Misericordia Foundation of Pará and at the Laboratory of Immunopathology, Center for Tropical Medicine, Federal University of Pará. Epidemiological and clinical data were collected using a structured form, as well as dry tube blood collection was performed for serum separation from pregnant women with and without covid-19. Quantification of the chemokines MCP-1, MIP-1β and IL-8 was performed using the Bio-Plex system (Bio-Rad) (xMAP technology) with the Bio-Plex Pro™ Human Cytokine 17- plex Assay kit (Bio-Rad). A total of 78 patients participated in this study, 39 pregnant women with covid-19 and 39 pregnant women without covid-19. The pregnant women with covid-19 had the highest quantification for MCP-1, with low quantification for IL-8 and MIP-1β. As for the pregnant women without covid-19, the highest expression was for MIP-1β, with lower expression of MCP-1, followed by IL-8. MIP-1β showed higher quantification in the control group, compared to the group of pregnant women with covid-19. Comparing the expression of IL-8 in the 3 stages of covid-19, it was found that its expression increased with the worsening of the disease. MCP-1 and MIP-1β showed no differences in expression in the different stages of covid-19. Regarding lung involvement, the expression profile of the 3 chemokines was similar in the group with 0-25% involvement and 50-75% involvement. The expressions of the 3 chemokines, IL-8, MCP-1, and MIP-1β, were higher in the group with 50-75% lung involvement

The Human T Lymphotropic Virus (HTLV) is a retrovirus with the most prevalent HTLV1/2 subtypes and is associated with adult T-cell leukemia and myelopathy where transmission by unprotected sexual intercourse stands out as one of the factors of viral propagation. Thus, the present study sought to assess the incidence of HTLV1/2 among sex workers in municipalities in the Amazon region. This work is based on a cross-sectional study with biological and socio-behavioral data of female sex workers in 19 municipalities and 18 riverside communities in the state of Pará. As a result, it was correlated that most of the participants are women, single, black or brown, heterosexual, with low education and monthly income. 19 samples with proviral DNA were identified, where 13 are HTLV-, 1 strain of subtype 1a (Cosmopolitan), with 12 samples classified in subgroup A (Transcontinental) and 1 sample in subgroup B (Japanese), 06 samples as HTLV-2 strains (2b and 2c) and 06 had positive results for other viruses, such as: HIV, HBV, HCV. It is concluded that risky sexual behavior contributes to the acquisition and spread of the virus and the inefficiency of the health system makes the need to implement public policy actions aimed at people infected with HTLV.

Syphilis represents an important public health problem, as it is a systemic disease, exclusive to humans, caused by the bacterium Treponema pallidum. This pathogen is transmitted mainly by sexual and vertical routes and its spread is greater in the early stages of infection. The transmission rates of this bacterium are related to a series of social, biological, cultural, and behavioral factors that influence the occurrence of infections in the population, among these factors, behavioral issues, such as unprotected sex and the use of illicit drugs, can increase the risk for sexually transmitted infections (STIs). The rates of syphilis and viral co-infections among people who use crack-cocaine (PWUCC) were assessed in this study. This cross-sectional study relied on biological and self-reported sociobehavioral data from a convenience sample of 990 PWUCC from twenty-six municipalities in the states of Amapá and Pará, northern Brazil. Blood samples were collected to assess the presence of Treponema pallidum using the Rapid Qualitative Test (RQT) and the Venereal Disease Research Laboratory (VDRL). Reactive samples by RQT were used to assess the presence of HBV, HCV, and HIV-1 using Enzyme Immunoassay (EIA) and Polymerase Chain Reaction (PCR). Logistic regression models were used to determine the association of variables assessed with syphilis. In total, 287 (29.0%) of the PWUCC sample had reactive results for syphilis. HBV (15.7%), HCV (5.9%), and HIV-1 (9.8%) were detected among PWUCC with syphilis. Young age, low monthly income and education level, long duration of crack-cocaine use, condomless sex, multiple sex partners, and exchange of sex for money/drugs were associated with syphilis. The present study provides unique insights on the epidemiological status of syphilis among PWUCC in northern Brazil, with multiple implications for improving urgent interventions for diagnosis, prevention, and treatment.

Recent studies have already shown that the formation and development of the child during pregnancy can be affected by numerous variables, such as maternal nutrition and exposure to neurotoxic substances. The objective of this research is to verify the correlations of the concentrations of Total Hg in different biomarkers of prenatal exposure and their association with the weekly consumption of fish, açaí and Brazil nuts, in the Xingu region. This was a descriptive and analytical cross-sectional study, involving parturients who had their deliveries in the maternity hospital located in the Xingu region, attended at the Hospital Geral de Altamira, São Rafael (HGASR), in the municipality of Altamira-PA. The total mercury concentration was measured by atomic absorption spectrophotometry. Of the total number of parturients who participated in the study, 105 pairs of mothers and children, none had mercury values above 1 µg/g. The average concentration of HgTotal in hair was 0.314 µg/g, for the placenta the values were 0.0795 µg/g and in the umbilical cord 0.0775 µg/g. Among the mothers' demographic characteristics, 77.14% were over 20 years old, 82.00% of them were brown and most of the interviewees had no income (34%). Among those who consumed fish, most had low consumption, and mercury levels were 0.104 μg/g for placenta, 0.085 μg/g for hair and 0.0302 μg/g for the umbilical cord. Among those who consumed chestnuts, most had low consumption, and mercury levels were 0.109 μg/g for the placenta, 0.602 μg/g for the hair and 0.079 μg/g for the umbilical cord. Among those who consumed açaí, most had low consumption, and mercury levels were 0.112 μg/g for the placenta, 0.531 μg/g for the hair and 0.113 μg/g for the umbilical cord. The results show low levels of HgTotal in the three bioindicators studied and no correlation of HgTotal concentrations between them.

There is growing concern of the toxic effects of chronic exposure to methylmercury through fish consumption in Amazonian riverine communities impacted by intense gold mining and deforestation in the region. In this context, the objective of this study was to evaluate dietary characteristics in relation to metabolic syndrome (MetS) in communities exposed to chronic contamination by methylmercury. For this purpose, an epidemiological, cross-sectional, analyticaldescriptive study was carried out with 233 participants from the riverside communities of Barreiras (BAR) and São Luiz do Tapajós (SLT) located in the Tapajós basin. A semi-structured questionnaire was applied to identify the socio-demographic and epidemiological characteristics and to determine the food profile of the populations studied. Hair samples were collected from the occipital region for the determination of total mercury using the atomic absorption spectrophotometry technique. Metabolic syndrome was defined by the revised NCEP ATP III criteria using the participants' biochemical, anthropometric, and blood pressure data. Data tabulation and analysis were performed using the IBM SPSS statistical package®version 10.0.1, adopting a significance level of 5% (p-value < 0.005). In the analysis of the results it was identified that MetS had an overall prevalence of 17% among the participants, with a higher occurrence in older people and among those classified in the highest quartiles of mercury concentration, and a predominance of a lower quality diet was observed in both groups with and without MetS. The SLT community had higher exposure to methylmercury associated with more frequent consumption of fish and the presence of hypertension. Income, education, smoking contributed to lower dietary quality in the surveyed communities, and higher consumption of fiber-rich foods was related to lower levels of capillary mercury. These findings reinforce the need for continuous monitoring of the health situation of the Tapajós communities in other study approaches, in order to confirm the relationship of mercury, diet quality, manifestation of MetS and other comorbidities.

The study aimed to investigate the association of oxidative and antioxidant markers in nonspecific squamous and glandular alterations of the cervix (ASCUS, AGUS) LSIL. In addition to associating altered levels of MDA and GSH with possible reported comorbidities, consumption or not of fruit, frequency of physical activity, in addition to HPV infection. The research involved women from the city of Belém, aged between 18 and 65 years, assisted by the Uterine Cervical Cancer Prevention Program (PCCU), which is part of an extension project of the Federal University of Pará (UFPA) developed at the Center for medicine. Tropical (NMT/UFPA). The study was developed over a period of 12 months. For the quantification of antioxidant markers, the technique of analysis of reduced glutathione (GSH) was applied. Likewise, for the quantification of the oxidative marker, the measurement of malonaldehyde (MDA). Sociodemographic, epidemiological, reproductive, food and frequency of physical activity information were obtained directly from the patient using the PCCU Form of the Ministry of Health (MS) in an interview prior to collection with the participants. Women with cytopathological alterations had no difference regarding their level of education, were single and had low income. In addition to not performing the PCCU regularly, they also had important risk factors for the emergence of STIs and HPV infection, such as not having knowledge about HPV and having spontaneous bleeding outside the menstrual period. Women who were diagnosed with cytopathological changes had plasma MDA levels >3.54 µM. A significant correlation was also observed between women older than 48 years and MDA levels < 3.54. As for the women who tested for glutathione, the women who were compatible for HPV DNA had equivalent levels of >61.29. However, no statistically significant difference was found between the age of the participants and the levels of GSH. Therefore, it is believed that the Oxidative stress is not interfering with the evolution of cytopathological alterations, other risk factors, already known, may be contributing to the appearance of precursive lesions of cervical cancer

Leprosy is a potentially stigmatizing chronic infectious disease. In Brazil, treatment is based on the multidrug regimen proposed by the World Health Organization (MDT-WHO). Cutaneous hyperpigmentation is one of the main adverse effects found in leprosy patients who use clofazimine. Such an adverse effect has already been described as intolerable for revealing the diagnosis and being able to contribute to social stigma by affecting self-esteem and adherence to treatment. (1) To quantify skin color variation in clofazimine-induced hyperpigmentation during and after treatment; (2) To verify the stigma related to the change in skin color and the impact of this adverse effect on treatment adherence. Methodology: The observational study was conducted at the Specialized Reference Unit – URE – Marcello Candia, located in the municipality of Marituba, Pará, Brazil. Objective measurements of hyperpigmentation were made using a spectrocolorimeter with CIELAB color system, analyzed by the Individual Typology Angle (ITAº). Photographic records and interviews with a structured electronic questionnaire were also collected, followed by the application of the Stigma Scale for People Affected by Leprosy (EMIC-AP). The study consisted of men (25) and women (26) over 18 years of age. The change in skin color induced by clofazimine is not homogeneous, while in other patients hyperpigmentation seems to follow the lesions of the disease. The most affected area for the hyperpigmentation was the face. The ITAº values show hyperpigmentation (darker skin) assuming more negative values in areas of lesions when compared to areas without lesions, mainly in areas exposed to the sun. The average EMIC-AP overall score was 18.8 points, the stigma of the disease was greater among women and the color change caused by clofazimine had a negative impact on self-esteem and interpersonal relationships, causing feelings of sadness in the study volunteers. Clofazimine-induced cutaneous hyperpigmentation was an adverse effect quantitatively detected in all patients in the study and strongly impacted the social domain and intersectionality of stigma, disease and skin color, contributing to the social isolation of these patients.

Mercury manifests itself in the environment in different species, which are classified as organic and inorganic. Among the inorganic compounds associated with mercury, the mercuric ion (Hg2+) can be highlighted as the most recurrent, whereas in the organic form the most common species is methylmercury (MeHg). Despite the large number of studies already carried out in the Amazon, it is questionable how much these studies are comparable, since each study has its own characteristics and that bring them closer or further away from each other. Traditional inferential statistics have difficulty looking for relationships in a multidimensional context and the use of machine learning tools that use different programming logics can help to group these studies in terms of similarity or differences in the characteristics of these studies. This work aims to describe a method of grouping data extracted from articles that investigated total mercury exposure in humans in watersheds in the State of Pará, Brazil. A literature search was performed in the following electronic databases: PubMed, MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Scopus, Web of Science and Google Scholar. Terms related to mercury exposure in human populations (Mercury and exposure and hair and concentration) were searched. Studies cited in more than one database were counted only once. After selecting the studies, a manual search was performed in the reference list of each article, in order to include additional studies. The following data were extracted from the selected articles: Sample size, Sample size of female population, Sample size of male population, Sample size of child or adolescent population, Size of adult population, Presence of mean age, Presence of information on the number of meals daily or weekly, Occupation, Average total mercury concentration in the hair, Presence of measures of dispersion of the total mercury concentration in the hair, Indication of the place of residence of the populations studied, Indication of functional alterations of the populations studied, Indication of sample selection of populations studied. A procedure for calculating dissimilarities between observations of a data set was performed based on Kaufman and Rouseeuw (1990). An algorithm was used to calculate dissimilarities for mixed type variables, that is, variables that can be numerical, binary, ordinal and nominal. For this, computational routines programmed in MATLAB R2020a language were used. Initially, a function called daisy( ) was used, which is an integral part of the LIBRA library for MATLAB (LIBrary for Robust Analysis) and the Gower distance was used to calculate the dissimilarity distances. Finally, each grouping of observations was described based on the characteristics used in their classification. A total of 126 studies were selected, which are listed in APPENDIX A. Each study was given a number so that it could be identified after classification by machine learning. Seven different methods of measuring distances between the characteristics were used in the clustering algorithm, and for each method the studies were classified into 10 groups, generically called G1, G2, G3, G4, G5, G6, G7, G8, G9 and G10. In order to choose the distance method that best divides the studies into 10 groups, the coefficient of variation of the number of studies per group was evaluated in each condition of distance metric used. Therefore, the distance metric that showed the least variability in the number of studies in each group would have the lowest coefficient of variability and would be the distance metric chosen to follow in subsequent analyses. Ward's distance metric was the one with the lowest standard deviation value in the number of studies per group and the one chosen for the sequence of analyses. To assess which of the groups presented the smallest distance between the members of the groups, the coefficient of variation of the distances of the elements of each group was calculated. Comparing between the groups, it was observed that the group with the lowest distance between components was GROUP 5, while GROUP 6 was the one with the greatest distance between the elements within the group. Group 1 was characterized by the fact that most studies did not present information related to the sex of the population. Most of them had an average age. The number of weekly meals was xii not reported in any of the studies that make up the group, in relation to the profession, all are composed of riverside dwellers. The average concentration of total mercury in the hair was reported in all studies, on the other hand, measures of dispersion of mercury concentration were not reported in most studies, in the variable place of residence of the populations studied, all studies in this group took place in areas not urban. Functional changes were reported in all studies. Regarding the sample selection of the populations studied, they were not informed in half of the studies, while in the other half of the studies they were informed. Group 2 was characterized by the fact that most of the studies did not present information related to the sex of the population. There was no mean age for the most part. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, on the other hand, measures of dispersion of mercury concentration were not reported in most studies, in the variable place of residence of the populations studied, all studies in this group took place in areas not urban. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were not informed in most studies. Group 3 was characterized by the fact that most studies did not present information related to the sex of the population. There was no mean age for the most part. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in most studies, whereas the dispersion measurements of mercury concentration were not reported in half of the studies, while in the other half of the studies they were reported in the variable place of residence of the populations Most of the studies in this group took place in non-urban areas. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were not informed in half of the studies, while in the other half of the studies they were informed. Group 4 was characterized by the fact that most of the studies did not present information related to the sex of the population. Most of them had an average age. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, whereas the dispersion measures of mercury concentration were not reported in most studies, in the variable place of residence of the populations studied, most studies in this group occurred in areas not urban. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were informed in most studies. Group 5 was characterized by the fact that most studies did not present information related to the sex of the population. There was no mean age for the most part. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, whereas the dispersion measures of mercury concentration were not reported in most studies, in the variable place of residence of the populations studied, most studies in this group occurred in areas not urban. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were informed in most studies. Group 6 was characterized by the fact that most of the studies did not present information related to the sex of the population. It's a group predominantly adult, because of the 5 studies listed, it presents the sample size of the adult population in 3 studies. There was no mean age in all studies. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, all studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, on the other hand, measures of dispersion of mercury concentration were not reported in most studies, in the variable place of residence of the populations studied, all studies in this group took place in areas not urban. Functional changes were reported in all studies. Regarding the xiii sample selection of the populations studied, they were informed in all studies. Group 7 was characterized by the fact that most of the studies did not present information related to the sex of the population. Most of them had an average age. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, whereas the dispersion measures of mercury concentration were not reported in most studies, in the variable place of residence of the populations studied, most studies in this group occurred in areas not urban. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were informed in most studies. Group 8 was characterized by the fact that most of the studies did not present information related to the sex of the population. It is a mostly adult group, because of the 16 studies listed, it presents the sample size of the adult population in 15 studies. There was no mean age for the most part. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, on the other hand, measures of dispersion of mercury concentration were reported in most studies, in the variable place of residence of the populations studied, most studies in this group took place in areas not urban. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were not informed in most studies. Group 9 was characterized by the fact that half of its studies presented and the other half of the studies did not present information related to the sex of the population. It is a predominantly children's group, because of the 14 studies listed, it presents the sample size of the child population in 8 studies. There was no mean age for the most part. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, whereas the dispersion measures of mercury concentration were not reported in most studies, in the variable place of residence of the populations studied, most studies in this group occurred in areas not urban. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were not informed in most studies. Group 10 was characterized by the fact that most of the studies did not present information related to the sex of the population. It is a predominantly adult group, because of the 18 studies listed, it presents the sample size of the adult population in 12 studies. There was no mean age for the most part. The number of weekly meals was not reported in most studies that make up the group, in relation to the profession, most studies are composed of riverine people. The average concentration of total mercury in the hair was reported in all studies, whereas the measures of dispersion of mercury concentration were reported in most studies, in the variable place of residence of the populations studied, all studies in this group took place in non-urban areas. Functional changes were reported in most studies. Regarding the sample selection of the populations studied, they were informed in most studies. Despite the characteristics of the sample size of adults, the average age of the sample and sample selection method were the ones that showed significant differences between the groups, it is important to emphasize that the formation of the groups is already a rigorous procedure for identifying similarities between the samples. The statistical significance found for the characteristics described above may indicate that they are more important in this classification found in the study. This thesis innovated by showing a method of comparison of bibliographic studies applied to the study of human exposure to mercury in the Amazon of Pará that can be used by scientists and managers who want greater rigor in the comparison of results of studies of interest for the construction of knowledge or creation of public policies for the exposed population.

Among all biological systems, the central nervous system is the most affected by mercury exposure due to its high toxicity, in its methylmercury format. Objective: To investigate the neuro-musculoskeletal and cardiorespiratory functional alterations of riverside dwellers from Tapajós exposed to mercury resulting from the regular consumption of fish in their diet. Analytical cross-sectional observational study, carried out from 2017 to 2020 with residents of riverside communities known as Barreiras (BAR) and São Luiz do Tapajós (SLT) in the municipality of Itaituba/PA. Hair samples were collected to determine total mercury (HgT) and sociodemographic, dietary and symptomatological data were collected to determine the population profile. The evaluation of the neuro-musculoskeletal system in its sensitive part was performed through functional tests and its motor part through handgrip. The cardiorespiratory balance condition through clinical tests. The results of the HgT analyses, carried out in the Human and Environmental Toxicology. A total of 151 people participated in the study, 43 from SLT and 108 from BAR. HgT levels range from 1.98 to 42.69µg/g, with a mean of 12.79±8.01µg/g in SLT. In BAR, the variation in mercury levels was smaller, from 0.18 to 17.93µg/g, with a mean of 4.65±3.37µg/g. Both in SLT and in BAR, the majority did not have neuro-musculoskeletal and cardiorespiratory alterations, advanced groups of mean levels of HgT only in SLT above what is considered tolerable (6µg/g) by the WHO. The riverside communities of the Tapajós have low levels of exposure to mercury with a small percentage of the population presenting neuromuscular alterations, which cannot be specifically associated with the effects of this exposure, however, clinicaltoxicological monitoring is recommended considering the habit of fish consumption by the population. diet and Hgtotal concentrations found in species frequently consumed by communities

The laboratory diagnosis of American cutaneous leishmaniasis (ACL) needs a tool accessible to the epidemiological reality of the disease in Brazil. Considering that Leishmania (V.) lainsoni is a species that strongly induces cellular immunity, with wide distribution in Latin America and easy cultivation in the laboratory, we decided to evaluate the stage-specific crude antigen of the axenic cultured amastigote form of L. (V.) lainsoni in the laboratory diagnosis of ACL using the Montenegro intradermal reaction (MIR). Thirty-one patients with confirmed diagnosis of ACL (clinical, parasitological and/or serological examination) were included in the aforementioned analysis, twenty-four (24) with localized cutaneous leishmaniasis (LCL) and seven (7) with mucosal leishmaniasis (ML), treated at the outpatient clinic of the leishmaniasis laboratory “Prof. Dr. Ralph Lainson”, Instituto Evandro Chagas (IEC, SVS, MS), Ananindeua, Pará State. To assess reactivity to L. (V.) lainsoni (MHOM/BR/81/M6426) axenic culture amastigote antigen [AMA], crude L. (V.) braziliensis (MHOM/BR/99/M17323) promastigote antigen [PRO] was simultaneously applied to the opposite forearm, which has been routinely used for two decades in the diagnosis of ACL in this service. Higher reactivity to L. (V.) lainsoni axenic culture amastigote antigen (p< 0.001) was observed when compared to the traditionally used L. (V.) braziliensis promastigote antigen, with 100% sensitivity and specificity. The MIR value (mean ± standard deviation) of the 31 patients with AMA antigen (21.0 mm ± 8.5) was higher (P< 0.001) than that of PRO antigen (11.8 mm ± 5.4). When the reactivity was evaluated from the clinical forms of ACL, we observed that the mean of the LCL form with AMA antigen (20.8 mm ± 8.5) was also higher (P< 0.001) than that with PRO antigen (11.6 mm ± 5.3). When the reactivity of these antigens against ML form was evaluated, it was observed that the mean with AMA antigen (21.4 mm ± 8.6) was higher (P< 0.001) again than that with PRO antigen (12.6 mm ± 5.4). These results clearly demonstrate that the L. (V.) lainsoni AMA antigen was more immunogenic than the L. (V.) braziliensis PRO antigen. Thus, it was possible to validate the AMA antigen of L. (V.) lainsoni as an antigenic component of the MIR in the laboratory diagnosis of ACL. These results also indicate that the AMA antigen represents a more accurate tool, capable of meeting basic needs in care units in regions with so little laboratory resources, not only in Pará State, but also in Brazil, with a high incidence of ACL

This research aimed at analyzing the underreporting of tuberculosis cases in Belém, capital city of Brazil’s state Pará, from 2012 to 2016, using the linkage technique between the “Sistema Nacional de Agravos de Notificação” (SINAN) (National System of Notifiable Diseases, in English); “Sistema de Informações sobre Mortalidade” (SIM) (Mortality Information System, in English); “Sistema de Informação de Tratamentos Especiais de Tuberculose” (SITETB) (Information System on Special Treatments for Tuberculosis, in English); and the “Gerenciador de Ambiente Laboratorial” (GAL) (Laboratory Environment Manager, in English). This is an observational, cross-sectional and population-based study, in which the databases were related using the probabilistic linkage method of records through the electronic program OpenRecLink version 3.1. Six blocking steps were performed with manual review at all stages. It was evident that there was underreporting in SINAN in all the analyzed years, and that the system that proportionally presented the highest rates of underreported cases in SINAN was SIM (47.36%, 305/644). Regarding the type of entry, there was a predominance of new cases (42.79%, 273/638), and regarding the clinical form, exclusively pulmonary tuberculosis (93.66%, 576/615) was noteworthy. Specifically related to SIM database, it was identified that most cases in which tuberculosis was considered the underlying cause of death were underreported in SINAN (54.54%, 210/385), whereas the cases classified as an associated cause were mostly reported (63.32%, 164/259), being statistically significant (p<0.0001). As for the incidence coefficient, there was a significant increase in cases, especially in 2015, in which the difference observed was 12.30 cases/100,000 inhabitants. The obtained results are pioneering for a city in the Amazon region, considering that they allowed the identification and measurement of tuberculosis underreporting in SINAN database. The database relationship technique is an important strategy for data systems’ qualification, since the existence of underreporting in the main tuberculosis case registration systems is a challenge that needs to be prioritarity addressed in the city of Belém-Pará, and that there is a necessity to qualify health professionals as well as to guide users on the importance of passing on quality information. The underestimation of the epidemiological situation of the disease has a direct impact on the planning of supplies for diagnosis and treatment, and can also difficult the control strategies and resource allocation, culminating in underfunding of actions

Leprosy is an infectious and chronic disease caused by Mycobacterium leprae, which has a unique characteristic of penetrating the Schwann cells of the peripheral nervous system. The presence of the pathogen in the nerves can trigger neural damage defined by changes in sensory, motor and/or autonomic function, in addition to long-term dysfunction with neuropathic symptoms. This damage associated with the lack of selfcare exposes the patient to a high disabling potential, which keeps the disease in a worrying condition for public health. The diagnosis and monitoring of neural conditions in this population is relevant for early intervention and adequate management, so it is clear the effort of the scientific community to find tools that help in this process. Considering that infrared thermography is a technique that has been studied lately for use in peripheral neuropathies and painful conditions, and aiming to contribute to the scientific basis of its use as an auxiliary diagnostic tool for neural damage in these patients, mainly under complaints, pain and disability conditions. This study sought to investigate neural damage in leprosy patients using a thermography and Semmes– Weinstein monofilament test, in addition to establishing correlations with the occurrence of neuropathic pain, degree of disability and clinical complaints. For this, a cross-sectional study with 25 leprosy patients was made comprising four assessment moments: (1) neurological assessment; (2) Semmes- Weinstein monofilaments assessment in the course of the upper limb nerves (ulnar, median and radial); (3) DN4 pain scale; and (4) Infrared thermography image recording. Clinical variables of interest were analyzed according to the occurrence of pain, clinical complaints and disabilities, using the Mann-Whitney and Pearson Linear Correlation tests to establish correlations. For accuracy in the use of thermography, ROC (Receiver Operating Characteristic) curves were made to establish cut-off points and the screening test, in addition to analysis of agreement with the monofilament test. The results showed that neural damage was more present in the clinical forms of the lepromatous pole, with the ulnar nerve being the most affected, both for the palpation test, as for the monofilament test or thermography tests. The occurrence of pain was associated with more advanced stages of sensory damage and higher temperatures along the nerve pathways. The correlation of sensory damage with temperature in the nerve pathway was in a directly proportional pattern, being mainly influenced by the forearm findings. The leprosy patient with installed deformity showed considerably greater sensory damage than the others, especially in the hands, in addition to lower temperature. Finally, the accuracy of the thermography analysis showed low sensitivity and specificity for the nerve path and low agreement with the monofilament test, which is the gold standard for the analysis of sensory neural damage. In general, this study concluded that the use of thermography in leprosy can be extremely valuable as an auxiliary tool for early diagnosis, differential diagnosis and therapeutic management of pain in leprosy patients. However, more studies are needed for a better understanding of how infrared images behave in the face of variability in disease manifestations.

