Faculdade de Medicina de São José do Rio Preto (FAMERP)
Assessment of Toxoplasmosis-Related Knowledge Among Patients and Their Companions at the University Hospital of Maringá
Introduction: Toxoplasmosis is a widely distributed parasitic disease caused by the protozoan Toxoplasma gondii. It typically causes mild symptoms such as lymphadenopathy and fever in immunocompetent individuals, but can lead to more severe symptoms in immunocompromised patients and congenital infections. Objective: Assess the knowledge of patients and their companions regarding various aspects of Toxoplasmosis. Methods: This study was conducted at the Regional University Hospital of Maringá from July to September 2024. Questionnaires were administered to patients and their companions about the manifestations, modes of transmission, and prophylaxis of Toxoplasmosis. Results: A total of 30 men and 40 women were interviewed, predominantly aged between 25 and 59 years (64.2%), with at least a high school diploma (71.4%) and prior knowledge of Toxoplasmosis (87.1%). The most common sources of infection mentioned were contact with cat feces (81.4%), consumption of raw vegetables (55.7%), and undercooked meats (52.9%). The most frequently cited symptoms associated with Toxoplasmosis were problems during pregnancy (75.7%) and fever (72.9%). Itching (57.1%) and a burning sensation (41.4%) were the most reported among ocular symptoms. Only one patient reported having the disease, with involvement of the left eye. Conclusion: Most respondents understand the risks associated with Toxoplasmosis, but the presence of myths and inadequate practices shows that measures to analyze and spread knowledge about this disease could be effective for its prevention and control.
Thematic Issue - Toxoplasma and Toxoplasmosis
Copyright (c) 2025 Arquivos de Ciências da Saúde https://creativecommons.org/licenses/by-nc-sa/4.0
First detection of Toxoplasma gondii DNA in African Giant Snails, Achatina fulica (Bowdich, 1822)
Introduction: Environmental contamination by Toxoplasma gondii oocysts poses a risk to human and animal health, especially in urban areas with poor sanitation. The giant African snail (Achatina fulica), due to its direct contact with soil and consumption of vegetables, may act as a mechanical vector of the parasite’s oocysts. Objectives: To investigate the presence of Sarcocystidae DNA in fecal samples of A. fulica collected in Feira de Santana, Bahia, Brazil. Methods: Epidemiological observations were conducted at the collection sites, and climate variables were provided by the National Institute of Meteorology. In the laboratory, the animals were washed in running water, measured, placed in individual plastic containers, and fed daily with water and cabbage until fecal samples were processed. The cabbage leaves were subjected to parasitological testing to detect the presence of protozoa and helminths. Fecal samples were resuspended in an equal volume of absolute ethanol and frozen until DNA extraction, which was performed using a commercial kit. Nested PCR (nPCR) was conducted to detect ribosomal DNA fragments of protozoa from the Sarcocystidae family. Results: Of the 220 samples subjected to nPCR, 58 (26.36%; 95% CI: 20.99–32.57) amplified the expected 290-base pair fragment and were then subjected to RFLP. Of these, 41 (70.69%; 95% CI: 57.92–80.81) were cleaved by the restriction enzymes used in this study, showing a profile compatible with T. gondii. Conclusion: This is the first report on the presence of DNA compatible with T. gondii in A. fulica.
Toxoplasma. Feces. Molluscum Contagiosum. DNA
Congenital Toxoplasmosis in Brazil: A Document Analysis of Government Guidelines for the Prescription and Medicine Use
Introduction: Congenital toxoplasmosis can result in severe clinical manifestations and long-term complications in newborns. Standard treatment typically comprises a combination of three medications, with the potential addition of a fourth temporarily. However, the lack of commercially available pediatric formulations in Brazil requires pharmacy compounding or alternative methods to adjust adult-dose tablets for neonatal use. Objective: This study aims to examine government guidelines on the prescription and use of medications for the treatment of congenital toxoplasmosis. Methods: Document analysis was used in this descriptive, qualitative, and exploratory study. Manual searches were conducted on the websites of Municipal Health Departments from all state capitals, State Health Departments, and the Ministry of Health portal. The inclusion criteria focused on documents containing guidelines for the prescription and/or use of medications for congenital toxoplasmosis. Medication information was compiled into a spreadsheet, detailing the source and specific government guidelines related to the prescription and/or use of medications for congenital toxoplasmosis. Results: The initial search yielded 1,640 documents. After screening, 1,615 were excluded based on the titles; 25 for detailed analysis were investigated. Of these, only five met the inclusion criteria. While all included documents provided information on the therapeutic regimen and dosage, only one addressed guideline for adapting adult tablets for newborns. This underscores the lack of relevant guidelines for the rational use of medicines and the need to ensure the expected therapeutic outcomes. Conclusion: This study underscores the urgency of establishing clearer and more comprehensive guidelines regarding the appropriate use of medications for treating toxoplasmosis in newborns in Brazil.