Yellow fever (YF) is an infectious, febrile hemorrhagic disease that remains endemic and zoonotic in the tropical forests of Africa, Central and South America, causing isolated outbreaks or epidemics of greater or lesser impact on public health. Faced with the need to better understand the pathogenesis of this disease and the factors involved in its transmission and spread among different species of non-human primates (NHP), which serve as sentinels to detect the early circulation of the Yellow Fever Virus (YFV), this study proposes to evaluate and characterize aspects of the virus-host interaction using NHP of the genus Callithrix, based on experimental infection with YFV. To this end, 7 hybrid NHP were selected, through the natural crossing of Callithrix penicillata and Callithrix jacchus, which were in good health and had no antibodies to YFV and other arboviruses. Of these, 6 were infected with YFV (9,7 x 106 PFU/mL) and 1 animal was maintained as a sentinel control. The experiment was carried out for 30 days, and the animals were monitored to observe clinical and behavioral changes, in addition to the collection of biological samples (blood, brain, liver, lung and kidney) on the 1st to 30th days post infection (dpi) , to carry out viral load detection by RTqPCR; analysis of hematological and biochemical parameters; detection of IgM antibodies by ELISA and total antibodies by Hemagglutination Inhibition. The NHP showed no signs of disease or behavioral changes, only a slight loss of body weight. Viremia was detected between 1°-30° dpi and detection of IgM antibodies and total antibodies between 5°-30° dpi. The hemogram showed leukopenia in almost all experimental kinetics, except for the 10° dpi, which showed leukocytosis and lymphocytosis. The coagulogram showed thrombocytopenia at the 5° and 10° dpi. AST, ALT and urea levels increased and creatinine decreased between 5°-10° dpi. The viral genome was detected in blood, brain, liver, kidney and lung during all kinetics, and the liver was the most affected organ with the highest viral load at 3°dpi in liver (3.25 x 107 genome copies/μL). This experimental study had demonstrated that NHP of the Callithrix genus are susceptible to infection by YFV, and that despite not developing disease, they have a high viral load in the blood and in the various organs studied. Thus demonstrating the importance of this genus in the transmission of YFV, and in the possible reurbanization of this disease.

Tegumentary Leishmaniasis is a neglected disease worldwide, caused by the protozoan Leishmania spp. The municipality of Ulianópolis, in the state Pará-Brazil, has an intense reduction in primary forests and growth in housing occupations, a fact that impacts the epidemiological pattern of the incidence of ATL cases. Therefore, it is necessary to carry out analyzes on the food preferencecs of sandflies species of medical importance circulating in the municipality in relation to mammals and humans, and to investigate their infection by the protozoan Leishmania spp. Furthermore, it is essential to investigate the incidente of ATL and indices of deforested areas in the municipality. The sand flies were captured using CDC-type light traps that were installed within three areas of the Nova Vida settlement. Only females of medical important species were selected to carry out the steps of DNA extraction and amplification by Polymerase Chain Reaction (PCR) of the DNA of the Leishmania spp. protozoan and the DNA of possible blood sources. The collected data were discovered through statistical analyzes using the EpiInfo® program. The deforestation rates and forest area per km2 of the municipality of Ulianópolis in the years 2000 and 2020 were provided by INPE. The incidence of confirmed cases of ATL in the municipality are secondary data by SINAN. Subsequently, a map was generated using the QGSIS® program. A total of 1676 sandflies were captured, 43.4% (728/1676) male and 56.6% (948/1676) females in the three areas. The species with the highest frequencies were Ev. Evandroi and Ny. whitmani, with 60.5% (1013/1676) and 36.6% (613/1676), respectively. The results were negatives in relation to the mammalian blood preference and Leishmania spp. It is important to carry out further research aimed at analyzing a protozoan infection and blood food preference in sandflies of medical importance related to ATL transmission, expanding the analysis to other groups of animals, including birds. 894 confirmed cases of ATL were reported in the city of Ulianópolis, between 2007 and 2019, with a relationship with forest degradation, which presented 3622.2 km2 of deforested area in the years 2000 to 2020. New studies are important to expand as permission on the food preferences of sandflies in relation to ATL with deforestation in the municipality.

Human Pegivirus 1 (HPgV-1) is a positive-sense, single-stranded RNA virus belonging to the Flaviviridae family, with limited cause-effect evidence in causing human disease. However, studies have shown an important role in the progression of chronic infection as well as in the development of drug resistance when co-infected with HBV and HCV viruses. Co-infection of HPgV-1 with hepatitis C virus (HCV) is common due to shared modes of transmission, with a prevalence of HPgV-1 viremia of approximately 20% among individuals with chronic HCV infection. This study is relevant to provide new data and increase knowledge about the impact of HPgV-1 in cases of coinfection with HCV in Northern Brazil. Potential donors treated at the blood center of the State of Pará were recruited, with reactive serology for HCV, referred to the Tropical Medicine Center at the Federal University of Pará, for confirmation of diagnosis and treatment when necessary. Blood samples were taken and an epidemiological form was applied. Confirmation of the diagnosis was made through serological testing for HCV, then the positive samples were submitted to polymerase chain reaction (RT PCR) in order to detect viral genetic material of HCV and HPgV 1, and subsequently genotyping was performed of viruses. A total of 147 samples were included in the study from 2015 to 2019: Among participants, 72.1% (106/147) were monoinfected with HCV, with detectable HCV viral RNA, and 27.9% (41/147) co-infected with HCV /HPgV-1. The genotypes frequently found were genotypes 1 and 2 of HPgV-1 (36.6% and 63.4%) respectively, while for HCV there was a predominance of genotypes 1 and 3 (58.5% and 41.5%). No significant differences were found when comparing any risk factors or socio-demographics between the groups. As well as, there was no statistically significant difference when relating the viral genotypes of both agents. This study indicated that the prevalence of infection by the HPgV-1 is high in HCV carriers in Belém, Pará, and probably does not change the clinical course of HCV infection, however, further studies are still needed

The World Health Organization estimated that in 2015, 71 million people worldwide were living with the Hepatitis C virus (HCV), accounting for 1.75 million new cases. HCV causes both acute and chronic hepatitis, ranging in severity from mild conditions lasting a few weeks to severe lifelong disease, progressing to cirrhosis, fibrosis, and hepatocellular carcinoma. Hepatic fibrosis is one of the most significant structural and functional changes, considered one of the main prognostic factors since it allows us to assess the degree of severity and progression of the disease, as well as the choice of therapy and its effectiveness. Objective: To determine the degree of correlation between the level of liver fibrosis, measured by two noninvasive methods, and viral genotyping in patients with chronic hepatitis. Material and Method: Analytical, crosssectional observational study, whose participants were patients with Hepatitis C, seen at the Hepatology Service of the Santa Casa de Misericórdia Foundation of Pará, in the period from April 2020 to August 2021. Participants were selected by the attending physician and referred for genotyping tests and assessment of the degree of liver fibrosis by non-invasive diagnostic methods: elastography (FibroScan) and the ELF (Enhance Liver Fibrosis) score test. The tests were performed before the start of treatment. For genotyping, each sample was used twice, with one reaction for AVA II and one for RSA I, so each sample was separated into two corresponding tubes. Data analysis was performed using Graph Pad Prism 7. Results: Of the 88 patients selected for the study, many were unable to follow through with the analytes and we had to reduce the sample size, due to the Pandemic outbreak (COVID-19). Of the 56 participants remaining in the study, females predominated (55.4%), and the median age was 60 years for males and 62 years for females. The majority were from the metropolitan region of Belém (89.0%). On average, the results of the two methods differ little, with the paired test comparing the score values of the FibroScan Test against those of the ELF Test, being graphically reproduced by the boxplot graph, having the median (middle line), 1st quartile (bottom edge of the box), 3rd quartile (top edge of the box). The vertical lines determine the normality limits, which allow the identification of the two most extreme points (outliers). No statistical difference was evidenced, which allows us to say that the tests present equivalent values. For comparison purposes, since they are scores in different measurement scales, the FibroScan kPa values were transformed into Z scores and then equated to the ELF test score values via linear transformation. The most prevalent viral genotype was 1B (51.8%),1A (28.6%) and G3(14.3%). Conclusion: The results found in this study are in agreement with those found in the literature. Thus, from the similarity found in the results of noninvasive tests, it can be inferred that these can be used in the evaluation and monitoring of the evolution of liver fibrosis in patients with chronic hepatitis, not so only, hepatitis C

Leprosy is a chronic, transmissible and highly prevalent disease and despite having treatment and cure, it still persists as a public health problem in Brazil. Although the disease is not significant in mortality rates, peripheral neural impairment is frequent, accompanied by sensory disturbances and motor changes, with consequent pictures of paresthesia, pain and possible deformities, severely compromising the individual's quality of life. The diagnosis of leprosy is largely established through the clinical manifestations and epidemiology of the patient. Clinical complaints, which can be multiple and present before and after treatment, can become important tools for early clinical diagnosis, impacting on the promotion of quality of life for the patient. Therefore, the objective of this study was to identify the complaints of patients with leprosy and compare them with the clinical and sociodemographic aspects during standard drug treatment and after discharge. An observational, retrospective cohort study was carried out, covering the period from 2010 to 2020, involving 95 leprosy patients examined at different stages of treatment by a multidisciplinary team. The results showed a predominance of male patients, aged between 15 and 30 years, coming from the metropolitan region of Belém, with complete high school, income of up to 1 minimum wage, brown color and with formal employment. The clinical analysis showed that the majority of the sample consisted of patients treated with a scheme for multibacillary cases, clinically MHD, with leprosy reactions during treatment – predominantly type 1 – and without comorbidities. These profiles are repeated in the group of users who maintained complaints even after drug discharge. The results showed that all patients had some complaints at the time of diagnosis and that their frequency decreased throughout the treatment. It was also observed that the complaints were presented in a heterogeneous way among the multidisciplinary team, with neurological complaints being less frequent for professionals who perform the first visit (such as a doctor and nurse) compared to the physiotherapist, while dermatological complaints were less reported for this professional. It was found that during diagnosis, dermatological complaints are more common, and during treatment and post-discharge, neurological complaints predominated. Patients with multibacillary and primary neural clinical forms were the ones who most reported neurological complaints and deformities, including after discharge. Thus, it is concluded that multidisciplinary care is essential throughout the treatment, especially at the time of diagnosis. In addition, the study demonstrates that proper diagnosis and treatment alone are often not enough to avoid physical and psychological suffering for patients even after the disease has been cured, reaffirming the need for early diagnosis and the complexity of following up leprosy cases. The extensive variability of complaints that can be presented by the patient reinforces the need to approach the patient from different points of view, in order to obtain greater accuracy in the detection of clinical manifestations and complaints throughout the entire treatment.

Indigenous populations are mostly vulnerable to respiratory infections, in such a way that the COVID-19 pandemic, cause by the SARS-CoV-2 virus, changed the morbidity and mortality patters around the world and higlighted these vulnerabilities. The disagreement about the responsabilty of notifying COVID-19 cases and deaths, in one side the indigenous health agency for those who lived in tribes, and on the other hand the public health system responsible for those living outside reserves, causes lack of transparency and clarity on the general epidemiology of the disease among indegenous people. As a consequence, organized native people developed a popular and collaborative system for notifying COVID-19 cases and deaths. This stud aims to perform an epidemiology investigation of COVID-19 in brazilian indigenous people, comparing both datasets, and realting the results with ethnoepidemiological characteristcs. This study comprehends and ecological study using diferente ecological approaches: classical destritive, spatial epidemiology ad ethnoepidemiology, during the first year of the pandemic. The datasests will be used to generate descritive epidemiology indexes, and then both descritive and analytical spatial analysis will be performed, in diferente geographical and time frames. The results will then be analyzed and discussed on the theoretical frame of etnoepidemiology, pursuing to understand the patterns that are involved in the results. The Scan statistic found 14 DSEIs with higher risk for incidence, totaling 28,693 indigenous people with a 4 times higher risk for the disease. For mortality, two groups were found, adding a population of 50,323 indigenous people with a higher risk of mortality from COVID-19. The results found show "vulnerabilities" within "vulnerability", with the pandemic presenting itself as multiple epidemics, in times and spaces distinct, with wide inequality between different population groups, which must be better understood for more effective sanitary control actions. Difficulties in the logistical and healthcare infrastructure of indigenous populations in the northern region, as well as cultural characteristics between different ethnicities such as varying population densities, distance between households, habits of collective events, interrelationships with non-Indians and peri-urbanization can explain the patterns ethnoepidemiologically found. The Scan statistic found 14 DSEIs with higher risk for incidence, totaling 28,693 indigenous people with a 4 times higher risk for the disease. For mortality, two groups were found, adding a population of 50,323 indigenous people with a higher risk of mortality from COVID19. The results found show "vulnerabilities" within "vulnerability", with the pandemic presenting itself as multiple epidemics, in times and spaces distinct, with wide inequality between different population groups, which must be better understood for more effective sanitary control actions. Difficulties in the logistical and healthcare infrastructure of indigenous populations in the northern region, as well as cultural characteristics between different ethnicities such as varying population densities, distance between households, habits of collective events, interrelationships with non-Indians and peri-urbanization can explain the patterns ethnoepidemiologically found

The first cases of COVID-19 occurred in December 2019, in the city of Wuhan, China, with the disease spreading to other Asian cities and countries, and later to all continents, leading the World Health Organization to decree it a pandemic on March 11, 2020. Pneumonia appears to be a severe manifestation of the disease, characterized mainly by fever, cough, dyspnea, and bilateral infiltrates on the chest image. Acute Respiratory Distress Syndrome (ARDS) is an important complication in patients with severe disease and may present soon after the onset of dyspnea, occurring in up to 20-40% of cases. Recent evidence points to the use of chest CT as a screening and diagnostic tool in patients suspected of having COVID-19 cleavage. To investigate the main tomographic findings of the chest in patients suspected for COVID-19, treated in the emergency room of a reference hospital in Belém-PA, according to the results of RT-PCR for SARS-Cov-2. Retrospective, descriptive and analytical study, case-control type. A total of 259 consecutive patients with clinically suspected COVID-19 were included in the study. SARS-CoV-2 infection was confirmed in 211 (81.4%), the majority (59%) being male. Cough (94%), myalgia (81%), dyspnea (80%), headache (77%), fever (72%) and anosmia (73%) were the main symptoms. The most frequent CT findings in confirmed cases of COVID-19 were: ground glass (83%), rounded opacities (72%), central vessel sign (60%), septal thickening (47%) and paving in mosaic (46%), with bilateral distribution (66%) and in the lower lobes (63%). When the diagnostic tomographic score was evaluated, a mean of 9 was found in the RT-PCR positive group and 3 in the RT-PCR negative. The sensitivity, specificity, and accuracy of CT tomography for the diagnosis of COVID-19 were assessed using a CO-RADS standardization, specific result of 84%, 50% and 78%, with a positive predictive value of 88%. A CO-RADS category greater than or equal to 3 in a tomographic study has an odds ratio assessed at 5.6 times for the diagnosis of COVID-19, compared to the gold standard test. When evaluating the best cutoff point for the tomographic diagnostic score for COVID-19, compared to the gold standard, we found a value of 8 points, with a sensitivity of 65.9%, specificity of 66.7% and diagnostic accuracy of 66% for COVID-19.Chest tomography has high sensitivity, low specificity, good accuracy and high positive predictive value for the diagnosis of COVID-19, using a CO-RADS standard. The score of points for diagnosis of COVID-19, on chest CT, has acceptable sensitivity, specificity, accuracy of positive predictive value, potential for use in clinical practice, prospective studies and with a larger number of patients for its validation

A perda auditiva é a forma mais comum de deficiência sensorial em humanos, afetando mais de 1,5 bilhões de pessoas em todo o mundo. Esta condição envolve mecanismos ainda pouco elucidados, mas que provavelmente estão relacionados a toxicidade de células cocleares, como neurônios ganglionares em espiral e células gliais. Dentro desse contexto, o presente trabalho procurou investigar alterações nas células gliais de Schwann da cóclea de camundongos com 1 a 3 dias de desenvolvimento pós-natal, após a exposição à cloroquina. Concomitante a isso, procurou-se avaliar o mecanismo protetor exercido pelo ácido flufenâmico nas células de Schwann frente a exposição ao xenobiótico. A redução na viabilidade celular (60%) após exposição a cloroquina comparada ao aumento na viabilidade (25%) após o pré-tratamento com ácido flufenâmico demonstrou que o ácido é capaz de proteger a célula contra danos citotóxicos induzidos pela droga. A análise da produção de EROs (Espécies Reativas de Oxigênio) pelas células que receberam tratamento somente com cloroquina ratificou o efeito nocivo do fármaco nas células de Schwann. E a proteção exercida pelo ácido flufenâmico através da diminuição na produção de EROs é sugestivo da ação antioxidante promovida pela ferramenta farmacológica. O presente trabalho demonstra ainda que os níveis de captação do neurotransmissor glutamato diminuiu (70%) após indução à cloroquina quando comparado ao aumento (20%) que obteve após o pré-tratamento com o ácido flufenâmico. Uma hipótese do mecanismo protetor exercido pelo ácido flufenâmico condiz com o bloqueio dos canais iônicos presentes na membrana celular da glia, favorecendo a redução da entrada de Ca2+ e do mecanismo citotóxico. Os dados apresentados visam a contribuição para estudos futuros e o desenvolvimento de novas terapias voltadas à prevenção de danos celulares.

The effectiveness of leprosy control program (LCP) is related to the attributes of primary health care and living conditions in regions of poverty which contribute to the maintenance of social inequality. Aim: to estimate the epidemiological situation of leprosy in the State of Pará (Brazilian Amazon) from territorial and specific populations perspective in the context of health policies and services. Methodology: ecological-analytical study including new cases of leprosy registered at State Information System for Notifiable Diseases (SISND), in the period from 2000 to 2019, in people living in the municipalities grouped within Regional Health Centers (RHC) of the State of Pará. Variables were age, year of diagnosis, assessment of the degree of disability (DD) in diagnosis, household contacts, DD assessment at discharge due to cure, discharge due to cure and abandonment of treatment, Municipal Human Development Index (MHDI) and coverage of the family health strategy (FHS). The micro-simulation of detection rates, for the period from 2020 to 2050, was carried out with the leprosy simulation trend program (SIMCOLEP). Results: The annual average of cases was 4,072 (95% CI 1,726-6,418). There is a reduction in detection rates in the population under 15 years of age, but with no impact on detection in the general population. In 2019, the DD in the diagnosis was evaluated as good at all RHC, except for the 4th and 9th RHC, while the examination of the contacts in the 1st and 8th RHC was precarious. In 2018, discharge due to cure was precarious; DD at discharge due to cure was regular in five RHC and precarious in the others, while discharge due to abandonment was good in eleven RHC. Discharge due to cure and abandonment tends to decrease in most RHC. In general, there was no correlation between the LCP operational indicators with the MHDI and FHS. For RHC with higher levels of hyperendemicity in 2019, simulation of detection rates from 2000 to 2050 was performed, being rates predicted based on observed rates from 2000 to 2019. We found that the goal will be reached in 2042 in the 5th RHC, in 2046 in the 8th RHC, in 2050 in the 10th RHC and after 2050 in the 11th and 12th RHC. There was no statistically significant difference between observed and simulated rates in the period 2000 to 2019 in the 5th, 11th and 12th RHC. Conclusion: The expansion of the coverage of the FHS and the values of the MHDI did not impact the operational indicators for the evaluation and monitoring of the FHS in most municipalities of Pará, e.g. the epidemiological situation of leprosy from the perspective of the territories and their populations, in the context of health policies and services in the municipalities of Pará included in the RHC is related to the characteristics of the populations that inhabit these regions, but mainly to the fragility of the attributes of primary health care, in addition to the precarious inter sectorial articulation between health policy and other public policies.