Danielle Maria de Souza Serio dos Santos
Gestational and Congenital Toxoplasmosis: Gaps in Healthcare Professionals' Knowledge at a Public Maternity Hospital in Central-West Brazil
Introduction: Congenital toxoplasmosis is transmitted from the mother to the fetus via the placenta, potentially leading to various adverse outcomes for the infant. Objective: To assess healthcare professionals' knowledge of gestational and congenital toxoplasmosis in the maternity ward of a public university hospital. Methods: This is a descriptive study, with a cross-sectional design and mixed approach, carried out between October 2023 and April 2024. A structured questionnaire was used to investigate aspects of gestational and congenital toxoplasmosis, covering topics such as diagnosis, transmission mechanisms, clinical manifestations, prophylaxis measures, and therapeutic options. Results: Fifty-one professionals between the ages of 36 and 50 responded to the questionnaire. All reported having heard of toxoplasmosis, and 43 (84.3%) correctly identified the etiologic agent. Regarding the frequency with which the health care team counsels patients; 37.2% (19/21) and 35.2% (15/51), respectively, stated that they rarely or never do so. The majority of respondents (82.3%) said that contact with cats was the mode of transmission, followed by eating raw meat (72.5%). Less than half of the respondents said that the disease could be transmitted by eating fresh vegetables, drinking unfiltered water and handling soil. In addition, less than half of the respondents correctly identified the possible manifestations of congenital toxoplasmosis. Regarding diagnosis; 94.1% identified serologic testing as the correct method. According to the treatment, the answers varied considerably. Conclusion: The results showed that health professionals who care for pregnant women lack accurate knowledge about the disease, reinforcing the need for this training.
Maternal and child health; Parasitology; Health Education; Toxoplasma, Foodborne Diseases.
Seroepidemiology and spatial distribution of Toxoplasma gondii in dogs from Ourinhos, São Paulo, Brazil
Introduction: Toxoplasma gondii can infect all warm-blooded animals, including humans, which makes it a significant public health concern worldwide. Dogs can play a crucial role in the epidemiology of toxoplasmosis by acting as mechanical vectors and sentinel for environmental contamination. Objectives: This study aimed to assess the seroprevalence and spatial distribution of T. gondii in dogs from Ourinhos, São Paulo, Brazil. Methods: Blood samples from 602 dogs from different areas of Ourinhos municipality were collected during the rabies vaccination campaign. Information about the age, gender, breed of the dogs, and residential address of each tutor were collected. The indirect fluorescent antibody test (IFAT) was performed to evaluate the presence of antibodies against the parasite, while the spatial analysis was used to evaluate regions associated with seropositivity. Results: In total, 23.7% (143/602) of the samples tested positive, with no significant association observed between gender, age, or breed. Spatial analysis revealed a high concentration of positive cases in the municipality's most peripheral neighborhoods. Conclusions: These results indicate that dogs in Ourinhos, SP, Brazil, are exposed to T. gondii, and that peripheral neighborhoods likely have higher environmental contamination."
Toxoplasma gondii in free-range chickens from Bahia State: serology, meta-analysis, associated factors and spatial analysis
Introduction: Free-range chickens have been studied extensively as environmental contamination markers by Toxoplasma gondii, a cat Coccidia, which causes important zoonosis and an agent of abortion in production animals. Objective: The objective of this study was to evaluate the frequency of infection of chickens reared in rural properties of Feira de Santana, Bahia, Brazil, and the factors associated with rates of positivity. Methods: A total of 290 blood samples were obtained from birds of 15 properties and examined by modified agglutination test in dilutions equal to or greater than 1:25. Data on the conditions of birds rearing and contact with other animals were collected. Sample collection was conducted between March and September 2016. Results: The Frequency of reagent sera (49.7%) in Gallus gallus can be considered similar to other Brazilian works, however, the titers found were less than or equal to 100 in 90% of birds with acute infection. Conclusion: Among the factors surveyed, the area of origin of the samples, the presence of cats, cats fed with raw meat, and the absence of dogs with less than six months were significantly associated with rates of infection of birds by logistic regression. Spatial cluster analysis showed an area of concentration of infected birds.