Within the context of neonatal invasive fungal infection, the involvement of the urinary
system is common, sometimes inducing to unusual complications such as intrarenal
lesions of mycotic etiology (fungall balls), of low suspicion and which potentially
aggravate the clinical condition due to delayed diagnosis. It was investigated the
occurrence of fungal balls in the urinary system in neonates under intensive care at
the Santa Casa de Misericórdia do Pará Foundation, in Belém, from November 2020
to January 2021, with a series of 150 newborns and infants. Neonates with laboratory
evidence of fungal infection (candidemia and candiduria) were selected and ultrasound
examination of the kidneys and urinary tract was performed in search of urinary
complications of the infection. Four cases of fungal balls were identified, in addition to
an estimated prevalence of 4% of candidemia among the patients studied. The most
common profile of the sample was: male gender, very low weight, moderate
prematurity and born by cesarean delivery. Considering the short period studied, the
high number of fungal ball cases found was highlighted, the same quantity or even
higher in relation to long-term studies in other centers, which expresses the need for
screening patients and active search for this diagnosis, in order to reduce
complications and associated morbidity and mortality, suggesting the development of
protocols for this purpose with the use of ultrasound.

Chlamydia trachomatis is the most prevalent bacterium that causes Sexually Transmitted
Infections (STI) in the world. Approximately 80% of infected women are asymptomatic,
although this infection can lead to serious complications in the female reproductive tract. The
objective of this study was to describe the prevalence and distribution of C. trachomatis
genotypes in sexual infections in university students from four municipalities in the state of
Pará. 686 participants were included from September 2014 to November 2019. Participants
completed a questionnaire about their social, epidemiological and reproductive health
characteristics. We performed genomic DNA extraction using a standardized kit following the
manufacturer&#39;s recommendations. For the identification of the infection by C. trachomatis, a
Nested-PCR was performed, for the amplification of 224bp of the ompA gene. For the
identification of the genotypes, a Nested-PCR was performed, for the amplification of 990bp
of the ompA gene, afterwards the nucleotide sequences were compared with those deposited
in the GenBank. The data were analyzed using the Chi-square, to verify differences between
the prevalences identified in each category of variables investigated. The p-value ≤ 0.05 was
considered statistically significant for a 95% Confidence Interval. This study found that the
prevalence in the general population was 11.2% (77/686) of sexual infection caused by C.
trachomatis, and the prevalence of this infection was significantly higher in university
students in the interior (15.2% / p- value: 0.0443). In general, students who reported not using
a condom during sexual intercourse at some point in life (17.8% / p-value &lt;0.0001) and those
who reported having suffered a miscarriage (32% / p-value &lt;0, 0001) showed significant
frequencies for this infection. The frequency of genotypes followed with genotype J (24.3%
[10/41]), followed by genotype E (21.9% [9/41]) and genotype D (21.9% [9/41]) , genotype F
(14.6% [6/41]), genotype K (7.3% [3/41]), genotype Ia (7.3% [3/41]), genotype G (2.4% [1 /
41]). The high prevalence of C. trachomatis in sexual infections among female university
students in the state of Pará, in the Amazon region of Brazil, was higher among female
university students in the interior, those who declared not to use condoms during sexual
intercourse and those who reported having suffered a miscarriage. The genotypes of C.
trachomatis had varied distribution between capital and interior, however the most frequent
genotypes were J, D, E and F. A high frequency of C. trachomatis was found in students from
the interior and the genotypic distribution was similar to other parts of world.

HTLV-1 patients can develop a disease characterized by a chronic, demyelinating, slow and progressive inflammatory process that affects the lower thoracic region of the spinal cord called PET / MAH. It is characterized by a clinical picture of spastic paraparesis, chronic and progressive weakness of the lower limbs. It is a disease that compromises mobility, impairing activities of daily living, and can lead to loss of independence and autonomy. In this scenario, the patient may develop depression, since the change is impactful and significantly changes his quality of life. In addition, the inflammatory condition can also influence psychological changes, as several studies have shown that some cytokines can lead to depression. Therefore, this work aims to evaluate the correlation between depression and the peripheral immune response in patients with HTLV-1 who have developed PET / MAH or not. In the present study, 61 infected patients were evaluated, divided into 3 groups: 17 asymptomatic patients, 17 mono / oligosymptomatic and 27 with PET / MAH. Peripheral blood samples were collected from patients for the separation of lymphomononuclear cells, for subsequent extraction of total RNA, using the Trizol reagent. Then the mRNA was subjected to reverse transcription to obtain the cDNA. The relative quantification of the IFN-γ, IL-4, IL-5 and IL-10 cytokines for these patients was performed using the real-time PCR technique in StepOnePlus (Applied Biosystem) with the GoTaq qPCR kit (Promega). Gene expression was calculated using the formula 2 -ΔCT, where ΔCT is CTgene - constitutive CTgene, with the constitutive genes used being GAPDH and β-actin. In relation to depression, asymptomatic patients had a greater number of individuals affected by depression compared to the other two groups (p<0,0001). There was no statistical difference in gene expression of the IFN- and IL-4 cytokines between the groups, there was only a tendency for greater expression of IFN- in asymptomatic patients. In the comparison between the expressions of IFN- and IL-4 in the groups, it was proved that all of them showed a higher expression of IFN- in relation to IL-4, but only in asymptomatic patients it was statistically significant (p<0,0001). In the analysis between the expression of IFN- and IL-4 in relation to the presence or absence of depression in the 61 patients without distinction of groups, it was evident that there was a tendency of greater expression of IFN- in patients with depression in relation to those who did not have depression. depression and IL-4 there was no difference in expression. In the comparison between IFN- and IL-4, it was noted that in the group with depression, the expression of IFN- was significantly higher in relation to the expression of IL-4 (p<0,0001), whereas in the group without depression the significance was lost, despite presenting a greater tendency for IFN- expression. In the correlation between IFN- and IL-4 in patients without depression, there was a strong and statistically significant positive correlation (r = 0.6615, p = 0.0003), showing that there is a balance between IFN- (Th1) and IL-4 (Th2). The did not occur in patients with depression, decreasing the correlation, losing significance (r = 0.3303, p = 0.0925). The results showed that there is a psychological component, especially in asymptomatic patients with the prospect of developing PET / MAH, and the inflammatory response generated by HTLV-1 may be a component that promotes the onset of depression

Human papillomavirus (HPV) and Chlamydia trachomatis share the same route of transmission. Among sexually transmitted infections (STIs), they are the two most frequent pathogens. These are also primarily responsible for asymptomatic infections that may persist. Infection with C. trachomatis is associated with an increased risk of persisting HPV infection and, therefore, progression to cervical neoplastic lesions. This study aimed to determine the prevalence of HPV and C. trachomatis co-infection in university students. Methodology: Were analyzed 300 samples of cervical-vaginal secretion from students seen in an extension project of a federal public university from October 2016 to December 2019. All samples were used for cytological and molecular analysis (nested PCR). Results: The study participants were mostly [53.3% (n = 160)] up to 25 years old; the onset of sexual life occurred on average at 18 years of age; 90% (n = 270) were single; 74.7% (n = 224) were not vaccinated against HPV; 65.7% (n = 197) started sexual life at the age of 18 years or less; 70.7% (212) reported up to five sexual partners in life; 80.7% (n = 242) reported not having children; 98.6% (n = 296) reported not using condoms in all sexual relations; 50.7% (n = 152) reported that they did not perform the preventive exam annually. Was observed a prevalence of 28% (n = 84) of HPV infection, 9.7% (n = 29) of C. trachomatis infection and 3% (n = 9) of the frequency of coinfection. The average age of women with HPV was 25 years, of those with C. trachomatis was 25 and of those with co-infection was 23 years. HPV infection stood out in younger women (p = 0.0002), single marital status (p = <0.0001), with more than 5 sexual partners (p = 0.004), and who do not use condoms at all sexual intercourse (p = 0.010). For C. trachomatis, the variables single marital status (p = 0.007), early sexarche (p = 0.038) and absence of children (p = 0.019) presented a higher frequency of infection. There was no significant difference for coinfection between the categories of the studied variables. Conclusion: Although the prevalence of HPV and C. trachomatis co-infection was low in university students, they were high when evaluated in isolation, especially in single women.

Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV) that causes acute and chronic infection, being recognized globally as a relevant public health problem. The immune response to HCV infection has the function of eliminating the virus and providing protective immunity. This study aimed to characterize the cytokine profile of Th1 cells (IFN-γ, TNF-α) and the Th2 profile (IL-4 and IL-10) in the immune response of HCV-infected patients. This is an analytical cross-sectional study that was carried out at the Immunopathology Laboratory of NMT-UFPA from May 2018 to December 2019. Forty two patients with chronic hepatitis C who had not started treatment were selected for this study. Blood collection, separation of lymphomononuclear cells, isolation and quantification of RNA, cDNA synthesis were performed. The real-time polymerase chain reaction, qPCR was performed for the constitutive genes and for the four cytokines. The gene expression of each gene was calculated with the 2-CT formula. Approximately half of the HCV patients showed an increase in liver biomarkers AST / TGO (52.38%) in ALT / TGP (57.14%) and an increase in GGT (45.23%). Patients with abnormal exams also had a degree of fibrosis on liver elastography. All patients with chronic hepatitis C with normal or increased liver biomarkers results and with any degree of fibrosis had a greater expression of pro-inflammatory cytokine TNF-α. There was a negative correlation between IL-4 and the other cytokines suggesting an inactivation of the Th2 profile. This study demonstrated the predominance of the immune response mediated by the proinflammatory Th1 profile in relation to the profile Th2 (antinflammatory) as evidenced by the increased expression of TNF-α. This imbalance in favor of the Th1 type response is related to the inability of the immune system to eliminate HCV, contributing to the chronicity of infection and liver fibrosis.

Acinetobacter baumannii is a Gram-negative bacillus coco, an opportunistic pathogen that has been emerging worldwide, associated with HAIs in neonatal intensive care units. On the other hand, in recent years, other species of the genus Acinetobacter have been related to nosocomial infections, and are considered emerging pathogens. Objective: The study aimed to: investigate the epidemiological profile of cases of bloodstream infections (ICS) related to health care and associated with Acinetobacter baumannii and non-baumannii species, in patients admitted to the neonatal unit of a teaching hospital in the region northern Brazil from 2012 to 2015. Method: retrospective analytical study, of the unpaired case-control type, with a quantitative approach. Results: 139 cases of ICS, 75 of which by A. nonbaumanni (54 A. pitti, 17 A.nosocomialis, 03 A. seifertii, 01 A. colistiniresistens) and 64 of A.baumannii, with prevalence in 2014 , the highest occurrence in both groups regarding gestational age was between 31 to 36 weeks, birth weight from 1001 to 1500g for A. baumannii and 1501 to 2500g for A. non baumannii, for A. baumannii 61% of the ICS was associated CVC and the cases of A. non-baumannii 76%. Mechanical ventilation for more than 30 days was a risk factor for the acquisition of SCI by A. baumannii (OR = 3.78) with 95% CI (1.55 - 9.24), while parenteral nutrition was associated with infections by A. not baumannii (OR = 3.8). The mortality rate for patients with A. baumannii was 40.6% and for A. non-baumannii 48%, with a probability of survival to the 15th day of 74.9% for A. baumannii and 71.5% for A. non-baumannii, with no significant difference between groups. The largest number of samples resistant to beta-lactam and carbapenemic antimicrobials was in the A.baumannii group and high susceptibility in the cases of A. non-baumannii, with Acinetobacter MDR (4.31%) and Acinetobacter XDR (31.6%). All MDRs were A. baumannii, from XDR, 95.2% were from A. baumannii, 2.4% from A. pittii and 2.4% from A. colistiniresistens. Conclusion: Acinetobacter spp plays an important role in morbidity and mortality in neonates admitted to the Intensive Care Unit, with greater antimicrobial resistance to A. baumannii, revealing an important emergence of A. non-baumannii species as a cause of HAI, with emphasis on A. pittii with 38.8% of the cases of CHI

Influenza viruses belong to the Orthomyxoviridae family and are subdivided into three main genus that cause disease in humans, they are: Alphainfluenzavirus, Betainfluenzavirus and Gammainfluenzavirus. Currently, the attention of the responsible agency for health surveillance, when it comes to influenza, it is exclusively dedicated to influenza viruses of genus A and B, known for the greater severity symptoms and their epidemiological characteristics. However, more recent studies have revealed the importance of respiratory infections caused by influenza C viruses. Unlike influenza A and B viruses, the detection of this infectious agent is not included in the routine diagnosis of public health laboratories, so epidemiological and molecular information about influenza C virus circulating in Brazil is still unknown. Thus, the aim of the study was analyze the genetic diversity of influenza C virus strains circulating in Belém city, Pará, Brazil, in the years 2015 to 2017. For this, clinical specimens (nasopharyngeal aspirate or combined swab) were included in the study. 660 outpatients with Acute respiratory infection (ARI) treated at the School Health Center of UEPA. The analysis of the samples included three main steps: a) extraction of the viral genome with a commercial kit; b) detection by RT-qPCR according to standardized protocol; c) complete sequencing of the influenza C virus genome using the synthesis system through the Illumina platform. Among the analyzed samples, influenza C virus vRNA was detected in seven (1%) of the samples by RT-qPCR, with children between one and seven years old being the group that concentrated the largest number of cases. Although the detection occurred in several months of the year, there was a predominance of cases in the first four months. Rhinovirus was detected in two of the three cases of co-detection with other respiratory viruses. In three of seven samples detected by RT-qPCR, was possible obtain and analyze the sequences based on the HEF, NP, PB1, PB2 and P3 genes for the influenza C virus, where all the strains analyzed were grouped in the lineage C/São Paulo/378/82. Thus, this study represents the first report of molecular epidemiological data about influenza C virus in the northern region of Brazil. However, complementary studies are needed to better assess clinical aspects, seasonality and molecular characterization of this agent

HTLV-1 infects about 5-10 million people worldwide and is the etiologic agent of HAM/TSP. HAM/TSP is an inflammatory disease of the CNS, caused by a large local inflammatory infiltrate. Therefore, chemokines play an important role in the development of this inflammation because they regulate inflammatory cells migration. Therefore, The aim of this study was to quantify the chemokines IP-10, MCP-1, MIP-1α, MIP-1β and RANTES in serum of HTLV-1 infected patients and to verify the correlation with HAM/TSP developtment. Sixty-seven HTLV-1 infected patiens were evoluted, divided in HAM/TSP (n=29; 43,28%), mono/oligosymptomatic MOS (n=15; 22,39%) and asymptomatic (n=23; 34,33%). For this, peripheral blood was collected from patients, and serum was separated. Chemokines quantification was performed using Bio-Plex (Bio-rad) equipment and the Bio-Plex ProTM Human Cytokine 27-Plex Assay kit (Bio-rad). The chemokine pattern showed that MIP-1α and RANTES were the most expressed chemokines in all groups. HAM/TSP patients showed higher expression of IP-10 and lower expression of MCP-1 compared to MOS and asymptomatic patients. HAM/TSP patients showed positive correlation between the chemokines IP-10 x MIP-1β, IP-10 x RANTES, MIP-1 x MIP-1β, MIP-1β x RANTES. MOS patients showed a negative correlation between IP-10 and RANTES, and positive between MIP-1 x MIP-1β. Asymptomatic patients showed a positive correlation between MIP-1 and MIP-1β. In conclusion, al patient groups showed similar pattern. Although, HAM/TSP patients showed more IP-10 expression, that is an inflammatory chemokine, and lower expression of MCP-1, associated to TH2 response, in comparison to MOS and asymptomatc patients. MOS patients, despite showing neurological signs/symptoms similar to HAM/TSP, the expression pattern of chemokines were similar to what was seen in asymptomatic patients.

Phase angle is a marker of health and cellular integrity and is associated with disease prognosis chronic. The vitamin D contributes to a number of pathological processes, such as immune dysfunction, inflammation, autoimmune diseases, cardiovascular diseases and malignancies. It is known morbidity and mortality are significantly more frequent in subjects with vitamin D deficiency. Recent evidence has shown a high prevalence of vitamin D deficiency in HIV-infected. Objective: To evaluate the correlation between the phase angle and plasma vitamin D concentrations.Methodology: Cross-sectional study with 58 individuals, of both sexes, and infected with HIV. The participants were submitted to electrical bioimpedance analysis, serum vitamin D measurement and interview. The data obtained by electrical bioimpedance, biochemical examination and anamnesis data were analyzed using the statistical programs Epi Info 7.0 and BioEstat 5.3, considered statistically significant p -value of <0.05. Results: In patients, the average phase angle was 6.6º and vitamin D was 31.16 ng / mL. Serum vitamin D showed desirable values in most participants. No statistically significant relationship was found between the phase angle and vitamin D (rs = -0.06; p = 0.64). In the other analyzes, it was possible to relate the phase angle to lean mass, body cell mass, extracellular body mass, intracellular water, body mass index, age and sex (p = <0.0001; p = <0.0001; p = 0, 03; p = <0.0001; p = 0.01; p = 0.00, respectively) and Vitamin D is related to Fat Mass (p = 0.01). Conclusion: The various changes found in PLHIV / AIDS in prolonged use of ARVs, the exclusion of patients with co-infection and high levels of TCD4 + may have contributed to not finding a relationship between PA and the needs of VitD, metabolic changes, ART, lipodystrophy and CD4. On the other hand, it was possible to show that PA is better associated with age and sex, and as body composition. AF in people living with HIV / AIDS tends to be smaller than the healthy population and this may be because this population ages earlier than healthy people

Systemic arterial hypertension (SAH) presents itself as a worldwide public health problem, contributing directly or indirectly to 50% of deaths from cardiovascular diseases. It has a multifactorial origin and whose development is related to several risk factors, including genetic and environmental. Mercury is a heavy metal responsible for several poisoning events around the world and presents serious effects on human health, riverside communities in the Amazon region have a history of mercury contamination due to local gold mining activities. The enzyme methylenetetrahydrofolate reductase (MTHFR) has an important role in the homocysteine metabolic pathway. The single nucleotide mutations (SNPs) C677T and A1298C in the MTHFR gene can reduce its enzymatic activity, and has been linked to a number of pathological processes including cardiovascular. This study aims to identify the distribution of these SNPs and relate them to the levels of systemic blood pressure in order to clarify whether vascular changes may have a genetic influence or an induced origin as result of the toxic effects of mercury contamination. Individuals from the communities of São Luiz do Tapajós (S.L.T) located on the Tapajós river and Limoeiro do Ajurú (LA) on the Tocantins river were studied. During this study blood samples, sociodemographic and clinical epidemiological data were collected from 189 individuals. The SNPs C677T and A1298C were identified using molecular genetic techniques. This study observed statistically significant differences in the variables of ethnicity, income and occupation between communities. The distribution of genotype and allele frequencies of SNP C677T differed between communities, with a higher prevalence of the TT mutant genotype (13%) in LA, while the CC genotype (75%) predominated in the Tapajós river community. For SNP A1298C, a higher frequency of the genotype AA were observed in Limoeiro do Ajuru (76%) and of the genotype AC in S.L.T (51%). When analyzing mercury concentrations, the Tapajós River community showed values above 10 μg / g in about 36% of the population. Among the analyzes only advanced age was a risk factor associated with SAH in the Tapajós river community. Based on our findings, no association were found between the studied genotypes or mercury contamination with the risk of hypertension. However, these results are still inconclusive and suggest the need for further studies with a larger sample size to assess the association between MTHFR gene variants and their clinical effects, in addition to monitoring the chronic effects that mercury poisoning can cause in residents of the Amazonian hydrographic basin.

O câncer é uma doença que traz indagações e sofrimento psíquico para a pessoa que passa por essa experiência de transtornos dos mais variados, desde alterações físicas, psicológicas, que elevam o nível de estresse, dentre eles está o câncer do colo uterino. Este estudo teve como objetivo investigar as estratégias psicoemocionais como mecanismos de enfrentamento nos casos com diagnóstico positivo e/ou lesão de alto grau para o câncer de colo do útero, e, por conseguinte a adesão ao tratamento, com vista a criação de um protocolo de atendimento psicológico para estas pacientes na região da Amazônia. A amostra foi composta por 225 pacientes, sendo dividida em um grupo com diagnóstico de Câncer de colo uterino (CCU) (n = 69) e outro com Lesão de Alto Grau (n = 156) na faixa etária de 25 anos a 65 anos especificamente pacientes atendidas na UREMIA – Patologia Cervical/SESMA. Foram aplicados um questionário de Avaliação de Qualidade de Vida, WHOQOL – BREF e a Escala de Modos de Enfrentamento (EMEP) nesses dois grupos (um com CCU e outro com lesão de alto grau). A análise e interpretação dos dados ocorreu por meio da estatística descritiva na qual utilizou-se o delineamento transversal analítico mediante o uso de recursos do Excel. O resultado quando se compara a relação entre as estratégias de enfrentamento (Fator focalizado no problema; fator focalizado na emoção; fator focalizado na busca por prática religiosa e fator busca por suporte social) e as dimensões da qualidade de vida nos dois grupos estudados, percebe-se de um modo geral, pouca significância estatística entre os mesmos. Sendo assim, conclui-se com base nos resultados encontrados, com a realização dessa pesquisa, que a qualidade de vida das pacientes de ambos os grupos participantes, independe da forma de enfrentamento do câncer do colo uterino. Com base nessas conclusões é que foi criado e apresentado uma proposta de um protocolo de avaliação e acompanhamento psicológico, que representa um recurso muito importante para a investigação das repercussões psíquicas provenientes do adoecimento humano, principalmente no que se refere a mulher com CCU ou lesão de alto grau

The flu is a highly contagious disease and one of the main responsible for the cases of acute respiratory infections (ARI's), where it is estimated that 10% of the world population gets sick with influenza annually. The etiologic agent of influenza is the Influenza virus, which is subject to intense epidemiological surveillance due to epidemics and pandemics having a major impact on public health. Since its introduction into humans in 1968, Influenza A (H3N2) viruses have a high rate of genetic and antigenic variability, which has impacted the need to make 28 changes to the vaccine composition since then. Among the countless factors that may determine the circulation of these viruses, the climate is the one that stands out the most, since the occurrence of influenza is associated with colder seasons in countries with temperate climates and in rainy seasons in tropical regions. In light of this, this study aimed to describe the genetic diversity and seasonal pattern of Influenza A (H3N2) viruses in the North and Northeast regions of Brazil from January 2011 to December 2017. Thus, epidemiological analyzes were carried out from database and phylogenetic analyzes. The analysis of the gene encoding hemagglutinin (HA) was performed through the synthesis of complementary DNA (cDNA), amplification of the cDNA by polymerase chain reaction (PCR) and subsequent capillary electrophoresis based on the Sanger method. After obtaining the nucleotide sequences, phylogeographic analyzes were performed, in which the sequences used in this study were compared with sequences from other geographic regions. Of a total of 18,547 samples in the Evandro Chagas Institute's Respiratory Virus Laboratory 732 database, they were positive for influenza A (H3N2), indicating a detection rate of 3.95%. The year 2017 presented a higher frequency of detection with 8.01%. It was found that the period of greatest circulation was in the first months of the years analyzed, with the peak between the months of February to April, the period of greatest rainfall in the regions. The circulation of five phylogenetic clades 3C, 3C2A, 3C2A1, 3C2A2 and 3C3A was observed. Therefore, it is confirmed that knowledge of the circulation profile and monitoring of phylogenetic variants of influenza viruses directly impact control and prevention measures, since the data obtained can support the best choice of vaccine strains, adequacy of the vaccine and auxiliary calendar in the adoption of prevention and control measures for this pathogen.

Infections wiTh The Hepatitis B (HBV) and Hepatitis C (HCV) viruses are The viral infections That most cause liver disease worldwide, and because They share common routes of transmission, co-infection wiTh These two viruses (HBV / HCV) is common, especially in endemic areas and among individuals at high risk of infections. It is known That host and viral immunological mechanisms are involved in The paThogenesis of chronic viral infections, so some studies have suggested That regulatory T cell cytokines play a key role in The extent of liver damage and viral persistence. The objective of This study was to identify The profile of The inflammatory response and The viral load behavior in The groups co-infected and monoinfected by HBV and HCV among patients seen at The Nucleus of Tropical Medicine - UFPA, in The city of Belém, state of Pará, in The period from December 2017 to October 2019. The selected samples were subjected to molecular biology tests to detect genetic material and quantify viral load, in addition to The measurement of cytokines using The multiplex immunoassay using The Luminex meThodology. 78 patients were selected for The study, 34 coinfected (HBV / HCV), 22 monoinfected by HBV, 22 monoinfected by HCV. The HCV monoinfected group showed a higher elevation of The cytokines INF-ᶌ, TNF-α, IL-1β and IL-5 demonstrating a dominance of The TH1 profile of inflammatory response, whereas The coinfected (HBV / HCV) and HBV monoinfected groups despite present a lower dosage of cytokines, showed a tendency to The TH1 response profile, wiTh emphasis on The cytokines IL-8, TNF-α and INF-ᶌ. The viral replication of The coinfected group was significantly lower compared to The monoinfected by HBV and HCV, wiTh The HCV RNA viral load being higher, which suggests a competition between viruses, wiTh possible HCV dominance. These findings will contribute to a better understanding of The paThogenesis of co-infection wiTh HBV and HCV

A hepatite C é um significativo problema que afeta cerca de 170 milhões de pessoas, aprox-imadamente 3% da população mundial. No Brasil, os estudos epidemiológicos são escassos e pouco precisos, englobando áreas geográficas e populações restritas. A hepatite C está associ-ada a alterações metabólicas e suas manifestações extra-hepáticas contribuem para a progressão da doença e cronicidade, influenciando a resposta à terapia. Os agentes antivirais de ação direta tornaram-se recentemente o padrão de tratamento, porém seus impactos na nutrição não foram ainda, completamente esclarecida. Este estudo objetivou avaliar o estado nutricional de pacientes hepatite C crônicos, tratados com antivirais de ação direta, no estado do Pará, Amazônia Ori-ental. Foram incluídos, transversalmente, por conveniência, pacientes com hepatite C crônicos, não diabéticos, provenientes da região metropolitana de Belém e interior, tratados com antivirais de ação direta (42) e não tratados (pré- tratamento) (37). Foram coletados e analisados dados sócio-demográficos, estilo de vida, clínicos, bioquímicos, antropométricos e dietéticos no período de agosto de 2019 a fevereiro de 2020. Dos 79 pacientes do estudo, houve maior frequência do sexo masculino (63.29%), genótipo 1 (64.3%), média de idade de 55 anos, e faixa etária entre 40 a 69 anos. Quando comparados os grupos, houve alteração significativa quanto aos níveis de alanina aminotransferase (p= 0.048) e adequação protéica em pacientes tratados com antivirais de ação direta (40.5% vs 76.2% p= 0.0007). Elevada presença de re-sistência à insulina foi observado nos grupos tratados e não tratados, com 40.5% e 33,3%, re-spectivamente. Quanto ao consumo alimentar, peixe e açaí foram os alimentos mais descritos e 47.6% do consumo lipídico estava adequado em pacientes tratados, embora não tenha sido significativo. Os resultados da presente pesquisa reforçam a necessidade de apoio e acompan-hamento nutricional, valorizando a inclusão do profissional de nutrição na equipe que acompanha esses pacientes durante e após a terapia medicamentosa, na tentativa de adequar o estado nutricional para a promoção de saúde e busca de qualidade de vida.

A febre de Chikungunya é uma doença infecciosa que pode evoluir para um quadro subagudo ou crônico. O objetivo do trabalho foi avaliar a resposta clínica à terapia medicamentosa na fase subaguda e crônica da infecção pelo vírus Chikungunya (CHIKV). Foi realizado um estudo prospectivo e retrospectivo (este último para que a população de estudo fosse ampliada), longitudinal, descritivo e analítico no Núcleo de Medicina Tropical, com portadores de infecção subaguda e crônica por CHIKV. Observou-se o paciente no Baseline, primeiro e segundo retorno, onde foram introduzidos medicamentos de acordo com fase da doença com posterior reavaliação. Foram avaliados 101 pacientes, onde 89,1% (N =101) eram do sexo feminino, 29,7% (N =101) encontravam-se na faixa etária de 50-59 anos, 75,2% (N =101) de cor parda, 76,2% (N =101) procedentes de Belém, e 76,2% (N =101) não apresentavam comorbidade. A artralgia foi o sintoma predominante nos três momentos avaliados, baseline (8,2%), primeiro retorno (4,3%) e segundo retorno (2,8%). Segundo a Escala Visual Analógica (EVA) observou-se dor moderada no Baseline em 58,1% e 58,6% dos casos subagudos e crônicos, respectivamente. No primeiro retorno, a dor moderada ainda predominava em 46,2% nos casos subagudos e 43% nos casos crônicos. No segundo retorno, onde todos os pacientes encontravam-se na fase crônica da doença, 43,8% apresentavam EVA com ausência de dor. Quanto ao número de articulações comprometidas no Baseline predominou comprometimento poliarticular tanto nos casos subagudos (79 %) como nos crônicos (74,1%), no primeiro retorno, predominou a comprometimento oligoarticular em 53,8% dos casos subagudos e 54,7% nos casos crônicos e no segundo retorno 40,6% dos pacientes apresentavam comprometimento oligoarticular e 43,8% apresentavam ausência de comprometimento articular. A velocidade de homossedimentação nesses pacientes não mostrou resultado estatisticamente significante. Quanto ao uso de medicamentos no Baseline, 33,4% dos casos subagudos faziam uso de antiflamatório e 40 % dos crônicos usava corticoide. No primeiro retorno, 25% dos pacientes crônicos já faziam uso combinado de corticoide e metotrexato (MTX) e 15 %, usavam apenas MTX. No segundo retorno, 35,1% fazia uso combinado de MTX e corticoide e 64,9% uso apenas de MTX. Observou-se que com o ajuste dos medicamentos houve redução do comprometimento articular, a EVA demonstrou índices de dor leve e em alguns casos com ausência de dor, mostrando o benefício do uso da terapêutica nos casos subagudos e crônicos e melhorando a qualidade de vida desses usuários.

Segundo o Informe Epidemiológico de 2019, apresentado pela Secretaria de Estado de Saúde Pública, no Pará registrou-se até a 18a semana epidemiológica, 957 casos confirmados de infecção pelo dengue vírus, com 860 ainda em investigação; 34 casos confirmados de infecção pelo Zika vírus, com 174 ainda sob investigação; e 661 casos confirmados de infecção pelo Chikungunya vírus, com 2.748 ainda sob investigação. Por outro lado, até a 22o semana de 2019, foram notificados no Pará 11 casos de suspeita de infecção pelo vírus febre amarela, sendo que 2 foram descartados e 9 estavam sob investigação até o momento de divulgação dos dados epidemiológicos. Por outro lado, o informe preliminar sobre a situação da febre amarela no Brasil mostrou que, até a 22o semana de 2019, foram notificados no Pará 16 casos de epizootia em primatas não humanos (PNH), sendo 1 confirmado, 9 indeterminados e 4 ainda sob investigação até a divulgação desses dados. Neste ano, foram notificados até a 22o semana no Brasil 1.240 casos de epizootia em PNH associadas só a febre amarela, sendo 48 confirmados, 435 indeterminados, e 321 ainda sob investigação. Neste contexto, percebe-se pelo quantitativo de casos indeterminados/sob investigação que os atuais meios de se confirmar casos em humanos e em epizootias ainda não são plenamente efetivos, e que, portanto, há uma demanda importante por outras metodologias que complementem as já utilizadas, no sentido de tornar a confirmação desses casos mais efetiva e, consequentemente, útil para as estratégias de vigilância da ocorrência de doenças causadas por vírus, principalmente aqueles ligados a alterações importantes no sistema nervoso central. Neste trabalho objetivou-se a caracterização do sistema nervoso central de PNH, com o intuito de investigar se a resolução de ferramentas de imageamento por ressonância magnética pode ser útil na determinação de alterações no sistema nervoso provocadas por infecções de natureza viral. Os resultados mostram que há um grande potencial a ser explorado com a utilização desses equipamentos no contexto epizoótico

A hanseníase continua a ser um grande desafio para a saúde pública, inclusive no que se refere ao diagnóstico precoce e vigilância em saúde no estado do Pará. Como forma de auxiliar no diagnóstico da hanseníase, testes sorológicos como o teste ELISA anti-PGL-I são usados para detecção de anticorpos contra o Mycobacterium leprae visando a identificação de casos com maior risco de adoecer ou casos assintomáticos, sendo assim, realizou-se um estudo transversal analítico com objetivo de investigar a soroprevalência do ELISA anti-PGL-I em casos com multirresistência medicamentosa, em casos novos diagnosticados no período de 2016 a 2019 e em contatos intradomiciliares residentes na Vila Santo Antônio do Prata, Igarapé-Açu, Pará. A soroprevalência nos casos multirresistentes e seus contatos consanguíneos e não consanguíneos considerando os valores da espectrometria ou valores dos pontos de corte de 0,2 e 0,3 apresentaram-se negativa. A soropositividade do teste ELISA anti-PGL-I foi de 9,52% nos 2 casos novos, correspondentes aos 21 casos novos diagnosticados no período de 2016 a 2019, enquanto que nos contatos intradomiciliares consanguíneos e não consanguíneos dos casos multirresistentes e dos casos novos não foram encontrados nenhum contato com sorologia positiva. A forma clínica Virchoviana apresentou os maiores títulos de anti-PGL-I tanto no grupo dos casos multirresistentes quanto no grupo dos casos novos. A distribuição espacial revelou que os casos multirresistentes encontram-se distribuídos por toda a comunidade, enquanto que os casos novos localizam-se concentrados na área central da comunidade. A distribuição espacial em associação com os níveis de anti-PGL-I permitiram categorizar dos menores até os maiores níveis de titulações, sendo possível observar correlação negativa de relação de proximidade dos casos soropositivos com maiores títulos de anti-PGL-I nos contatos. O teste ELISA anti-PGL-I tem sido reportado como um bom indicador do risco de contágio da doença entre os contatos domiciliares, no entanto neste estudo não foi possível estabelecer essa relação nessa população, mesmo na área que é considerada hiperendêmica.

O estudo da disseminação de doenças infecciosas como redes complexas, uma vez seja conhecida a cascata de eventos em que cada nó foi infectado é uma forma de se investigar a relação do binômio saúde-doença, e para o qual ainda há poucos trabalhos na literatura. Neste cenário, um processo de difusão geralmente se reduz a abstração de “quando” e “onde” os nós da rede foram infectados por um vírus, por exemplo, e para o qual se busca encontrar o grafo que descreva a dinâmica de propagação da doença. Como o objetivo de caracterizar a dinâmica temporal de notificação de casos de dengue como uma rede complexa heterogênea e avaliar a relação temporal das notificações com a distribuição espacial dos locais de residência, foram usados neste trabalho os dados de casos de dengue notificados no primeiro trimestre do ano de 2015, em Belém-PA. Foi empregado um algoritmo de otimização convexa estocástica para gerar a rede, a partir dos traços temporais de difusão, considerando como distribuição entre os nós a lei de potência. Foram analisadas a distribuição de probabilidade dos graus da rede, o seu nível de heterogeneidade e a relação entre a distância dos locais de notificação e as probabilidades de infecção. Foi construído um grafo direcionado acíclico com igual a 19,4, distribuição de probabilidade não apresentando um comportamento normal, com 62% de heterogeneidade, grau de saída médio em torno de 10, o valor de ligação entre pares de nós igual a 0,007 e correlação linear não significativa entre as distâncias geográficas entre pares de nós e os seus respectivos pesos de ligação. Concluiu-se que a dinâmica temporal de notificação de casos de dengue pôde ser representada como uma rede complexa, caracterizada por uma distribuição heterogênea e sem influência da distância dos locais de notificação sobre a probabilidade de infecção, pelo menos para o período investigado.

Primary Bloodstream Infections (BSI) are among the most prevalent health care-related infections (HAI) and are associated with high morbidity and mortality, especially in young children, preterm, low birth weight newborns and admitted in intensive care units (ICU) . These infections are even more severe when caused by antimicrobial resistant microorganisms common to clinical practice. To determine the type of etiological agents involved in primary BSI acquired hospitals and to know the local profile of antibiotic resistance will improve an appropriate choice of empirical antibiotic therapy and consequent positive impact on clinical outcomes. The objective of this study was to know the microbiological profile and mortality rates of primary BSI in children under one year of age in a public hospital of Belem, a maternal and referral maternity hospital in northern Brazil. A retrospective cohort study was conducted utilizing demographic and microbiologic data and clinical outcome of laboratory-confirmed primary BSIs with a blood culture positive for a known pathogen and its antibiotic susceptibility which was assessed using an automated system Vitek2 (bioMérieux, France), between april 2015 and april 2018. There were 1736 cases of IPCS in children under one year of age with 631 blood culture positive with pathogenic strains. Candida e Klebsiella were the three most prevalent genders; premature newborns, males and low birth weight were the most affected. The ESBL phenotype (extended-spectrum beta-lactamase / extended-spectrum beta-lactamase) occurred in 70,8% Serratia marsecens. Overall crude mortality was elevated, 36,3% (224/617). Use of central venous catheter, mechanical ventilation and admitted in UCI were risk factors to mortality. In multivariate analysis, the pathogen Candida (p = 0.05) was the most significantly associated with deaths. Hospital IPCS are serious adverse events and are associated with a high fatality rate in children under one year of age.

Cervical cancer is one of the major challenges facing the current management model of the Unified Health System. With approximately 530,000 new cases per year worldwide, it is also responsible for 265,000 deaths per year. The disease develops from precursor lesions that have potential for progression when not detected and treated early.
It is estimated that an 80% reduction in cervical cancer mortality can be achieved by screening women aged 25-64 with Pap smears. This requires ensuring the completeness, organization and quality of the screening program. However, little is known about the management mechanisms used to achieve the proposed objectives for the cervical cancer screening program.
This research aimed to identify possible management factors that interfere with the cervical cancer screening program in a municipality in the state of Pará. This is a cross-sectional, analytical study with a quantitative approach. The research was carried out with 20 Family Health Strategies having as study population the managers, community health agents responsible for searching the users for the collection of material for colpocytological examination and the users of the PCCU program. Information was collected using the interview technique. It is concluded that there are management problems that interfere and weaken the cervical cancer screening program, resulting in low coverage of women aged 25-64, considered the most at risk.

The tropical spastic paraparesis is caused by HTLV-1. It has unknow etiology; a more likely hypothesis due to the viral protein activity Tax that increases the production of reactive oxygen species, resulting in cell transformation, immortalization, DNA damage and disease. Oxidative damage to DNA can be measure by 8 hydroxydeoxyguanosine (8 OHdG). The objective of this study was to evaluate if there was oxidative DNA damage by 8 OHdG in patients with tropical spastic paraparesis and patients with HTLV 1 seen at a referral service in Belém, Pará, Brazil. A total of 82 patients were selected, 8 of whom were defined, 12 were probably (according to the Castro-Costa classification,2006), 34 asymptomatic patients and 28 healthy controls. The mean age was 47,9 years, with 30,5% men and 69,5% women. The urinary 8 OHdG concentration was determined by HPLC, the mean in the defined patients was 2,5 ng/ml, probable 2,7 ng/ml, asymptomatic 2,6 ng/ml and healthy controls 2,5 ng/ml, with no statistically significant difference (p value=0,989). Therefore urinary 8 OHdG did not show oxidative DNA damage in patients with tropical spastic paraparesis and carriers, suggesting that this probably should not be the most likely mechanism in the pathogenesis of this disease.

Malaria caused by Plasmodium vivax is still an important public health issue in the
Brazilian Amazon basin, with 169,000 cases recorded in 2018. The treatment is
based on the concurrent administration of chloroquine and primaquine. Despite the
efficacy and tolerability over 60 years of use, there are several issues related to
chloroquine uses that should be elucidated in the Brazilian Amazon. The aims of the
present study were to estimate the doses administered and to assess the
pharmacokinetics parameters of chloroquine by a no-compartmental approach
associating with patients age and gender. A prospective study of cases was carried
out in the municipality of Anajas, PA, with 161 patients diagnosed with malaria
caused by P. vivax, 81 children and 80 adults. The geometric mean of parasites at
admission were 2,644 in children and 1,210 per mm3 of blood in adults. Parasites
were cleared from the peripheral blood within 28 days. The doses of chloroquine
administered ranged from 20,2 to 28,9 mg/kg in children and 16,3 to 34,09 mg/kg in
adults. The proportions of patients with chloroquine doses below 25 mg/kg ranged
from 29,4% to 63,6% in children and 59% in adults. The required doses were lower
than the given doses in ages ranges of 4-8 years (U=64; p=0,007), 9-11 years (U=32;
p<0,001) and 12-14 years (U=18; p<0,0001). Blood chloroquine concentrations in
168h in ng/ml ranged from 107 to 440 in children and 201 to 582 in adults. Blood
levels of desethylchloroquine ranged from 167 to 412 in children and 178 to 482 in
adults. The pharmacokinetics parameters derived from no-compartmental approach
were elimination rate constant, area under the curve at day 28, extrapolated to
infinite, maximum concentration, total clearance, elimination half-life, volume of
distribution and meantime of residence. Overall, the data were similar to those found
in other population groups and confirmed the high elimination half-life and a large
volume of distribution of the drug. There was no significant influence of gender, but
the age decreased significantly the clearance and the volume of distribution. The
results permit to conclude that chloroquine is yet effective in the research area. Most
of the patients received sub-doses of chloroquine. The pharmacokinetics parameters
were not influenced by gender, but the age promoted a significant decrease in the
volume of distribution and in the clearance, with the lower values in children.

O Vírus Respiratório Sincicial Humano (HVRS) é um dos principais patógenos associados às infecções do trato respiratório, sobretudo em crianças menores de cinco anos de idade, e que contribui para a elevação das taxas de morbidade e mortalidade infantil (PIEDIMONTE; PEREZ, 2014). Este vírus é considerado o principal agente desencadeador de quadros de bronquiolite em crianças menores de dois anos de idade (PIEDIMONTE; PEREZ, 2014; WHO, 2017). O HVRS pertence à ordem Mononegavirales, família Pneumoviridae, do gênero Orthopneumovirus (ICTV, 2016). Morfologicamente, suas partículas apresentam-se esféricas medindo cerca de 150-300 nanômetros (nm) de diâmetro, envelopadas, com capsídeo helicoidal. Seu genoma é composto por RNA fita simples, polaridade negativa, nãosegmentado, com aproximadamente 15.200 nucleotídeos a partir dos quais são codificadas as 11 proteínas virais (COLLINS, P. L.; KARRON, 2013). Dentre estas, as glicoproteínas de superfície F e G são as responsáveis pela entrada do vírus na célula hospedeira e principais alvos de estudos de terapêutica e variabilidade quando se trata de HVRS. Evidências sugerem que a proteína F é o principal alvo para resposta imune protetora, sendo, por isso, eleita como alvo de estudos para desenvolvimento de vacinas e medicamentos utilizados na profilaxia da infecção pelo HVRS (CHEN et al., 2018). Atualmente, a terapia mais eficaz contra HRSV consiste no uso do anticorpo monoclonal humanizado anti-F, chamado Palivizumabe (CHEN et al., 2018; PIEDIMONTE; PEREZ, 2014). Contudo, investigações conduzidas ao redor do mundo têm evidenciado a detecção de estirpes virais resistentes, isoladas a partir de pacientes que receberam esse tratamento (BATES et al., 2014; ZHU et al., 2012)

A infecção causada pelo vírus da febre amarela (VFA) desencadeia uma relação complexa entre patógeno- hospedeiro que se baseia principalmente nos seus aspectos imunopatológicos, sobretudo no tecido hepático. Em seres humanos o fígado é o principal órgão alvo da infecção. As alterações imunológicas características na febre amarela (FA) são determinadas principalmente por um padrão de células com o perfil Th1, seguida de células TCD8+, macrófagos, leucócitos mononucleados, células NK, além da presença e ação das citocinas, por exemplo, TGF-β, TNF-α e IFN-γ. Dentre os vários aspectos relacionados à resposta imunológica, temos que considerar o endotélio, que desempenha um papel importante, pois influencia diretamente na migração das células para os tecidos infectados, além de estar envolvido na regulação da vasodilatação e vasoconstrição evitando o extravasamento de plasma. Objetivo: Objetivamos fazer uma análise do fenótipo de ativação e ligantes de endotélio na evolução das lesões do fígado, bem como na progressão da FA grave, a fim de contribuir para o entendimento da patogênese da doença, em especial as alterações do endotélio que podem estar associadas aos quadros hemorrágicos. Materiais e Métodos: Foram utilizados 21 fragmentos de tecido hepático de indivíduos com a FA grave, submetidas a análise imunoistoquímica para a imunomarcação do tecido com os anticorpos específicos monoclonais para ICAM-1, VCAM-1, VLA-4, P-selectina, E- selectina. Resultados: A imunomarcação das adesinas ICAM-1 e VCAM-1 bem como as moléculas VLA-4, Pselectina e E-selectina estiveram mais expressas no trato portal quando comparadas à outras áreas do ácino hepático e amostras controle. Conclusão: Este estudo demostrou alteração dos marcadores endoteliais no fígado em todos os casos graves de FA , não sendo observadas lesões semelhantes nos conjuntos de controles estudados. Acreditamos que permeabilidade vascular na FA é causada por diversos fatores, dentre os quais a ação de citocinas inflamatórias e efeito citopatico viral, sendo as alterações na expressão dos marcadores endoteliais fatores que apontam para o papel significativo dessas alteração na patogenia da doença.