Luana Maria Silva de Macedo e Marques Guerra
Epidemiological aspects and spatial distribution of cases of Toxoplasma gondii infection in pregnant women in the state of Sergipe, Brazil
Introduction: Toxoplasmosis is an infectious disease caused by the protozoan Toxoplasma gondii, which can infect humans and other warm-blooded animals. In humans, when contracted during pregnancy, it poses a significant public health concern due to the risk of vertical transmission. This transmission can lead to miscarriage or severe complications for the fetus and newborn. Objective: To analyze the epidemiological aspects and patterns of spatial distribution of the occurrence of T. gondii infection in pregnant women reported in the state of Sergipe, Brazil, between 2019 and 2021. Methods: Descriptive, retrospective study using spatial analysis techniques of reported cases of toxoplasmosis acquired during pregnancy in the state of Sergipe. Descriptive statistical analysis was performed, with absolute and relative frequencies of categorical variables, and for spatial analysis; the Kernel intensity estimator was used. Results: The cases primarily involved young, low-educated, single adult women of brown ethnicity residing in urban areas. Most were multiparous and consumed untreated water, raw or undercooked beef, and unprocessed vegetables. Spatial analysis revealed cases across all state regions, with clustering observed in certain municipalities. Conclusion: Low educational levels and socioeconomic conditions may increase women's vulnerability to risk; hinder preventive care and be directly associated with the incidence of gestational toxoplasmosis. This study provides an epidemiological and spatial characterization of cases, offering valuable insights to inform discussions and guide the development of new public health and educational policies.
Knowledge of primary healthcare professionals about gestational toxoplasmosis
Introduction: Toxoplasmosis is considered a public health problem because it occurs worldwide and causes complications in immunocompromised individuals and potentially serious consequences with congenital transmission. Objective: to analyze the knowledge of primary healthcare professionals in relation to gestational toxoplasmosis. Methods: This is a cross-sectional study. Data were analyzed using descriptive statistics estimating the prevalence ratio and respective 95% confidence intervals to identify the presence of associated factors. Results: Most primary healthcare professionals have no access to information about toxoplasmosis, have never participated in training, and few provide individual or collective guidance to pregnant women on this subject. Just over half are aware of the need to notify the disease, and a minority know all the transmission routes, diagnostic tests and preventive measures. Conclusions: this survey suggests that professionals lack knowledge about toxoplasmosis and highlights a need for continuing training and discussions, so that the planning of strategies for the prevention and control of gestational toxoplasmosis are constantly improved.
Toxoplasma; Education, Continuing; Primary Prevention; Secondary Prevention
Knowledge of Toxoplasmosis Among Health Professionals in Areas with Toxoplasma gondii Infection in Pet Animals
Introduction: Toxoplasmosis is a significant zoonotic disease that requires a multidisciplinary approach for effective control and prevention. Objective: This study aims to assess health professionals' knowledge about toxoplasmosis in areas with animal seropositivity in Rio de Janeiro, Brazil. Methods: A survey based on serological diagnostic results was conducted to identify areas with a high prevalence of toxoplasmosis in animals in Rio de Janeiro. Based on these findings, selected primary healthcare units in these areas were targeted for distributing semi-structured questionnaires to 70 health professionals, including individuals with high school and superior education backgrounds. Results: The findings revealed that while health professionals had partial knowledge of toxoplasmosis transmission and prevention, significant gaps were evident, particularly in their understanding of the etiology and biology of T. gondii. Notable differences were observed between groups regarding the routes of transmission. Conclusion: Health professionals exhibit partial knowledge of toxoplasmosis. Integrated approaches could consolidate knowledge and improve health practices. Conclusion: Health professionals have demonstrated partial knowledge of toxoplasmosis. Integrated approaches may help strengthen their understanding and enhance health practices.