American visceral leishmaniasis (AVL) is a protozoosis caused by the parasite Leishmania (L.) infantum chagasi, considered by the World Health Organization to be a neglected disease, severe and fatal if not diagnosed and treated early. Identifying individuals with suspected AVL through effective laboratory diagnosis is of fundamental importance in controlling and monitoring the disease. The choice of serological tests and the antigen employed are relevant factors in the sero-diagnosis due to cross reactions with different etiological agents, especially with the pathogens that present phylogenetic proximity, as they may present antigenic epitopes similar to those of L. (L.) i chagasi. Thus, the antigen employed is essential to improve the sensitivity and specificity of diagnostic techniques. In this context, although AVL is recognized the main clinical-immunological profile of the interaction between the parasite [L. (L.) i. chagasi] and the immune response of man, there is no doubt that the other clinicalimmunological profiles of this interaction also play an important role in this infectious context. In this awy, these clinical-immunological profiles of human infection with L. (L.) i. chagasi were recently defined by the Leishmaniasis Laboratory “Prof. Dr. Ralph Lainson ”of the Parasitology Section of the Evandro Chagas Institute (IEC, SVS, MS) through the combined use of the Montenegro Intradermal Reaction (RIM) and the Indirect Immunofluorescence Reaction (RIFI-IgG) in addition to clinical examination of infected individuals (reactors for RIM, RIFI, or both tests). This diagnostic model allowed us to identify five clinical-immunological profiles of the infection in individuals living in an endemic area of the State of Pará, namely: Asymptomatic Infection (AI: RIM+/++++, RIFI-); Resistant Subclinical Infection (RIM+/++++, RIFI+/++); Indeterminate Initial Infection (RIM-, RIFI+/++); Oligosymptomatic Subclinical Infection (ISO) and Symptomatic Infection (SI = AVL), both with the same profile (RIM-, RIFI+++/++++). Thus, considering the need to improve the serological diagnosis of the infection diagnosis, represented by IFAT (IgG) using crude amastigote antigen, the present study evaluated the performance of IFAT with crude antigens, stage and species-specific: amastigote of the viscera (spleen and liver) of experimentally infected hamster, and amastigote of L. (L.) i. chagasi; as well as from the enzyme-specific immunoassay (ELISA) with stage-specific soluble antigen of amastigote of L. (L.) i. chagasi, in the serological diagnosis of the different clinical-immunological profiles of human L. (L.) i. chagasi-infection. We analyzed 84 serum samples from individuals who participated in an epidemiological survey in an urban area - headquarters of the municipality of Conceição do Araguaia - in 2015, 69 with previous diagnosis of the infection, i.e., 16 from AI profiles, 15 from SRI profile, 15 from III profile, 11 from SOI profile, and 12 from SI profile (= AVL), and 15 uninfected individuals (RIFI-IgG-/RIM-). The results generally showed a higher serological reactivity by ELISA with axenic culture antigen (72.62%) than by RIFI with both antigens employed, crude hamster antigen (63.10%) and crude culture antigen. (69.05%), however, showed no statistical difference P> 0.05. However, when comparing the reactivity in the clinical-immunological profiles, it was noted that, in particular, in the AI profile, the gross and soluble axenic culture antigens showed significantly higher yields by both IFAT (56.3%) and ELISA (68.7%), to IFAT crude hamster antigen (0%), reflecting poor diagnostic agreement between axenic culture antigens versus crude hamster antigen. However, at the pole of symptomatic clinical-immunological profiles (SOI and SI =AVL), excellent diagnostic agreement was observed between the antigens used in both IFAT and ELISA, being considered perfect (k = 1.0), as well as in groups of uninfected individuals (k = 1.0). However, at the pole of symptomatic clinical-immunological profiles (SOI and SI= AVL), excellent diagnostic agreement was observed between the antigens used in both IFAT and ELISA, being considered perfect (k = 1.0), as well as in groups of uninfected individuals (k = 1.0). Based on these results, it can be inferred that the crude and soluble amastigote antigens of L. (L.) i. chagasi from axenic culture antigen present better antigenic performance than hamster amastigote crude of the same species, which is why they should be indicated for use by RIFI and ELISA in the serological diagnosis not only of the AVL, but also in the serological diagnosis of the other clinical-immunological profiles of interest for studies of infection monitoring in an endemic area.

Tactile detection consists of the ability to identify the touch generated by a stimulus, since locognosia represents the ability to identify the stimulus and the place of origin of the stimulus. Neural damage in leprosy causes loss of tactile / thermal and / or pain sensitivity compromises the sensory receptor function of capturing and translating body surface stimulus into nerve impulse, so this study is relevant because it identifies the presence of sensitivity change in the face prevents serious lesions of facial structures such as nose and eyes, and can contribute to the early diagnosis of leprosy. The study was cross-sectional, observational, including patients with leprosy and non-carriers. The aim of this study was to compare the tactile sensitivity of patients with leprosy diagnosed with healthy individuals using SemmesWeinstein monofilament (MSW). The research site was the Nucleus of Tropical Medicine - Federal University of Pará. Ten cases of leprosy and 17 non-leprosy cases participated in the study. The blue, lilac and red filaments of the MSW monofilament kit and an adapted evaluation containing tactile detection examination (locognosia) were used for data collection. The leprosy group consisted of 10 cases, seven were male, nine were between 20 and 59 years old, eight were multibacillary and Dimorfo. The non-Hansen group consisted of 17 cases, nine were female, sixteen were aged between 20 and 59 years. The main thesis was the characterization of tactile sensitivity at different sites of the leprosy face for monofilaments of different weights comparing the results with non - leprosy individuals. It was observed that the monofilament that differentiated the greatest number of points between the leprosy and non-leprosy group was blue (0.2g). However even in filaments of heavier than the blue color, it was still possible to find differences in some points. It was also found that points P3 (maxillary branch), P5 (mandibular ramus) and P7 (mandibular ramus) were those that allowed to find more frequently differences between the leprosy group and the non-Hansen group. These points are located on the lateral face of the face, region of innervation of the trigeminal nerve, maxillary branch and branch of the mandibular, near the nervous trunk of the same where it divides in its sensitive branches to innervate the face.

The AIDS continued been one of more important pandemics in existence of the world and a serious
public health problem in Brazil. Universal access to antiretroviral drugs has been adopted since
1996, which has culminating in numerous benefits for patients living with the disease. However,
lipodystrophy was an obvious adverse event. This effect can culminate in serious consequences
related to self-image and mental health. The objective of this study was to study the satisfaction of
body image and your relationship with adherence to treatment in patients with lipodystrophy secondary
to antiretroviral therapy. A cross-sectional, analytical study was carried out involving 71
patients in a hospital of Belem do Pará by of anthropometric data, body image and and adherence
to the treatment. The results indicate that the majority of the participants were male, with in complete
primary education and income of 1 to 2 minimum wages. The clinical forms indicate the
prevalence of the mixed forms (70.40%), followed of lipoatrophic (16.90%) and lipohipertrofic
(12.70%). The nutritional status indicate the majority of the participants with over weight
(46.90%), but when when the nutritional status between the sexes was compared, no statistically
significant difference was observed. The majority of the sample had body dissatisfaction, being
higher in women than in men (92.00% vs. 65.22, p = 0.02), being in the mild prevalence the most
prevalence. Most of the patients self-perceived according to the clinical form of lipodystrophy.
Regarding the index of facial lipoatrophy, the majority presented the moderate form, and there was
no association with lipoatrophic and mixed clinical forms (p = 0.07). There was an association
between nutritional variables and clinical forms in both sexes. The majority of the participants
(54.93%) had low adherence to the antiretroviral treatment. When body image was associated with
adherence to treatment, it was 1,40 times more likely that the dissatisfied ones were less adherent,
but without significance

Since 2015, Brazil began to face epidemics related to diseases caused by dengue,
chikungunya and zika viruses, all of which are a consequence of the transmission of
these viruses to humans by the Aedes aegypti mosquito. Dengue fever is the infectious
disease that spreads most rapidly throughout the world, with clinical conditions ranging
from asymptomatic to hemorrhagic. On the other hand, chikungunya fever is
characterized by high morbidity and mortality, leaving the affected population with
severe sequelae. Zika infection is a cause for concern, as it is associated with
microcephaly in newborn infants and Guillain-Barré syndrome. In this context, and
considering that vector-host interactions occur mainly in residences, it is important to
understand if the distribution of the residences of the notified cases in the space of the
cities obeys a completely random dynamics, or if it is possible, through a robust
mathematical analysis, to recognize patterns associated with the presence of the
underlying dispersion network, formed by interactions in the environment-virus-vectorhost
complex. Thus, this scientific research project aims to test the null hypothesis that
the distribution of the residences of the notified cases obeys a pattern of Complete
Spatial Randomization. For this, data from diagnosed cases notifications in all 144
municipalities of the State of Pará, provided by the Health Secretariat of the State of
Pará (SESPA), will be used, as well as location data from the Global Positioning
System of the residential addresses of these notified cases. With the geo-spatial
coordinates, measurements of randomness, modularity and heterogeneity, which are
used in Graph Theory, will be carried out in the spatial distribution of these coordinates.
Therefore, the results of this proposal are expected to serve as a basis for the inference
of dispersion networks that are more attuned to the reality underlying the
epidemiological data of viral infection, and with a more precise and accurate forecasting
power, applicable both to the understanding of the dynamics of the complex
environment-virus-vector-host, and for the practice of epidemiological surveillance.

As populações rurais concentram no peixe e na farinha de mandioca as suas principais bases alimentares, o que pode ocasionar a exposição ao mercúrio e ao cianeto respectivamente. Dessa forma, ambas entidades químicas são de grande interesse toxicológico, devido ao elevado grau de toxicidade e oxidativo sobre indivíduos quando expostos Objetivo: Avaliar as respostas toxicológicas e oxidativas associadas ao consumo de peixe e farinha de mandioca em uma população rural do nordeste paraense Material e métodos: Trata-se de um estudo observacional, transversal, desenvolvido em área rural do nordeste do Pará, em 2016 a 2018. Foram avaliadas as concentrações de cianeto em 14 amostras de farinha de mandioca e níveis de Hgtotal em 90 exemplares de pescado e em 76 residentes de uma comunidade rural. A frequência semanal de ingestão de peixe e de farinha de mandioca, além das concentrações de MDA e MeHb foram também investigados.As concentrações média de cianeto total das amostras de farinha de mandioca foram 20,06 e 14,24 mg/HCN/Kg na comunidade A e B respectivamente, diferindo estaticamente do valor preconizado pela OMS (10 mg/HCN/Kg), p=0,02. As concentrações de Hgtotal no pescado analisado ficaram abaixo 1,0 ppm. As maiores concentrações de HgTotal foram obtidas das amostras do peixe C.latus com 0,42 µg/g e H.malabaricus com 0,4 µg/g respectivamente na comunidade A e B. A concentração mediana de Hgtotal dos residentes foi de 2,72 µg/g e máximo de 23,0 µg/g. O peixe foi o alimento mais consumido em relação a farinha (p=0,03). Na categoria <2 refeições semanal de peixe a mediana de Hgtotal foi maior (4,77 µg/g), quando comparada aos grupos de maior consumo. Maiores concentrações de MDA e de MeHb foram observadas no grupo de maior consumo de farinha. As concentrações de MDA foram maiores no grupo de alto consumo de pescado (p=0,02). A MeHb no grupo de baixo consumo (3,4%) foi menor que a de maior consumo (4,0%). O grupo não exposto ao HCN através da produção de farinha, apresentou mediana de 1,7 e no grupo exposto, 1,9 µM/MDA. A mediana de MeHb foi de 4,0% e 1,9% respectivamente nos grupos exposto e não exposto, sem diferença significativa (p>0,05). Conclusão: Os resultados mostraram altas concentrações de cianeto na farinha de mandioca, baixas concentrações de Hgtotal no pescado, em população rural com elevada frequência de consumo de peixes. Os resultados sugerem a influência do mercúrio e do cianeto nas alterações bioquímicas e oxidativas observadas. Sendo assim, a orientação acerca das etapas de produção desse alimento deve ser feita no sentido de garantir a ingestão segura da farinha de mandioca

O objetivo deste estudo foi analisar os parâmetros posturográficos em pacientes portadores de
HTLV-1 com e sem PET/MAH. Foram incluídos 74 voluntários nesta pesquisa, sendo 18
portadores de HTLV-1 com PET/MAH (grupo PET/MAH), 21 portadores de HTLV-1 sem
PET/MAH (grupo HTLV-1) e 35 voluntários saudáveis (grupo Controle). Nos pacientes
portadores do vírus foram realizadas avaliações que incluíam registros de queixas clínicas
relacionadas à PET/MAH e funcionais, pesquisa de reflexos aquileu e patelar, sensibilidade da
região plantar dos pés com uso do Kit de monofilamentos, aplicação da escala Berg balance, e
a avaliação do equilíbrio postural semi-estático por meio da plataforma de força de olhos
abertos e fechados. Os dados obtidos foram tabulados em planilha do Excel, e nas variáveis
quantitativas foram realizadas análises descritivas de média, mediana e desvio padrão. A análise
estatística dos dados da plataforma de força foi realizada pelos programas RStudio e BioStat
considerando p-valor < 0,05. Os resultados mostram parâmetros posturográficos de amplitude
AP e ML, deslocamento total, área, velocidade e frequência mediana AP alterados no equilíbrio
postural semi-estático de pacientes com PET/MAH quando comparados aos grupos HTLV-1 e
Controle de olhos abertos e fechados; pacientes do grupo HTLV-1 tiveram valores discrepantes
quando comparados ao Controle em alguns parâmetros, mas não foram suficientes para
apresentarem diferença estatística significante entre eles. O grupo PET/MAH apresentou maior
prevalência de queixas clínicas e funcionais, assim como alteração de reflexos, da sensibilidade
e maior risco de quedas. Concluímos que os parâmetros posturográficos encontram-se alterados
nos pacientes de HTLV-1 com PET/MAH e que as modificações no grupo HTLV-1 são mais
sutis não demonstrando grandes oscilações do centro de pressão comparados ao grupo Controle.

The evaluation of sensitivity is an important part of the diagnosis and individuals monitoring after a peripheral nerve injury, therefore, it is essential to have experiments with capacity to quantify the damage and the recovery of sensitivity more objectively. The Semmes-Weisntein (MSW) monofilament test, although widely used, both in research and clinically, reliability and reproducibility have been shown already to be fragile due to being dependent on the pressure used by the hand of each evaluator. Thus, the present study aimed to develop and test in healthy individuals an automated device for sensory somesthesic evaluation for a locognosia task and to compare it to the traditional MSW test, aiming to contribute with high precision of the diagnosis and treatment of peripheral neurological lesions with peripheral sensory behavior. Forty individuals were evaluated without lesions of peripheral nerves or complaints of changes in sensitivity, being submitted to the manual test with the MSW and to the automatic test. The tests were performed in one of the volunteers' hands, blindfolded and tested in seven points, it was repeated three times for each filament. Volunteers should point out in an image of the hand the exact point of where they felt each stimulus. After the data collection, the results were analyzed, being assigned two points to correct locations, one point for locations near to the correct, and zero point for erroneous or missing locations. The results showed that green filament, smooth filament that identifies normal sensitivity, was shown more difficult to be correctly localized by study volunteers in all seven points of the hands that were investigated when applied with the automatic test. The automated test differed from the manual test with respect to the locognosic recognition results in healthy people in the lower grammage filaments, because the green filament has presented statistically different when applied with the automatic test in all evaluated points. It is also necessary to emphasize the need for automatic test investigations in individuals with changes in peripheral sensitivity, in order to determine the sensitivity and specificity of the automatic test.

The cervical cancer is, after breast cancer, the leading oncologic cause of death among women living in developing countries. The cervical cancer is the third most incident cancer in Brazil and without considering non-melanoma skin tumors is the most incident in the northern region of Brazil. Human papillomavirus-HPV is considered the causal agent of cervical cancer and associated with different risk factors inherent to each woman (behavioral, reproductive and socioeconomic), determines the development of this disease. The HPV infection is most often asymptomatic and transient; however, 10-20% of infections caused mainly by genotypes of high oncogenic risk of the virus may persist and lead to invasive cervical cancer. The objective of this study was to investigate the persistence of HPV in cervical specimens in women with invasive cervical cancer after being treated with radiotherapy and / or concomitant chemotherapy in order to determine if the infection with the virus may be a risk factor for recurrence of disease or be associated with a worse prognosis. Forty four patients were selected, from July 2015 to July 2018, with a mean age of 47 years, with cervical cancer (at stages IB1-IVB of disease), attended at Ophir Loyola Hospital, an oncological reference center in the state of Pará. Clinical-epidemiological data and two cervical smear samples (one prior and one post-treatment) were collected, totaling 88 samples for the diagnosis of HPV. Samples were analyzed by Polymerase Chain Reaction (Nested PCR) to detect the presence of HPV DNA; and were genotyped for 9 viral types (two low risk: 6 and 11, and seven high oncogenic risk: 16, 18, 31, 33, 35, 52, 58) by real-time PCR. It was verified that the majority of the patients were treated by epidermoid cancer in stage IIB of the disease; and that prior to treatment HPV was present in 93% (41/44) of the patients, persisting in 75% (33/44) of them, at the end of treatment. Seven viral genotypes were detected (HPV 6, 16, 18, 33, 35, 52 and 58) causing both single and multiple infections, with HPV 16 being the most prevalent genotype. It has been shown that treatment with concomitant radiotherapy / chemotherapy is effective to eliminate the virus, but more studies are needed to determine if the presence of the virus influences the final response to treatment. Making evident the need to implement strategies of prevention and control of this type of cancer, based on the detection of HPV DNA

O vírus da leucemia das células T humanas 1 (HTLV-1) infecta cerca de 10-20 milhões de pessoas em todo mundo, e as doenças associadas ao vírus são uma importante causa de mortalidade e morbidade em áreas endêmicas, onde as taxas de infecção variam de 2 a 30%. Embora a maioria das pessoas infectadas permaneça assintomática, o vírus está associado com doenças graves, tais como leucemia /linfoma de células T do adulto (LLcTA), e a paraparesia espástica tropical/mielopatia associada ao HTLV-1 (PET/MAH). A PET/MAH é uma meningomielite crônica da substância cinzenta e branca na medula espinhal, caracterizada clinicamente por uma paraparesia espástica progressiva e lenta, com prejuízo na marcha. Os mecanismos que levam o HTLV-1 a causar diversas doenças ainda não são compreendidos, porém a hipótese mais aceita é que a resposta imunológica do indivíduo seja o principal determinante, uma vez que nenhum genótipo viral tenha sido associado com nenhuma doença em particular. A existência de uma importante resposta imunológica antiviral reforça também a hipótese da participação do sistema imunológico. As células T CD4+ são os principais alvos para a infecção viral e a presença de infiltrado de linfócitos CD4+ e CD8+ infectados na medula espinhal, além da produção de algumas citocinas considerados mediadores inflamatórios importantes no dano tecidual, demonstra a participação do sistema imunológico na infecção pelo HTLV-1. Dentre as citocinas, temos as miocinas que são as citocinas e outros peptídeos que são produzidos e liberados pelas fibras musculares e exercem efeitos autócrinos, parácrinos ou endócrinos. Como na PET/MAH há uma piora da fraqueza muscular e aumento da espasticidade com a progressão da doença, o objetivo deste estudo foi avaliar a resposta imunológica através da análise das miocinas nos pacientes com HTLV-1 e também correlacionar com as manifestações clínicas, uma vez que as alterações na resposta imunológica estão envolvidas na patogênese da doença. Foram avaliados 68 pacientes, sendo 27 com PET/MAH, 15 oligossintomáticos e 26 assintomáticos, atendidos e matriculados no Ambulatório do Núcleo de Medicina Tropical. Foi realizado a quantificação periférica das miocinas e os pacientes foram submetidos a uma avaliação médica. Para o diagnóstico da PET/MAH utilizou-se os critérios da Organização Mundial da Saúde (OMS), além dos propostos por Castro-Costa et al., 2006. Observou-se diferenças estatisticamente significativas dos reflexos, sensibilidade táctil e vibratória, e tônus, nos membros inferiores, na comparação entre os grupos oligossintomáticos e PET/MAH. A Escala de Incapacidade de Kurtzke (EDSS) demonstrou diferença significativa entre os grupos, com escores elevados no PET/MAH. Houve uma correlação positiva e significativa dos níveis de miocinas IL-6, IL-8 e MCP-1 com o EDSS do grupo PET/MAH. Não houve diferença significativa das miocinas IL-6, IL-8, IL-15 e MCP-1, entre os 3 grupos. Apesar destes resultados, as miocinas IL-6, IL-15 e MCP-1 apresentam uma tendência de níveis mais elevados nos oligossintomáticos em comparação com o grupo assintomático, excetuando-se a IL-8 que estava mais elevada no PET/MAH, mostrando uma possível reação da resposta à nível muscular nos pacientes com alguma sintomatologia relacionada ao vírus. A avaliação das miocinas provavelmente seria um bom biomarcador para os pacientes com HTLV-1, e sua mensuração poderia ser uma referência para instituição de medidas que pudessem evitar a evolução para o quadro de PET/MAH.

Tuberculosis continues to be a public health problem throughout Brazil. Several efforts have been made to increase their cure rates, such as the use of the DOTS strategy (Directly Observed Treatment for Short Term) to reduce cases of abandonment and improve adherence to treatment. As a result of the increase in primary resistance to isoniazid, the Ministry of Health modified the therapeutic regimen in 2010, adjusting the doses of isoniazid and pyrazinamide, and adding ethambutol in the intensive treatment phase. Due to the lack of data on serum concentrations of first-line drugs in the brazilian population in this new scheme, this study aimed to determine the serum concentrations of rifampicin, isoniazid and pyrazinamide during treatment and its associations with hematological and biochemical alterations, adverse reactions and clinical outcomes. A prospective cohort study was carried out between september 2013 and november 2016 in two basic health units in the city of Belém (Pará). The most common adverse effects were gastric irritation and pruritus, especially in the intensive phase of treatment and the most frequent clinical outcome was discharge by cure (87.5%). There was a high rate of smear negative (98,90%) in the end of intensive treatment phase. Hematological parameters were determined by automatic cell counter (Cobas 2300®) and biochemical parameters by spectrophotometry (Varian®), which did not present any relevant changes during treatment. The drugs analyzed were rifampicin, isoniazid, and pyrazinamide, and their serum concentrations were determined by reverse phase high performance liquid chromatography (HPLC-RP). Rifampicin and isoniazid presented serum concentrations within the minimum inhibitory concentration (MIC), except for pyrazinamide, which presented values below MIC (3.3 μg/ml), but with a maximum concentration (Cmax) well above the recommended values (63.3 μg/ml). Female patients had higher serum rifampicin concentrations than males. The serum concentrations of rifampicin and isoniazid did not show significant variations between the intensive phase and the maintenance phase. The findings of this study allow us to conclude that the current treatment is safe and effective, since the minor adverse reactions were the most frequent, there were no relevant hematological and biochemical alterations, and the majority of the patients evolved to cure.

A criança é particularmente suscetível a infecções virais, devido à imaturidade de seu sistema imune. Embora sejam mais comuns após o sexto mês de vida, as infecções respiratórias virais (IRV) possuem grande morbidade antes disso, especialmente no período neonatal. Há carência de estudos sobre o tema na Região Amazônica. Objetivo: Delinear os aspectos clinico-epidemiológicos das IRV em crianças internadas em unidades neonatais da Fundação Santa de Misericórdia do Pará (FSCMPA), durante o período de maio de 2015 a maio de 2016. Método: Neonatos e lactentes que apresentavam sinais e sintomas sugestivos de IRV segundo equipe de neonatologistas assistente tiveram amostras de nasofaringe analisadas quanto à presença de vírus respiratórios através da reação em cadeia da polimerase. Resultados: O trabalho consistiu na coleta de 50 aspirados nasais de 37 crianças. No total, 14 crianças tiveram pelo menos uma amostra positiva para os vírus respiratórios estudados, caracterizando incidência de 38,0%. Uma criança apresentou coinfecção. O tipo viral mais comumente encontrado foi o rinovírus (RVH), presente no exames de 11 crianças. Duas crianças foram positivas para o vírus parainfluenza (VPI) , uma para o influenza B e uma para o metapneumovírus. Uma das crianças positivas para o VPI estava co-infectada com o RVH. Metade dos casos positivos foi adquirida na comunidade, e dentre os adquiridos dentro do hospital todos foram causados pelo RVH. As crianças moradoras da capital tenderam a predominar nos casos positivos, e apenas um dos sete casos comunitários era oriundo do interior do estado. Os casos positivos concentraram-se no primeiro semestre, com pico em março, período conhecido como “inverno amazônico. Conclusões: Neonatos internados na FSCMPA podem adquirir IRV durante a internação, e também é frequente internação neonatal por essa doença na instituição As crianças moradoras da capital tendem a ser admitidas por IRV mais precocemente que as do interior. A maioria dos casos foi causada pelo rinovírus, e ocorreu durante o período de maior pluviosidade na região, sendo o pico no mês de março. O rinovírus foi o agente mais encontrado, e sua morbidade nesta faixa etária não deve ser subestimada

Extrahepatic manifestations are frequent in the course of chronic hepatitis C, with marked impaired glycemic metabolism occurring approximately three times higher than in the general population. Objective: to study the changes in glycemic metabolism in patients with Hepatitis C virus (HCV). Methodology: this is a cross-sectional, observational, analytical-descriptive study. Seventy-two individuals of both sexes, aged between 18 and 85 years and a history of chronic HCV infection, without concomitant infection with the Hepatitis B virus or HIV were included. Patients enrolled in the ambulatory of the Liver Group of Santa Casa do Pará were referred to the Jean Bitar Hospital, where they were submitted to medical consultation and laboratory examinations. The glycemic variables studied were fasting glycemia, glycemia of 2 hours after TOTG, insulin, HbA1c, HOMA-B and HOMA-IR. Results: From total of 72 participants, 38 (52.8%) were women. The mean age was 61.5 ± 8.4 years. The frequency of DM was 26.4% (19 patients). The mean BMI was 28.6 ± 4.7 kg / m². The frequency of obesity was 33.3%, and overweight, 43.1%. The occurrence of Metabolic Syndrome was 27.8%. The main genotype was type 1 (78.2%), followed by type 3 (21.8%). Most patients (55/72) had mild liver disease (FIB-4 <3.25). The diagnosis of cirrhosis was present in 37.5% and there was no difference in the glycemic profile between cirrhotic or non-cirrhotic or between the different viral genotypes. The majority of the patients (58%) had already received and completed the proposed anti-viral regimen, composed, albeit by interferon-free regimens (57%) and obtaining SVR in almost all patients (88.9%), of fibrosis. Only 4 patients were considered non-responders. Patients with diabetes had a tendency to be older (64.5 ± 7.3 years, p 0.065), with lower HOMA-B values (98.0 ± 87.7, p <0.05) and HOMA values IR, weight and BMI similar to nondiabetics. SVR was achieved in 80% of DM and in 92% of non-diabetic patients. In addition, there was an association between advanced degrees of fibrosis and lower levels of BMI (p 0.015), lower serum insulin levels (p 0.048), lower HOMA-B values (p 0.009) and higher glycemia after dextrosol (p 0.028). The other parameters of glucose metabolism (HOMA IR, fasting glycemia and HbA1c) were indifferent to the degree of fibrosis, such as the lipid profile (CT, LDL, HDL, TG). Conclusion: The frequency of DM was high in the studied population and the glycemic alterations presented less relation with the traditional components of the metabolic syndrome. It is suggested, therefore,
that the glycemic changes occurred due to a lower production and not by the insulin resistance itself.

The great progress in controlling HIV infection through combined antiretroviral therapy (HAART) has transformed AIDS from a fatal into a chronic disease. Women living with HIV/AIDS will experience the climacteric and its events more often, what justifies the necessity to know the female population in order to design an action plan for this phase. This transversal, descriptive study was based on an exploratory documentary analysis of HIV/AIDS registries among women in the 40-64 age group, from 2014 to 2017, in the state of Pará. The Brazilian Notifiable Diseases Surveillance System (SINAN), Mortality Surveillance System (SIM), Logistic and Supply Management System of Drugs (SICLOM), Medical Laboratory Examination Management System (SISCEL), and Hospital Surveillance System of the National Health System (SIHSUS) provided data studied herein. This research aimed at describing the epidemiological profile of women living with HIV/AIDS in the state of Pará to identify the rate of hospital stays for AIDS and its related diseases, the AIDS mortality rates in the state, the number of women in virological failure, and their whereabouts. A total sum of 1.237 cases were reported in the period, with the highest amount in 2017 (37.1%), mainly in the 40-44 age group (30.3%), brown (82.1%), low schooling (41.2%), and urban dwellers (85.2%). The highest hospital mortality rate was in the metropolitan region I (73.9%). The viral load was detectable in 383 women, being the 40-44 age group the one with the highest detectability rate. UREDIPE and CASA DIA are the services where most women were observed in virological failure. It is concluded that brown female urban dwellers, with low schooling, in the 40-44 age group were the ones with the highest number of notification at SINAN. The metropolitan region I had the highest mortality rate, being UREDIPE and CASA DIA the units with the most virological failures.

Hepatitis B and C are the most common causes of liver disease in the world, sharing many
similarities, such as world distribution, transmission, hepatotropism, and the ability to induce
chronic infection that can lead to cirrhosis and hepatocellular carcinoma. It is relatively
common in endemic areas and among individuals at high risk for parenteral transmission.
Coinfected patients seem to develop worse clinically with a greater chance of fibrosis and
hepatocellular carcinoma. In the present work we perform a cross-sectional study, which aims
to describe and compare the epidemiological and laboratorial profile, and the evaluation of
hepatic fibrosis between HCV monoinfected patients and coinfected patients with HBV/HCV.
The study comprises a total of 162 patients of both sexes from a initial population of 453
patients with anti-HCV positive serology, and selected patients with HCV infection with
positive RNA PCR. Of this initial set, 146 patients were considered HCV monoinfected and
16 coinfected with HBSAg and/or HBV DNA positive by PCR. Laboratory analyzes of
biochemistry, serology and molecular biology were carried out. The majority were male
(58.02%), married (59.08%), group age between 40 and 50 years (51.23%), schooling up to
the complete middle school level (58.64%). The prevalence of coinfected patients was 9.87%
(16 patients). Of the total of 162 patients, risk factor such as sharing of piercing-cutting
material, tattoo, piercing, and non-use of preservative were frequent. However, the number of
hospital admissions and drug use was the variable statistically associated with coinfection.
Alkaline phosphatase was the enzyme most correlated with coinfection. Most patients were
hepatitis C genotype 1 (84.57%) and presented F2 for hepatic fibrosis (51.85%). There was no
statistically significant difference between monoinfected and coinfected patients.

Hydrocephalus is a childhood neurosurgical disorder with high incidence and morbid-mortality. Hydrocephalic children commonly need long time hospitalizations and multiple neurosurgical procedures. In Pará State, the official incidence of ventriculoperitoneal “shunt” complication is unknown. This paper intends to help the prevention and treatment of such complications, as well as helping the reduction of morbi-mortality. Its objective was analyse the incidence of ventriculoperitoneal shunts infection in children admitted to FSCMPa, from January 1st, 2011 to December 31st, 2016. It was a retrospective cohort, involving 132 hydrocephalic children, of which 79 were submitted to ventriculoperitoneal shunt procedure. Data were collected from the patient’s medical records, from FSCMPA’s files, after it has been approved by the “Research Ethics Comitee”. Hydrocephalic children were mainly male infants, with congenital hydrocephalus, coming from the interior of Pará State and were born in poor families. The ventriculoperitoneal shunt infection’s average incidence was 34,21% and Gram-negative bacteria were the main infectious agents involved. MDRO’s were present in 40,91% of the cerebrospinal fluid (CSF) cultures. The risk factors involved in higher incidence of ventriculoperitoneal shunt’s infection were: CSF collected previously to the procedures with infectious features and the presence of infection out of the central nervous system during the hospitalization. The treatment consisted of the use of antibiotics agents plus the removal of the device in 97,44% of the cases and the mortality rate was 9%. Conclusion: the incidence of ventriculoperitoneal shunt infection in this series was higher than those reported in the literature, demonstrating flaws in the care process and the need for adjustments in the institution’s surgical protocol. Due to specific features of the studied population and geographic region, there was predominance of Gram-negative bacteria in detriment of skin germs found in most studies. There were two risk factors in the genesis of post-shunt infection: CSF prior to surgery with infectious profile and the presence of infection outside the CNS. However, prospective studies are necessary to elucidate the risk factors involved in post-shunt infection in this population. It’s important to reduce this incidence, enable early diagnosis and treatment of hydrocephalus, ensure fast access to referral service to solve complications and follow-up these children, aiming at a better quality of life.

Cerebral malaria (MC) is a serious neurological manifestation caused by
Plasmodium falciparum infection. In animal models, the involvement of the bloodbrain
barrier (BBB) in the pathogenesis of this condition has been demonstrated.
Caffeine, an inhibitor of adenosine receptors, has been described as an important
modulator of BBB functions. In this sense, the aim of the present work is to
evaluate the possible protective effect of caffeine on the MC induced by
Plasmodium berghei ANKA (PbA) infection in murine model. Swiss Albino mice
(20-25 g) were used between 45-54 postnatal days (ethics committee:
6211241117), inoculated with 106 erythrocytes parasitized intraperitoneally. The
groups were divided as follow: caffeine 5 or 10mg / kg, PbA and PbA + Caffeine
5 or 10mg / kg, with caffeine administered 4 days before and 4 days after PbA
inoculation. To evaluate the malaria scenario, the survival and evolution of the
parasitemia of Swiss albino mice inoculated with the PbA strain on the postinfection
days in all groups were monitored. The survival curve was obtained from
the determination of the number of animals that evolve to death on their
respective post-infection days (d.p.i) and the parasitemia was monitored every
two days in blood strains. The Vascular Permeability Assay was performed to
characterize the presence of vascular extravasation in the brain tissue of mice
infected with the PbA strain and to confirm the presence of Experimental Cerebral
Malaria (MCE) by using Evans Blue stain as marker. The measurement of the
amount of water in the brain of the animals was performed aiming to evaluate the
formation of edema. To perform the task in the open field, an apparatus was used,
which was made in wood and internally coated with black canvas, having a
circular arena of 83 cm in diameter and 52 cm in height. This test is widely used
to evaluate locomotor activity in rodents. In order to perform the test in the
Elevated Cross Labyrinth (LCE), a wooden apparatus with two open arms of
30x10 cm with a protective border of 1 cm and two closed arms of 30x10x15cm,
arranged perpendicular to the open arms in the shape of a cross Greek. The arms
was raised to 50 cm from the ground. This test is used in experimental models to
evaluate anxiety-like behaviors. Histological analysis from the cerebral cortex of
the animals were performed by light microscopy from sections stained with
hematoxylin and eosin. The one-way ANOVA test with Tukey's post-hoc was
used for comparison between the groups and within the same group on the
different days of analysis. Values of p <0.05 were considered significant

Syphilis is a serious infectious disease with multiples stages that can lead to
severe complications, as well as adverse pregnancy outcomes. T. pallidum, the
causative agent of syphilis, is transmitted through sexual contact and for the
transplacental way, characterizing congenital syphilis – CS. Worldwide, two
million cases of syphilis occur annually among pregnant women and one half
past million of CS cases. In the clinical routine, syphilis is diagnosed through
non-treponemal and treponemal serological tests, such as VDRL and FTA-ABS.
After publication of the T. pallidum genome, different molecular biology methods
were evaluated for DNA detection of the bacterium, representing an alternative
diagnostic for disease, in addition to enable an investigation the genetic profile
of strains. Thus, considering the epidemiological importance of this infection in
public health, this study investigated the presence of T. pallidum DNA in
peripheral blood of women and her newborns, using the polA and bmp genic
markers; identified the molecular subtypes by variants of the arp and tpr
treponemic genes and researched the presence of genetics mutations in the
23S rRNA gene that give resistance to macrolide antibiotics. Through the
molecular analysis of 162 positive syphilis samples, was possible find a high
rate (86% in the newborns and 99% in the mothers) of T. pallidum DNA
detection by N-PCR polA/bmp. Was verified that PCR efficiency in the
diagnostic detection of T. pallidum DNA varied according to the target gene
tested. By the CDC method, 34% of the samples were subtyped and three T.
pallidum molecular subtypes were identified, the 14d most prevalent, followed to
3d and 10d. The 23S rRNA locus was amplified in 62% of the mothers’ samples
and in 53% of the newborns, but the neither A2058G nor A2059G mutation was
found. Moreover, in this study was verified that smoking, alcoholism, drug use,
low schooling, low income, STIs occurrence, partners multiplicity, premature
sexual initiation

The levels of how nutritional factors may contribute to progression of liver disease is still not well scientifically defined, in this sense the nutritional characterization of the patients helps to detect nutritional changes and can be an adjunct to clinical therapy. Objective: To evaluate the clinical and nutritional status of patients diagnosed with hepatitis B and / or C. Methodoly: Was conducted a cross-sectional, descriptive and analytical study, from june to november 2017, at the Fundação Santa Casa de Misericórdia do Pará (FSCMPA). The study involved patients with hepatitis B and/or C, with or without hepatic cirrhosis. Data collection began after approval of the FSCMPA research ethics committee (acceptance nº. 2.084.522). Patients who volunteered to participate in the study signed the Informed Consent Form. A pre-prepared research form has been applied, was carried out: biochemical evaluation, anthropometric evaluation (body mass index-BMI; Waist-to-height ratio- WHtR; mid-upper arm circumference- MUAC; triceps skinfold thickness-TST; arm muscle circumference-AMC; arm muscle area corrected-CAMA; and subscapular skinfold thickness-SSF); subjective parameters (using the Royal Free Hospital Global Assessment-RFH-GA proposed by Morgan et al., 2006) and food consumption assessment (24 hour recall). Results: 90 patients were evaluated, 54.44% were male with a avarage age of 58.19 years (±11.89). Most of the patients were diagnosed with hepatites C (80.00%); 22.22% were diabetics; 35.56% hypertensive; 21.11% had cirrhosis and 8.89% had moderate ascites. 23.46% were in clinical stage F4, 50.00% presented necroinflammatory activity 1 (A1); and among cirrhotics, 78.95% of the classification in Child A. At biochemical parameters, the inadequacy was observed only for LDL cholesterol (57.78%). In nutritional assessment was obtained 45.46% of overweight in adults and 50.00% of eutrophic for seniors, by BMI. When assessed the WHtR, 81.48% presented risk for cardiovascular diseases. In isolated assessment of muscle and fat compartments, there was 66.66% of eutrophy verified through MUAC; 78.89% of eutrophy through the AMC; 77.78% eutrophy in CAMA; 32.22% of obesity by TST and 83.33% of eutrophy by SSF. In RFH-GA, 76.67% were classified into moderate malnutrition or at nutritional risk. When food consumption was evaluated, the majority presented insufficient consumption of calories (60.00%), carbohydrates (46.67%), proteins (40.00%) and lipids (65.56%). When the association between the anthropometric variables and the degree of liver disease was evaluated, there was no significant difference through the Metavir and Child-Pugh classification, but trends were observed. Regarding the anthropometric variables and the food consumption, an association was observed between RFH-GA and caloric intake (p<.0001); and in relation to protein consumption, an association was observed between MUAC (p=0.0273), AMC (p= 0.0250), CAMA (p= 0.0207) and RFH-GA (p<.0001). Conclusion: Overweight, eutrophic and insufficient food intake are common in patients with viral hepatitis B or C. The anthropometric variables were not significantly associated with the degree of inflammation or fibrosis, only with the degrees of hepatic cirrhosis. There was an association with food consumption, which suggests that insufficient intake may contribute, in the future, to the development of malnutrition, emphasizing the need for nutritional interventions.

The Human T-Cell Leukemia Virus type 1 (HTLV-1) was first isolated in the 1980s and was soon related to a type of lymphoma previously described in Japan, the Adult T-Cell Lekemia/Lymphoma (ATL). Subsequently, the infection by HTLV was also associated to diseases such as the HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP), uveitis, dermatitis, arthritis, strongyloidiasis, among others. The transmission of the HTLV-1 occurs through horizontal routes: sexual contact, blood transfusion and sharing contaminated needles; and vertical routes: from mother to child through transplacental transmission and, mainly, by breastfeeding. Studies indicate a greater efficacy of sexual transmission from men to women, about 60.8%, against 0.4% in the opposite direction. Studies have also shown that it is possible to detect the virus in the semen and vaginal secretion of infected people. Young people of college age are more exposed to infectious and sexually transmitted diseases. This study sought to previously detect infected lymphocytes in vaginal secretion samples from university students simultaneously to the blood search (including in men). With the goal of previously detecting an infection, which might become systemic, preventing the transmission to others and also trace the social profile of the university students attended. The collection of peripheral blood and endocervical secretion was carried out, where anti-HTLV antibodies (ELISA method) and viral genome (PCR) were investigated in the blood, and in secretion only the viral genome (PCR).323 students were analyzed (55 men and 271 women), during the period from October of 2016 to January of 2018. 116 were investigated only through blood samples, 105 only through endocervical samples and 102 through blood samples and endocervical secretion. None of the analyzed students showed positive results to HTLV search. In the same project, other results were found: 10 positive students for Chlamydia trachomatis and 35 for HPV in secretion, and 2 for syphilis, all female. The epidemiological profile of students attended was also described. Although no positive results were found for the detection of HTLV, this study has proved important in several aspects. Among them, to demonstrate that even with numerous campaigns encouraging the use of condoms, the use of it in all sexual relations is still considered low. This finding is associated with the results found for other STI also searched. Although there are studies that demonstrate the detection of the viral genome in endocervical secretion of infected women, it was not possible to detect early (prior to HTLV-reactive serology) from vaginal secretion in this study. Factor that may be associated with low amount of infected lymphocytes in the endocervical region, constant cell renewal of the uterus due to menstruation and slow progression of the disease.
Key words: Young people. Endocervical secretion. Late seroconversion. Early detection.

Type 1 Human T-Cell Lymphotropic Virus (HTLV-1) is associated with serious diseases such as Adult T-cell Leukemia / Lymphoma (LLcTA) and HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis HAM/TSP). In particular, HAM/TSP is a chronic inflammatory disease of the central nervous system, which leads individuals to functional disability, especially gait, bladder dysfunction, among others. These conditions generate impairment in the quality of life, functionality, performance of occupations with possible changes in levels of anxiety and depression. Although these are of great importance, few studies have done the evaluation of the individual's perception of HTLV-1 infection. Since the Amazon is an endemic region, it should be noted that no study was conducted. Objective: This study investigated the manifestations and correlations between quality of life, depressive and anxious symptoms and occupational performance in individuals with asymptomatic HTLV-1 and with probable and definitive HAM/TSP. Material and methods: This is a cross-sectional observational study carried out on patients infected with HTLV-1. Sixty-two individuals with HTLV-1 infection were diagnosed clinically and laboratorially, 17 of whom were asymptomatic, 18 with probable HAM/TSP and 27 with definitive HAM/TSP. The participants were submitted to clinical and neurological evaluation, followed by the application of protocols for the evaluation of Quality of Life, through the application of the Short Form Health Assessment 36 (SF-36, Medical Outcomes Study 36 - item Short Form Health Survey); of Depression with the application of beck Inventory; of Anxiety, through the Spielberger Trait Anxiety Inventory (Idate-T); of Occupational Performance from the Canadian Occupational Performance Measure (COPM). For the analysis of the data, a descriptive analysis was carried out, being informed the percentage values of the results of the categorical variables, in addition to obtaining means, medians and standard deviation of the numerical variables. For analysis of statistical significance, parametric and non-parametric tests and 5% alpha level were used for rejection of the null hypothesis. Results: Regarding quality of life, asymptomatic individuals presented better perception for functional capacity domains (79,70 ± 32,47), limitation for physical aspects (77,94 ± 39,41), pain (80,35 ± 27,57), social aspects (62,76 ± 21,86) and low perception for emotional aspects (11,76 ± 33,21) and mental health (33,88 ± 27,17). Individuals with the definitive HAM/TSP group presented better scores for the domains: emotional aspects (56,81 ± 45,14), mental health (58,96 ± 28,07) and low values for functional capacity (24,62  28,95), physical aspects (16,66 ± 33,25), pain (43,22 ± 25,72) and social aspects (42,25 ± 24,76), there was a significant difference between all these domains. As for depressive symptoms, there was a significant difference between groups, in which 100% of the individuals in the asymptomatic group showed some level of depression, 38.9% of the individuals with HAM/TSP were likely, and 37.0% were the definitive ones. Regarding anxiety levels, 100.0% of the asymptomatic individuals showed between medium to high levels of anxiety state, when compared to individuals with probable HAM/TSP 72.2% and definitive 37.0%. There was a significant difference between the asymptomatic groups and the probable HAM/TSP, and between the individuals in the asymptomatic group and the definite HAM/TSP (p = 0,0139; p = 0,0001, respectively). As for the comparison between the variation between the trace and the anxiety state in each group studied, a significant variation occurred only in the individuals of the asymptomatic group (p = 0,0001). Asymptomatic subjects showed a higher level of performance and occupational satisfaction (09,47 ± 1,40, 09,37 ± 1,55, respectively) when compared with individuals with probable HAM/TSP (06,45  1,66, 6,54  1,92) and definitive (02,77  1,53, 3,40  2,10), with a significant difference in performance and occupational satisfaction between the asymptomatic groups and with probable HAM/TSP (P = 0,0001, p = 0,0001, respectively) and between the subjects of the probable and definitive HAM/TSP group (p = 0,0001, p = 0,0001, respectively), between asymptomatic groups and with definite HAM/TSP (p= 0,0001, p = 0,0001, respectively). Conclusion: HTLV-1 triggered changes in quality of life, levels of depression, anxiety and occupational performance in the different groups and stages of disease progression. The findings pointed to the relevance of care beyond somatic and biological, with emphasis on occupational therapy, in order to assist in the quality of life, in the conditions of depression, anxiety and to prevent the functional impoverishment and the restriction in the repertoire of the daily occupations.

The Sabethes chloropterus, Sabethes glaucodaemon and Sabethes belisarioi mosquitoes are species of medical and epidemiological importance for arboviruses transmission such as yellow fever and St. Louis encephalitis. Despite this, information on the mitochondrial DNA of these species has not been found in literature or genomic databases yet, demonstrating that taxonomic classification has only been based on analyzes of the morphological characters. This work aimed to study phylogenetic relationship of these species from the COX1, COX2, NADH4, NADH5 and CYTB mitochondrial genes. The mitochondrial genome was constructed by De novo using the IDBA UD 1.1.1 and SPAdes 3.10.1 softwares and phylogeny with jModelTest v2.1.7, RaxML v8.2.11 and FigTree v1.4.3 softwares. The phylogenetic tree has 5 clusters: 1 outer group and 4 referring to Culicidae and the position of Sabethes chloropterus, Sabethes glaucodaemon and Sabethes belisarioi showed to be in accordance with a known morphological classification, beyond this, Sabethes belisarioi appeared first on evolutionary scale. This work corroborates the morphological taxonomic classification of the species studied and has the potential to be the support of studies that involve, for example, phylogenetic, phylogeographic and epidemiological features. Keywords: Genus Sabethes. Mitochondrial genome. Sequencing.

Chronic liver disease and cirrhosis represent a 12th cause of death in the general population. Chronic hepatitis C virus (HCV) is the most responsible for cases of cirrhosis and liver transplants in the West, where there are 200 million people with chronic carriers. The highest prevalence of HCV in Brazil was reported in the northern region. To the extent that, for example, they are non-invasive and have associated morbidity and mortality, other non-invasive methods, such as traffic elasticized (Fibroscan®) and Doppler ultrasound. Objective: To investigate a correlation of Mode B ultrasound and Doppler findings with transient elasticizing data using Fibroscan®, determining the cutoff points, sensitivity and specificity of hepatic vessel resistance and pulsatility indexes for the prediction of hepatic fibrosis significant. Method: A cross-sectional, observational, descriptive and analytical study, including 30 patients with chronic hepatitis C treated at FSCMPA. Data were collected from transient elastography and B mode and Doppler ultrasonography, evaluating a linear correlation between the methods through the Pearson test. The various Doppler-velocimetric index were compared between the groups according to a presence of significant fibrosis (≥F2). Results: There was moderate to strong linear correlation between the data of the transient elastography using the Fibroscan® and the Doppler velocimetric index of the hepatic vessels, as well as for the splenic index; The mean values of HARI, HAPI, PVRI, PVPI, HVRI, HVPI, differed between the groups with absent / mild hepatic fibrosis (F0 / F1) and significant hepatic fibrosis (≥F2). The HARI, PVRI, PVPI and HVRI cut-off points were 0.68, 0.30, 0.53 and 0.99, with sensitivities and specificities of 95,5% and 87,5%, 77.3% and 87.5%, 72.7% and 87.5% and 77.0% and 87.0% for hepatic fibrosis prediction ≥ F2. There was an association between the monophasic and biphasic wave pattern of the suprahepatic veins and a stratification of hepatic fibrosis estimated by the kiloPascal values in the transient elastography. Conclusion: Doppler ultrasonography and transient elastomosis using Fibroscan® are correlated methods in the non-invasive evaluation of hepatic fibrosis, with some index showing acceptable sensitivity and specificity for the prediction of fibrosis ≥ F2 in patients with chronic hepatitis C.

Invasive Mechanical Ventilation (IMV) is characterized as the administration of intermittent positive pressure to the respiratory system by means of a tracheal prosthesis (oro or nasotracheal tube or tracheostomy), among complications in a hospital environment, the pneumonia associated with IMV presents as one of the most common in Intensive Care Units. Ventilator Associated Tracheobronchitis (TAV) is the infection acquired in the Intensive Care Unit (ICU), and is considered the intermediate process between colonization and Ventilator Associated Pneumonia (PAV). The most commonly isolated pathogens of respiratory secretions in patients with TAV are Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. The present project seeks to estimate the prevalence of TAV in the pediatric Intensive Care Unit of the Santa Casa de Misericórdia Foundation of Pará (FSCMPa). As a method of study the clinical-epidemiological, nested case-control type will be applied retrospectively to be performed In the Pediatric Intensive Care Unit of the FSCMPa, Annex Almir Gabriel, from September 2015 to May 2017. In this way, the work aims from this identification, a plan of action to reduce its incidence and consequent complications. 

Several small forest residual spaces in the Amazon biome, denominated urban forest fragments, are located within the Metropolitan Region of Belém (MRB), located in the State of Pará and in the Legal Amazon. These fragments have a wide variety of species of fauna and flora, among the species of fauna, we found the phlebotomine insects that may be involved in the transmission of agents causing zoonoses, such as leishmaniasis, a disease caused by a protozoan species of the genus Leishmania (Kinetoplastida: Trypanosomatidae). Thus, the aim of this study was to investigate the occurrence of sandflies naturally infected by Leishmania sp caught in forest fragments of the municipalities of Belém and Ananindeua. The studies were carried out in three areas: Utinga State Park (PEUT), 2º BIS Forest (Jungle Infantry Battalion) and Navy Forest, located within the MRB. Ten light traps were used in each area between 08:00 am and 06:00 pm in the months of September and November 2014, April and June 2015 and June and May 2016. Some females of sand flies were subjected to DNA extraction, amplified by PCR with molecular markers for detection of Leishmania. Of the total of 8,465 sandflies, the most prevalent species was Lu. antunesi (60.01%), followed by Lu. davisi (18.01%), Brumptomyia sp (8.33%) and Lu. flaviscutellata (4.89%). Of the 5,463 females used to detect Leishmania DNA, all were negative, presenting minimal rate of natural infection zero. The MRB has the circulation of phlebotomine species of medical importance, which deserves vigilance and further studies in these increasingly anthropized areas in order to obtain a more accurate profile of the existing ecotype.
Keywords: Leishmaniasis, Phlebotomines, Polymerase Chain Reaction

Wound healing is a dynamic process involving a synchronized and coordinated combination of multiple cell types and aiming at restoring the protective function of the skin. Various organisms and molecules have been investigated because of their beneficial effects in stimulating the wound healing process. Findings from histopathological examination of the lesion tissue of patients with chromoblastomycosis demonstrate a dense granulomatous inflammatory infiltrate with marked fibrosis suggesting that the etiologic agent, Fonsecaea pedrosoi, may influence the wound healing process. The aim of this study is therefore, to investigate the antibacterial and wound healing activities of the topical application of the lysates of the different cellular forms of F. pedrosoi on acute cutaneous healing in BALB/c mice, using a prospective, controlled and experimental study. For this, were induced in vitro fungal forms, sonicated, and filter with PES 0.22 μM membrane for the topical application of 20 μl on the lesions performed with 8 mm punch in the mice. The lesions were photographed and measured using ImageJ® software. Statistical analysis was performed using GraphPad Prism 6.0® software, establishing the significance level p <0.05 and using the Mann Whitney test. Statistically significant differences in the contraction of the lesions could be observed from the 7th PO, and after twenty one days of treatment was observed that the topical application of the fungal lysate of F. pedrosoi induced areas of reepithelization greater when compared to the control group and similar to the findings in the control positive. Furthermore, it was observed that both the fungal samples and the supernatant of the muriform cell induction did not show antibacterial activity. These results suggest that F. pedrosoi cell lysates have a potential healing property in the repair of lesions.
Key words: Skin lesion; Fungal lysate; Fonsecaea pedrosoi; Wound healing.

Infections related to health care represent an important cause of morbidity and
mortality among the agents involved in the Acinetobacter spp contribute 20 to 30% with
the ocurrences. Several factors contribute to the fact that newnborns become susceptible
such as immaturity of the immune system and fragility in the mechanisms of barrier on
the skin and the gastrointestinal system. With the aim of evaluating the prevalence,
epidemiological profile, risk factors, prognosis, and sensitivity profile of antimicrobials.
We conducted a cross sectional study, prospective inneonates with bloodstream
infection by Acinetobacter spp , hospitalized on th FSCMPa, in the period from January
to June 2015. It was observed the occurrence in 62 newborns with 48,4% of male and
51,6% the female sex, and exposure to invasive procedures 50% made use of PICC, and
to 46,8% umbilical catheter, with 24,3% underwent surgical procedure gastrointestinal
and 4,8% neurological surgery, was 53,2% presented high improved, and 37,1%
evolved in death. Th bloodstream infection in neonates with isolation of Acinetobacter
spp showed a prevalence of 3,6% in the period studied. In the profile of sensitivity was
observed to colistin was th antibiotic most sensitive with 93%, followed by tigeciclina
with 89% and amikacin with 85%, to detriment of the antibiotics that were more
resistant to cefoxitin, with 105%, cefuroxime 90%, ceftazidime 82% and piperacilin
tazobactan with 76%. Thus, it is important to stress that the bloodstream infection
presents case fatality rate that can vary from 17 to 46 %, in the present study was
37,1%, and with profile of resistance to two classes of antimicrobial. There is need for
strengthening in the guidelines and the preventive measures and the rational use of
antimicrobials.

A lipodystrophy syndrome is a disease that is common among people with HIV who undergo antiretroviral therapy, promoting the rearrangement of body fat and metabolic changes, including dyslipidemia and peripheral resistance to the action of insulin. Due to these factors, it became essential to study techniques and methods that contribute to an evaluation of the nutritional status of patients. The phase angle is a bioimpedance variable, which allows an analysis of cell membrane integrity. Recently, its function as an indicator of nutritional status in various disease conditions has been studied. The aim of the present study was to evaluate the use of phase angle as an indicator of the metabolic alterations of nutritional status in patients with lipodystrophy syndrome secondary to antiretroviral therapy at a referral hospital in Belém do Pará. With prospective data collection, on anthropometric variables, duplicate bioimpedance, laboratory tests and clinical history (highlighting metabolic changes) in 53 patients with lipodystrophy syndrome secondary to antiretroviral therapy. In clinical / outpatient follow-up. The results showed a prevalence of men, remaining in the active majority, in terms of occupation; Regarding the analysis of the anthropometric variables, such as weight, height and waist-hip ratio, the highest values were those of the male sex, as expected, while the triceps skin fold, the highest mean was found among women ; No significant differences were identified for BMI between genders; The most prevalent nutritional profile was overweight (42%), with an NRTI + NNRTI + PI + PI scheme, the mixed clinical form represented (86.79%) the sample. The mean AF obtained from the duplication measures was 6.45 ± 1.09, being used as a cutoff point, positively correlated with a lean mass, body cell mass and intracellular water and negatively with fat mass; Correlations with anthropometric measurements and BMI were not significant. The AF ° presented was associated with the sex and age of the individuals, but with p-value not significant for the relation with ART time. It was also evidenced a tendency of association between AF and multiple metabolic alterations in the same individual (diabetes + hypertension + dyslipidemia). It was observed that the age variable presented Odds Ratio (OR) of 1.0859, that is, the patients who are older have a probability of 1,0859 times greater than being below the cutoff point of AF, based on multiple logistic regression analysis. According to the multiple linear regression analysis, the variables: AI, extracellular mass, MM and a new association parameter to be better studied, HDL; were the metabolic markers that most explained the variation of the patients' phase angle. It can be concluded that AF ° is an important tool to monitor the evolution of patients with lipodystrophy syndrome, being an indicator of body mass depletion and alteration of HDL that influence the clinical / nutritional state of the patient.
Key words: Lipodystrophy, phase angle, metabolic changes.

A tuberculose e a hanseníase são doenças causadas por micobactérias que, por fatores inerentes aos patógenos, necessitam de tratamento utilizando-se de diversas drogas e administrado durante um período prolongado.

A Organização Mundial da Saúde (OMS) apoia pesquisas que visem diminuir o período de administração destas medicações, bem como o desenvolvimento de novos fármacos, de modo a instaurar uma monoterapia que seja finalizada em períodos cada vez menores.

Episódios de farmacodermia podem ser provocados por diversas drogas, destacando-se os antibióticos como principais responsáveis. Entretanto, a terapêutica utilizando estes medicamentos não pode ser interrompida, sob o risco de desenvolvimento de resistência do micro-organismo às drogas utilizadas.

Em razão do número, dosagem e frequência dos tratamentos, os pacientes de hanseníase e tuberculose podem manifestar efeitos adversos que podem incluir breves desconfortos a complicações graves. Deve-se, portanto, conhecer quais as principais reações adversas à poliquimioterapia, a frequência na qual estas reações acontecem e se o fato do uso prolongado de diferentes antibióticos em conjunto possa favorecer os episódios de farmacodermia.

The infection by H. pylori, particularly by cagA+ virulent strains, is related to the
gastric cancer development, the mechanism that this bacterium induces the
tumor genesis seems also be the cause of changes in adhesion proteins
expression, like E-cadherin and α-catenin. So, this study aimed to determine the
E-cadherin and α-catenin expression patterns in tumor and non-tumor tissues
from patients carrying diffuse and intestinal type gastric cancers infected by H.
pylori virulent strains. Epidemiological data were collected, serological tests
were performed to detect anti-H. pylori and anti-CagA antibodies, gastric
biopsies were taken and subjected to Gram stain and immunohistochemistry
technique for further analysis of histological alterations and expression of Ecadherin
and α-catenin molecules. By the Lauren classification method 60%
(29/48) of the patients had diffuse-type tumor and 40% (19/48) had intestinaltype,
but a statistically significant variation about the epidemiological data
between the tumors type was not found. From all the infected patients near to
95.4% exhibited antibodies against the virulence factor CagA, revealing a high
prevalence of virulent strains infection in both intestinal and diffuse tumor
subtypes, which supports the evidence that the H. pylori infection is strongly
related to the gastric carcinogenesis, but not to the development of a specific
tumor subtype. The most of the analyzed individuals were men (75%), with 60
years old or older (71%) and presented epidemiological features with a life style
which favors the gastric carcinoma development. The Gram stain analysis
showed that there was not a difference in the histological alterations severity
between tumor and non-tumor tissues, neither between tumors types. The
membrane E-cadherin expression in tumor and non-tumor tissues was absent
in 90% (43/48) and 22.9% (11/48) respectively. The α-catenin was absent in
100% (48/48) of tumor fragments and in 33% (16/48) of non-tumor fragments.
The semiquantitative analysis of cytoplasmic and membrane expression scores
revealed a tendency of non-tumor tissues to present a predominantly
membrane expression while the tumor tissues showed a predominantly
cytoplasmic expression. None relationship between the tumor types and the
molecules expression levels was found. Clearly, more studies are necessary to
elucidate the influence of H. pylori virulent strains on different gastric tumors,
related to the mechanism which alters the cellular adhesion molecules
expression, E-cadherin-α-catenin complex, during the carcinogenic processes.

Cryptococcosis is a systemic disease caused by the fungus species Cryptococcus neoformans and C. gattii. In Pará, there is the prevalence of this mycosis characterized is endemic. This study intends to describe image findings in pediatric patients affected by pulmonary and/or cerebral cryptococcosis hospitalized at the University Hospital João de Barros Barreto (HUJBB) from january 2005 to december 2015. The research is characterized as a case study, of pediatric patient with imaging examination of HUJBB. The sample consisted of children up to 13 years of age, both sexes and residents of the urban and rural area of the state of Pará. 15 medical records were avaluated, and the highest occurrence of cases on cryptococcosis residing in the rural area (nine cases) was found, the majority being male. There were more cases of cryptococcosis in pediatric patients in rural areas with nine cases, most of them male. There were no immunocompromised patients. Among the main diagnostic impressions of cryptococcosis, there was a predominance of symptoms, such as fever, vomiting and headache, for both sexes and zones. The mean time of hospitalization was 65 days. In the imaging patterns found in TC and RM scans, there was no predominance of any radiological changes, typical of cryptococcosis between the sexes. On TC scan of skull would show changes in the exams, such as, multiple cryptococoma and other symptoms. The results of this study corroborate with that described in the literature and contribute to the knowledge about this disease in the state of Pará. Key words: Cryptococcosis. Pediatric. Rural and urban areas. Male and female. Cryptococcus neoformans /C. gattii.

This was a cross-sectional study which analyzed a cohort of 50 mongrel dogs with seropositive diagnosis (IFAT/ELISA-IgG) for canine visceral leishmaniasis (CVL) (28-56% from a subclinical group [SCG] and 22-44% from a disease group [DG]), living in endemic area of American visceral leishmaniasis in the Brazilian Amazon, with the aim of evaluating the humoral and cellular immune responses to CVL, based on the IgG1 and IgG2 subclasses, as well as CD4+/CD8+ T cells, inflammatory (TNF-α+ and INF-γ+) and regulatory (IL-10+ and TGF-β+) cytokines expressions, taking in account their relationship with the clinical status and delayed-type hypersensitivity (DTH) of the infected dogs. The IgG1/IgG2 responses were measured by ELISA, while CD4+ and CD8+ T cells were evaluated by immunohistochemical analysis in paraffin-embedded samples of liver, spleen and popliteal lymph node of dogs. TNF-α+, INF-γ+, IL-10+ and TGF-β+ cytokines were measured by ELISA in the supernatants of macerated liver, spleen and popliteal lymph node samples. Data analysis used Fisher`s exact test and coefficient r of Pearson with 95% confidence interval. With regards to DTH and the clinical status of dogs, it was noted that 100% (8) of dogs with positive DTH were from the SCG, while 100% of dogs with negative DTH were from the DG. By the other side, it was observed higher IgG2 response compared to IgG1 in both clinical groups of dogs. However, when this comparison was between both clinical groups, it was recorded that IgG1 response in the dogs DG was higher than that in the dogs SCG, while IgG2 response in the dogs DG was similar to that in the dogs SCG. In addition, it was found lower IgG1 response in the dogs SCG with positive DTH than that in the dogs SCG and DG groups with negative DTH, whereas no difference was found in the IgG2 response in both groups of the infected dogs, SCG or DG. By the other side, taking in account the CD4+/CD8+ T cells as well as the inflammatory (TNF-α+ and INF-γ+) and regulatory (IL-10+ and TGF-β+) cytokines expressions, it was demonstrated, in general, that canine L. (L.) i. chagasi-infection is sustained by a mixed immune response profile (Th1/Th2-Treg), which in the early onset of infection may be with a slight TCD4+/Th1profile on the way to control the dissemination of the parasite, but on the curse of the infection there is an expressive production of regulatory cytokines (IL-10+ e TGF-β+) that inhibits the TCD4+/Th1 response and modulates a definitive polar TCD4+/Th2 response. These findings together strongly suggest that dogs are highly susceptible to CVL in viewing of its weak ability to develop an efficient cellular immune response against the infection.
Keywords: canine visceral leishmaniasis; Leishmania (L.) i. chagasi; cellular immune response; humoral immune response.

Malaria is considered a serious public health problem, being responsible for both social and
economic damages, as it interferes in the community's productivity, as well as in the quality of
life, so it is relevant to obtain an instrument that helps in making decision on public health. This
study aimed to evaluate the quality of life in patients with malaria in an endemic region of the
state of Pará. A cross-sectional study with a quantitative approach was carried out in the
municipality of Itaituba-Pa in the period of 2016, with the use of forms to identify the
socioeconomic, demographic and clinical data of the patients, as well as the quality of life
through the descrivoEQ-5D system and the visual analogue scale (EQ-VAS). The results
showed that the majority of the participants were male, with incomplete primary education,
married or in a stable union, workers in the mining area, with monthly income of one to two
minimum wages. The most frequent species of Plamodium was Plamodium vivax, the parasite
density equal to or less than 10,000 mm3 was predominant, and only 17.6% of patients evolved
with the malaria triad. Regarding quality of life, through relevant statistics, it was observed
that the mean quality of life score was 0.63, while the self-rated health status was 43.5. Most
domains of EQ-5D such as mobility, personal care, usual activities, pain / malaise, anxiety /
depression were more compromised in females and in the advanced age group. The factors
associated with the quality of life of patients with malaria were age, marital status, schooling,
family income, number of malaria cases, number of symptoms, plasmodium species,
parasitemia, disease time and self medication, but there was no statistically significant
association. The variables that exhibited statistical significance, that is, that interfered in the
quality of life were "sex", "days without work" and "malaria triad". It can be concluded that
malaria compromises the quality of life of individuals since it hinders the performance of daily
activities with an increase in the absenteeism rate both in the school environment and at work.
Therefore, it is fundamental to strengthen strategies for health promotion, prevention and
control of the disease, especially in areas of mining that facilitate proliferation and disease.
Key words: Malaria, plasmodium, quality of life.

In HTLV-1 infeccions 90% of carriers remain asymptomatic, 2-3% develop Adult T-cell leukemia/lymphoma (ATL) and 0.25-4% develop HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP). In HAM/TSP, specific CD8 + T cell infiltrates are found in the marrow that destroy infected CD4 + T cells, leading to a chronic activated immune response. Recently emigrated T cells (or naïve T cells) have excised circles by the rearrangement of T cell receptor (TREC) genes that do not double in cell proliferation, being a good indicator to quantify the number of naïve T cells and thus evaluate the thymic function. This study aimed to verify the thymic function of patients with HTLV-1 infection by quantifying the number of TREC in peripheral blood mononuclear cells. This is a cross-sectional, analytical study of 39 patients over 18 years of age, divided into two groups: HAM/TSP (PET) and without HAM/TSP (NPET). We performed a clinical and physiotherapeutic evaluation, blood collection, lymphomononuclear cell separation, DNA and RNA extraction, absolute TREC curve, DNA and RNA quantification, TREC particle detection and quantification, cDNA synthesis, cytokine IL-7 and statistical analysis with the Mann-Whitney tests and Spearman's correlation, with p ≤ 0.05 as significance level. Of the 39 patients studied, two were excluded from the study because they presented autoimmune disease. Regarding the comparison between groups of TREC quantification: there was a difference between the PET and NPET groups (p = 0.01), in patients with age ≤59 years between the PET and NPET groups (p = 0.04), in the (p = 0.003) and the group with a wheelchair and without a wheelchair (p = 0.05). As for the comparison of IL-7 gene expression between groups: in the NPET group there was a difference between the group ≤59 years and the ≥60 years (p = 0.02), in the female there was a difference between the PET and NPET groups (p = 0.04). Thymic function was impaired in patients with HTLV-1 with HAM/TSP compared to those without HAM/TSP, as there was a loss in naïve T cell production in this population, shown by the differences between variables in both PET and NPET groups With respect to the quantification of TREC. Although the importance of this compromise in the triggering and / or evolution of HAM/TSP is not yet clear, it is inferred that the reduction of naïve T cell production can alter the immunological response in these patients, directly affecting their clinical picture.

Helicobacter pylori (H. pylori) is a gram-negative spiral bacterium that infects the gastric mucosa and causes epithelial lesions in the stomach that can evolve and generate chronic inflammatory conditions. Population studies conducted in Brazil indicate that prevalence rates are still very high. In the Northern region, in the state of Pará, few studies have investigated the occurrence of infection by the pathogen in the interior of the state. Thus, this study investigated the virulence markers of H. pylori (VacA, CagA and DupA) and their associations with Gastritis and Peptic Ulcers in the city of Bragança-Pará. In a prospective approach, tissue biopsies were collected from 166 patients diagnosed with gastritis or duodenal and peptic ulcers treated at the gastroenterology and digestive endoscopy service of the Santo Antônio Maria Zaccaria Hospital in the municipality of Bragança, in the northeast of the State of Pará. Detection of H. pylori DNA and vacA, cagA and dupA genes was done by Polymerase Chain Reaction (PCR). In this context, it was possible to isolate bacterial DNA from gastric biopsies of 92% (153/166) patients. Of these, 140 presented monoinfection, prevailing in the vacA alleles, regions s1 and m1, with 61.43% (86/140) and 87.86% (125/140) respectively. The cagA and dupA genes were shown to be high at 64.28% (90/140) and 61.43% (86/140) respectively. When we correlated cagA with gastritis and gastric ulcer, we observed that there was statistical significance (p = 0.02). Regarding dupA, the presence of virulence factor was directly associated with gastritis, gastric and duodenal ulcer (p = 0.04, p = 0.03, respectively). In the cases studied, there was a predominance of virulent strains when compared to non-virulent strains and the most present was s1m1/cagA+/dupA+, being associated with a higher degree of inflammation and with eutrophilic activity. Thus, this study demonstrates the high incidence of H. pylori infection in the patients analyzed with gastritis, gastric ulcer and duodenal ulcer treated in the northeast of the state. Keywords: H. pylori, VacA, CagA and DupA

The epidemiological characteristics of the processes of demographic and epidemiological transition in Brazil, evidenced by population aging, increased occurrence of chronic diseases and maintenance of infectious disease indexes, demonstrate the importance of research in this area.The objective of this study was to determine the incidence of notifiable infectious diseases in the elderly and to analyze the trend of these rates over time.Thus, a longitudinal descriptive ecological study was carried out, with data referring to the incidence of infectious diseases collected from SINAN between 2003 and 2012. Of the 33 aggravations of notification of national interest, 14 were included who had records in the elderly in the period (Dengue, tuberculosis, leprosy, American tegumentary leishmaniasis, hepatitis, AIDS, chagas disease, leptospirosis, visceral leishmaniasis, meningitis, tetanus, typhoid fever, malaria, schistosomiasis). The incidence rates were calculated based on the population estimated by IBGE for each year analyzed. Statistical analysis was performed with the BioEstat 5.4 program. For the comparison of the rates between elderly and non-elderly, the chi-square or G test was used, depending on the sample size. For trend analysis, by 2020, regression curves were constructed from the incidence rates by the curve fitting method. The coverage ratios of the Family Health Strategy and Community Health Agents Program, were determined through the DAB / MS website and the Pearson Linear Correlation Test was used to evaluate the possible dependence of these proportions with the incidence rates. It was observed that the diseases of higher incidence in the elderly in Pará are, respectively, dengue, tuberculosis, leprosy, American tegumentary leishmaniasis, hepatitis and AIDS. Increased incidence of AIDS, LTA, dengue, hepatitis, LV and Chagas disease, maintenance of rates of tuberculosis, leptospirosis, leptospirosis, meningitis, tetanus and schistosomiasis, and reduction of malaria and typhoid fever rates were observed. The average incidence of the infectious diseases added, showed a rise in the period from 2003 to 2012, with a subsequent decline from 2013 to 2016, with exceptions referring to the information system in the last triennium. The incidence of infectious diseases in Pará was higher than in Brazil. The trend analysis, until 2020, showed a statistically significant increase in the incidence of AIDS, dengue and tuberculosis, maintenance of leprosy and a decrease in the incidence of malaria and typhoid fever. The other diseases, due to the variability of the occurrence or the small absolute number of cases, did not demonstrate a reliable trend curve. The incidence of tuberculosis, leprosy, dengue, American tegumentary leishmaniasis and viral hepatitis in the elderly in the last years was significantly higher in relation to the non-elderly population. There is a positive correlation between incidence rates of AIDS, dengue, viral hepatitis, visceral leishmaniasis, and chagas disease, and the proportion of coverage of the Family Health Strategy and the Community Health Agents Program, and a negative correlation with the incidence of malaria And typhoid fever. The results showed that the profile of infectious diseases in the elderly in the period are related to the characteristics of the transition processes in health in the State of Pará and Brazil, corroborating with the need of health policies to act at all levels of prevention In an integrated way that is the Quinary Prevention.

A leishmaniose visceral (LV) é uma enfermidade infecciosa de caráter crônico, cujo agente etiológico no Brasil é o protozoário Leishmania infantum chagasi. Os cães são considerados reservatórios urbanos desse agente, sendo um indicador da ocorrência de casos humanos. O objetivo desse trabalho foi comparar o desempenho da PCR em tempo Real e PCR convencional para o diagnóstico da infecção por L. infantum chagasi e quantificar a carga parasitária em diferentes amostras biológicas de cães e gatos residentes em área de alta transmissão da LV. Para isso foram colhidas amostras de sangue venoso, pele e swab conjuntival de cães e amostras de sangue e pele de gatos adultos amostrados por conveniência, oriundos de nove comunidades rurais da cidade de São Domingos do Capim, estado do Pará. Amostras de sangue foram colhidas para extração de DNA e obtenção de soro, as amostras de pele foram retiradas da orelha, e o swab conjuntival foi coletado das duas conjuntivas. Os soros foram analisados por meio de ensaio de imunoadsorção enzimática indireta, (ELISA-I). Para a PCR convencional utilizando-se um par de iniciadores de oligonucleotídeos RV1 e RV2. Para a PCR em tempo real, as amostras foram submetidas aos iniciadores LEISH1 e LEISH2 e a sonda utilizada foi a TaqMan® para amostras de cães, e com os primers RV1 e RV2 com Syber green nas amostras de gatos. 21% (20/95) dos cães amostrados foram sororreagentes, e detectou-se o DNA de L. infantum chagasi em 22,1% (21/95) dos cães, e em 13,6% (3/22) dos gatos testados, não havendo diferença estatística significativa (p=0,3970). Esses animais eram oriundos de 77,7% (7/9) e 33,3% (3/9) das comunidades rurais visitadas, respectivamente. Nos cães a qPCR foi a técnica que detectou o maior número de animais positivos (p<0,0001), houve uma boa concordância entre a PCR convencional e a qPCR (k=0.5514), e a pele foi a melhor amostra para se detectar o DNA de L. infantum chagasi, tanto pela PCR convencional(p=0,0004), quanto pela qPCR(p= 0,0364). Já nos gatos, foi detectado o DNA de L. infantum apenas nas amostras de sangue, e por meio da qPCR. A carga parasitária nas amostras de pele dos cães variou de 722 a 33x 106 parasitas por amostra, e nas de sangue variou de 954 a 11 x 104 parasitas por amostra. Já a carga parasitária nas amostras de sangue de gatos variou de 113 a 63684 parasitas por amostra. Concluiu-se que a qPCR teve melhor desempenho em detectar o DNA de L. infantum chagasi tanto em cães quanto em gatos, sendo a pele a melhor amostra para se investigar a infecção por L. infantum chagasi em cães, já nos gatos o DNA do parasita só foi detectado no sangue.

Hepatitis E virus (HEV) infection is a major public health problem in many developing countries and is also endemic in some industrialized countries. Hepatitis E is fecal-oral transmission, which favors the spread of infection in developing countries where contamination of water reservoirs keeps the chain of transmission of the disease. The riverside dwellers live in small communities mostly on the banks of rivers, streams, igapós and lakes. Poor sanitation and lack of access to safe drinking water in these communities often lead to enteric infections in early childhood, and poor schooling and poor access to health services can further expose this population to various diseases. This study aimed to determine the HEV seroprevalence in two riverside communities in the State of Pará, outlining the socio-epidemiological profile, comparing seroprevalence among communities and describing the main risk factors for the acquisition of viral infection. The study was developed in distinct riverside communities near the municipality of Belém: Furo do Maracujá Community, located in the municipality of Acará and Furo do Nazário, located in the municipality of Barcarena. A total of 414 samples were collected and an enzyme-linked immunosorbent assay (ELISA) was performed for the detection of Anti-HEV antibodies. The prevalence of Anti HEV was 3% (13/414) in these populations. There was no association between the prevalence of hepatitis E markers with age, gender, schooling and family income, however, precarious basic sanitation in both communities favors the acquisition of HEV infection. The seroprevalence of hepatitis E in this study was similar to the rates found in other regions of Brazil. However, the distribution of infection may vary within the country and even within the regions themselves, depending on the risk factors to which the communities are exposed. . Keywords: Hepatitis E. Epidemiology . Bordering .

Group A rotavirus (RVA) is the most viral agent associated with acute gastroenteritis,
responsible for about 200,000 deaths among children aged under five years
annually. RVA belongs to Reoviridae family, Rotavirus genus, its genome is
composed by double-stranded RNA (dsRNA) with 11 segments encoding 12
proteins, six structural (VPs) and six non-structural (NSPs). Each protein designating
a specific RVA genotype, being VP7 protein responsible for G genotype and currently
there are 32 genetic variants. G9 genotype emerged on a global scale in the 90s, a
period before RVA vaccine introduction in Brazil that occurred in 2006, and is
continuously detected until present day. This study aimed to describe the frequency
and genetic constellation associated with the current G9 genotype in Northern Brazil.
It was selected 50 samples collected between 1999 and 2013, being 45 G9P[8], 2
G9P[4] and 3G9P[6], for fecal suspension preparation and dsRNA extraction for
further genome amplification and sequencing of nucleotides. It was observed that
during pre-RVA vaccine introduction period G9 frequency rate was 43%, while after
RVA vaccine introduction the most frequece obtained was 12.5% (2008 to 2010).
Phylogenetic analysis of VP7 gene showed that all strains belong to lineage III of G9,
observing aminoacidic substitutions in antigenic sites when compared with vaccine
strains. It was demonstrated in VP4 gene that P[8] strains gathered in lineage III,
whereas P[4] grouped into lineage V and P[6] strains into lineage I. All G9P[6] and
G9P[4] samples were associated with DS-1 constellation, genogroup 2, while G9P[8]
samples showed Wa constellation, genogroup 1, except for one sample showing
NSP3 gene with DS-1 profile. G9 samples from Northern region analyzed were
associated with the expected constellations described in other parts of the world,
except for one G9P[8] sample that showed a genetic restructuration in NSP3 protein.
In the present study the same G9 lineages have circulated during pre and post RVA
vaccine introduction periods, and it was described aminoacidic substitutions in
relevant antigenic regions, such as it was reported genetic restructuration
phenomenon in one sample of this genotype, emphasizing the continuous monitoring
of current genetic variants of RVA.

Syphilis is an infectious disease caused by the bacterium Treponema pallidum (T. pallidum) and still stands today as one of the biggest challenges to public health. According to the World Health Organization (WHO), about 937,000 people are infected, and 10 to 15% of these individuals would be pregnant women, with 70% chance of transmitting the parasite to their concepts, for lack of proper treatment. The objective of this descriptive study, ecological and retrospective, was to analyze the epidemiology of congenital syphilis and maternal syphilis in the state of Para mesoregions in the period 2006-2015 and trend analysis by 2025. In the methodology we used data relating to cases of congenital syphilis and maternal syphilis, using as a primary source of information available in the State Coordination of STD / AIDS, the State Public Health Department (SESPA), Pará state, which receives the SINAN data, diagnosed between 2006-2015 in the state of Pará municipalities, adopting the mesoregions criteria of integration, the total of twelve. The variables were sociodemographic and epidemiological order of newborns and mothers with syphilis, descriptive statistical tests being applied, using the G and chi-square test and the Student t test and Mann-Whitney. For trend analysis were used polynomial regression models for time series. It was considered the 95% confidence interval with significant p-value <0.05. This study met the criteria of Resolution 466/2012 CONEP. It was observed in this study an increased incidence of congenital syphilis in the state of Para 0.4 mesoregions in 2006 to 46.0 cases / 10,000 live births in 2013. In trend analysis by the year 2025. The results observed an estimate High of cases in most of the state of Para mesoregions, especially in the Tapajos, Rio Carajás and grass; and low in the Araguaia and Marajó. Regarding RN's was not observed significant difference in sex, but there was a predominance of mulattos. As for the mothers, prevailed the age group between 20-34 years and also the brown race, most mothers held prenatal care and the treatment was performed, but mostly inappropriately. Found an increase in the incidence of congenital syphilis in mesoregions the 2006-2013 state of Pará; the mesoregions with greater growth trends by 2025 are Tapajos, Rio Carajás and grass; the period 2006-2015 the frequency of genres of RN's was similar, the race of frequent neonates was mixed; from 2007 to 2015 maternal age group that predominated was between 20 and 34 years in all mesoregions and congenital syphilis occurred more frequently in mothers enrolled in prenatal care, but with high frequency of inadequacy to the treatment. 

The effects of methylmercury on growth hormone and its relation to liver function, weight and growth were evaluated in an experimental model of acute and subchronic exposure with mercury. Forty wistar rats were divided into four groups: control, acute, subchronic2 (SB2) and subchronic3 (SB3). Measurements of total mercury (HgT), growth hormone (GH), glucose, ALT and AST enzyme activities, body weight and length of animals were measured in all groups. The results demonstrated that the dose of 25mg/kg was lethal for all animals in this group. The concentrations of mercury measured in the hair’sfrom the SB2 and SB3 groups were significantly higher than in the control group. GH levels were elevated in the acute group and reduced in the subchronic groups. The reduction of glycemia in the subchronic groups was highly significant in relation to the control group (p <0.01). The ALT and AST enzyme activities were altered. These results suggest that methylmercury high doses administered is hepatotoxic, able of to compromise glycemic control and to promote significant alterations in GH levels, which may interfere in the growth of the animals. However, other studies are required to understand the alterations found.
Keywords: Growth Hormone, Methylmercury, Growth and Development.

Neglected tropical diseases, particularly leprosy, correspond to a group of infectious diseases that predominantly affect the poorest and most vulnerable populations and is a major public health problem in Brazil and especially in the state of Pará. The objective was to describe the epidemiological profile, anthropometric, dietary and seropositivity of phenolic glycolipid I (PGL-I) of leprosy patients and household contacts residents in the state of Pará municipalities. We conducted a cross-sectional descriptive study of cases of leprosy and its met household contacts in Services industry Medical Institute Evandro Chagas Unified (IEC) in the period from May to December 2015. Data were collected for related socioeconomic, housing conditions, the clinical history of the disease and lifestyle of patients; evaluated the nutritional status and body composition by anthropometric techniques; characterized the food profile through food frequency questionnaire (FFQ) and detected the sopositividade of PGL-I by Test Method immunoenzymatic (ELISA). The sample consisted of 75 participants, 50.67% (38) female; 57.33% (43) cases of leprosy and 42.67% (32) household contacts. There was prevalence of leprosy patients male adults in stable, with income from 1 to 2 minimum wages, with incomplete primary education and from the metropolitan region of Belém, while among household contacts, predominated female. The operational classification by sex showed that 78.27% (18) men were multibacillary (MB) and 60.00% (12) of the women were paucibacillary (PB) and 39.13% (10) for the clinical form dimorphic and 45.00% (9) for tuberculoid, respectively. The characterization of the household shows that most patients were living in their own home, with electricity, access to urban waste collection without public sewer. The prevalence of non-smokers, non-alcoholic, sedentary and who considered herself healthy eating. The assessment of nutritional status indicated prevalence of overweight in 58.14% (25) of leprosy cases and 62.50% (20) of household contacts. There was a statistically significant association for seropositivity of PGL-I in relation to the study group (cases/ contacts) and the operational classification of the disease (MB/PB). It occurred prevalence of anti-PGL-I seropositivity among multibacillary. The profile of food consumption of these patients demonstrates the monotony and certain dietary restrictions (taboos) related to disease. It revealed a similar feeding behavior in the general population with low consumption of fruits and vegetables. These results indicate the need for professional nutritionist insertion monitoring and care of leprosy patients and their same household contacts because of the complications of treatment. This table highlights the need for constant nutritional surveillance, to improve the quality of life of patients and their families.

Tuberculosis treatment involves a combination of drugs with possible interactions with each other and other drugs. The most common side effects are related to hepatotoxicity. The biotransformation of drugs may result in the formation of reactive metabolites that can produce cellular damage which has been considered as an important process in the pathogenesis of hepatotoxicity. Goals: Evaluate the role of oxidative stress in patients with hepatotoxicity that have used anti-TB drugs. Methodology: To reach the first goal a Review of hepatotoxicity as an adverse reaction to anti-TB drugs was performed. Such an review was done through a wide search in the Portal of the Virtual Library of Health that targeted Portuguese and English literature to find papers pub- lished until December 2014. On the other hand, a Case Control study was performed to reach the second goal. For the analysis of antioxidant enzymes, patients treated at HUJBB in Secondary Reference Clinic of Pulmonology Clinic and admitted in línica of Pulmonology, and the patients seen at the Basic Health Unit Guamá in Belém were included. Results: As for the literature review, it was found that hepatic impairment is among the highest incidence of adverse reactions associated with anti-tuberculosis drugs in the Brazilian scene and adverse reactions during treatment of tuberculosis are one of the main factors associated with therapy abandonment. Regarding the analysis of antioxidant enzymes, the analysis of glutathione in the control group with hepatotoxicity (PCH) and the group without hepatotoxicity with anti-TB drugs (PCT) achieved median glutathione levels of 221 nmol / ml, 227 nmol / ml, and 236 nmol / ml, respectively. The distribution of catalase in the control group with hepatotoxicity (PCH) and the group without hepatotoxicity with anti-TB drugs (PCT) showed medians of catalase activity with values of 213 nmol / ml, 319 nmol / ml and 2035 nmol / ml, respectively. The median levels of antioxidants glutathione to the PCT group was the largest. However, glutathione levels were not statistically significant when applying the ANOVA test. Distributions of catalase activity in the population of TB patients in the group who developed hepatotoxicity (PCH) and that evolved without hepatotoxicity (PCT) were larger when compared to healthy volunteers. In particular, there was a statistically significant difference in catalase activity in the group (PCT) compared to the remaining groups. Conclusion: The results suggest that hepatotoxicity is not only associated with antioxidants enzymes and further analysis with more explanatory variables should be made to better understand this phenomenon.
Keywords: Tuberculosis. Liver diseases. Oxidative stress.

Although curable, leprosy is still a major public health problem. This is a chronic infectious disease caused by Mycobacterium leprae and characterized by dermatological and neurological involvement. If not treated, this disease can lead to serious disability. The evaluation of the neurological function of the patient is very important for the early dignosis and treatment of nerves damage. The exams in neurological evaluation of leprosy are too subjective. This study, worrying about the consistency of neurological evaluation in showing in a reliable manner the situation of patients, aims to correlate the clinical complaints from leprosy patients with sensory and motor findings in upper and lower limbs. For this, an analytical cross-sectional study was conducted in two steps. The first stage included 97 leprosy patients treated at the service between the years 2014 and 2015, in them was applied the simplified neurological evaluation, which was made the examination of nerve palpation, voluntary muscle strength test, tactile sensitivity test at hand and feet with Semmes-Weinstein, in addition to the collection of clinical complaints. For the second stage were randomly selected 14 patients who were submitted to surface sensitivity tests (thermal, painful and tactile) in the path of the most commonly affected nerves. Data analysis was performed using the chi-square test, G test and t test, when relevant to the comparison with the population or between groups. For correlation ordinal variables the Spearman correlation test, considering the alpha significance level of 0.05. Of the 97 leprosy patients, 77 (79.4%) had complaints, the most common being those related to sensory fibers, including pain and numbness were the most mentioned. On palpation, the ulnar nerve and tibial were the most affected and multibacillary patients had higher averages of affected nerves and most sensitive damage. Engine damage was not very common among patients, but low levels of muscle strength found were related to higher sensory damage stages, higher degree of disability and greater amount of affected nerve. When compared to the occurrence of complaint, the complainants patients had more advanced stages of sensory damage, higher degree of disability in the lower limbs and motor damage occurring more frequently, but the type of complaint did not influence these results. In the evaluation of the surface sensitivity in the nerve pathway, there was a higher incidence of sensory changes also among the plaintiffs, and the heat the most affected. It is clear, then, that the complainants patients are more sensitive to sensory and motor damage, the high degree of disability, and the sensitivity of changes in nerve path. Therefore, health professionals should be alert to this patient group, allocating more attention at the time of evaluation in order to avoid the dreaded disabilities.

As doenças pulmonares infecciosas são identificadas, com frequência, em pacientes infectados com o vírus da imunodeficiência humana (HIV). O objetivo deste estudo foi descrever os aspectos clínicos, epidemiológicos e as técnicas utilizadas no diagnóstico de pneumopatias infecciosas em pacientes com HIV/AIDS. Foram avaliados  prontuários de pacientes admitidos no Hospital Universitário João de Barros Barreto Barros Barreto – Belém – PA, no período de 2005 a 2014, com diagnóstico de pneumopatias infecciosas, positivos ao HIV, e com idade superior a 18 anos. Foram excluídos indivíduos cujo prontuário médico não foi encontrado, ou aqueles em que os dados foram insuficientes para o preenchimento da ficha de inclusão. Resultados: Foram avaliados 830 indivíduos, com média de idade de 37,7 anos, a maioria do gênero masculino (64,4%). Foi verificada uma grande associação entre sinais e sintomas, onde, isoladamente, os mais comuns foram febre, tosse produtiva e dispnéia. As técnicas diagnósticas mais utilizadas foram, em ordem de frequência: análise de escarro, lavado broncoalveolar e biópsia pulmonar transbrônquica, e os diagnósticos mais encontrados foram pneumonia bacteriana, tuberculose e pneumocistose. Conclusão: A amostra estudada demonstrou quadro clínico e epidemiológico compatível com o encontrado na literatura. A técnica diagnóstica mais utilizada foi a análise de escarro e o diagnóstico mais encontrado foi pneumonia bacteriana.

O vírus da hepatite B (HBV) pertence ao gênero Orthohepdnavirus e a família Hepadnaviridae, O vírus da hepatite B pertence ao gênero Orthohepdnavirus e a família Hepadnaviridae, compreendendo um vírus de DNA, hepatotrópico capaz de infectar mamíferos. Classificados em 10 genótipos (A-J) diferentes e muitos subgenótipos, estudos sugerem que eles podem influenciar na gravidade da doença, na resposta ao tratamento e na resposta vacinal. Os genótipos e subgenótipos do VHB tem uma distribuição variada, sendo alguns restritos a determinadas regiões geográficas, enquanto outros mostram uma distribuição mundial. É encontrada nas diversas regiões do Brasil com prevalência dos genótipos A, D e F. Este estudo teve como objetivo identificar os genótipos e subgenótipos do vírus da hepatite B entre os pacientes atendidos no Núcleo de Medicina Tropical - UFPA, na cidade de Belém, estado do Pará, no período de janeiro de 2011 a dezembro de 2015. De um total de 1274 pacientes atendidos no NMT-UFPA dentro do período, foram selecionadas para o estudo 222 pacientes, de ambos os sexos, com sorologia reagente para os marcadores HBsAg e/ou anti-HBc total. As amostras foram submetidas a testes de biologia molecular, PCR “in House” e PCR multiplex para detecção do DNA viral e genotipagem, e posteriormente ao sequenciamento, para a confirmação e determinação dos subgenótipos virais. Em 65 das 222 amostras foi detectada a presença do DNA do VHB, sendo identificada a presença dos genótipos A (46/65), com predominância os subgenótipos A1(36/48) seguido do subgenótipo A2 (10/46), e genótipo F (17/65) sendo detectado apenas o subgenótipo F2 (17/17) circulando nesta população. A média de idade entre os paciente foi de 38 anos, com predominância do sexo masculino, sendo a maioria dos pacientes naturais do estado do Pará. Alguns fatores de risco foram identificados entre a população estudada, sendo a não utilização de preservativo durante as relações sexuais o mais predominante. Ao se comparar a presença do DNA viral com a sorologia para o marcador HBsAg, fica evidenciado um quadro que sugerem a presença de hepatite oculta entre os pacientes atendidos. Os resultados encontrados nesta pesquisa estão de acordo com o que é relatado em outros estudos no Brasil.

The cervical cancer is a problem of global public health. Despite the easy tracking and have high cure rates when detected early, it is still responsible for the death of approximately 230,000 women, of which 80% occurred in developing countries. Therefore, the objective of this research was to conduct a study of the prevalence of genital infection with human papillomavirus (HPV) and associated risk factors in women living in the city of Bragança, in the state of Pará. It was a cross-sectional observational clinical study and analytical, held in Bragança Regional Hospital Antonio Maria Zaccaria and in health units that municipality, through data collection was conducted with a clinical epidemiological form and collection of biological samples of cervical cells, and then the detection of HPV molecular biology technique known as "nested PCR (polymerase chain reaction). The prevalence of HPV was 37.5% in women from Bragança city, having identified subtypes: 11, 16, 18, 31, 35, 52 and 58, the most prevalent were 16 and 35 and three cases coinfection of subtypes. Infected women were predominantly married, were between 18 and 25, had high levels of education, non-smokers, but were alcoholic, had first sexual intercourse after 15 years, more than 5 partners in life, one or more sexual partners in the last year, and at least one new partner, did not make regular use of contraceptives, they had up to two pregnancies, childbirth, at least one abortion and were taking the first examination of PCCU. A high prevalence of HPV in these women was found but no risk factors was associated with statistically. However, one can trace a profile of the infected women to support health actions and minimize the transmission of this virus through educational activities, mainly focused on the proper use of condoms, in addition to increasing nastiness for cervical cancer in especially the awareness of the preventive test.