Toxoplasmosis; One Health; Primary Health Care
Serological Monitoring of Gestational Toxoplasmosis: Retrospective Analysis of Pregnant Women in Petrópolis, RJ, Brazil
Introduction: Congenital toxoplasmosis is one of the most serious forms of Toxoplasma gondii infection, acquired by the fetus when pregnant women are infected, at the beginning of pregnancy or close to conception. Therefore, diagnosis, monitoring, and guidance during prenatal care are essential factors to help reduce the number of cases of this disease and its consequences. Objectives: To evaluate the serological monitoring of gestational toxoplasmosis during prenatal care based on data collected from medical records of postpartum women treated at a public hospital in Petrópolis city, Rio de Janeiro state, Brazil, between 2020 and 2022. Methods: Pregnant women were divided into four groups, according to the number of serological tests they were subjected to during prenatal care. Variables related to mother, pregnancy, and prenatal care were analyzed and compared between groups. Results: In total, 240 (39.9%) of the 602 analyzed medical records presented IgG antibodies, whereas eight (1.3%) of them showed IgM antibodies; 16 (2.7%) of patients were subjected to four serological tests during pregnancy; 115 (19.1%) of them were subjected to three tests; 214 (35.5%), to two tests; and 257 (42.7%) of patients only underwent one test. Group 4 was the only group in which all susceptible pregnant women underwent all three serological tests following the initial test. Consequently, the number of toxoplasmosis tests conducted decreased as pregnancy progressed. Conclusions: Based on the analyzed data, approximately 60% of pregnant women were susceptible to infection caused by Toxoplasma gondii, and many were not monitored as recommended by the Ministry of Health."*
Investigation of a Toxoplasmosis Outbreak in a Rural Family in Iguaraçu, PR, Brazil
Introduction: Toxoplasmosis is a disease caused by the parasite Toxoplasma gondii, which is transmitted through the consumption of contaminated food or water, ingestion of infected meat, or via transplacental transmission. Humans act as intermediate hosts, while felines serve as the definitive hosts. Objective: To investigate an outbreak of toxoplasmosis affecting a family residing in the rural area of Iguaraçu, Paraná; southern Brazil. Method: DNA analysis of T. gondii was performed on soil, water, and cat feces samples collected at the outbreak site. The samples were sent to the Parasitology Laboratory of the State University of Maringá, PR, and the affected individuals were monitored in an outpatient setting. Results: A toxoplasmosis outbreak was confirmed in a family residing in a rural area, leading to severe outcomes, including miscarriage and ocular manifestations of the disease. The environment exhibited several risk factors, such as the presence of cats, chickens, pigs, cows, a ground-level water tank, a well, and untreated sewage discharged directly into a nearby river. The residents consumed water from both the tank and the well. However, environmental analysis using conventional PCR did not detect T. gondii DNA in the water, soil, or cat feces samples. Conclusion: The infection is likely attributed to an external factor that has not yet been investigated or to the limited sensitivity of the collected samples for detection via PCR. This underscores the difficulties in identifying T. gondii oocysts in environmental samples and highlights the necessity of conducting further studies in the region, along with a thorough investigation into the family's food sources.
Hematological and biochemical analysis of sheep naturally infected with Toxoplasma Gondii and Neospora Caninum
Introduction: Toxoplasma gondii and Neospora caninum are recognized as significant causes of reproductive issues in sheep; however, studies examining the impact of natural infections on clinical pathology parameters remain limited.Objectives: To determine whether natural infections by Toxoplasma gondii and Neospora caninum may influence hematological and biochemical parameters. Methods: Blood samples were collected from 119 sheep in Rio de Janeiro, Brazil, and divided into four groups based on the presence of IgG antibodies: anti-T. gondii and anti-N. caninum. The tests used were MAT and ELISA. Results: T. gondii-infected animals had significantly increased values for the MCV, MCHC, and the number of basophils compared to the seronegative group (P<0.05). The number of leukocytes, erythrocytes, lymphocytes, eosinophils, and segmented neutrophils was statistically lower in the infected group than in the uninfected group. On the other hand, there were no significant differences in the hematological and serum biochemical parameters between the N. caninum-infected and uninfected sheep. Increasing T. gondii antibody titers also did not interfere with any analyzed parameters (P>0.05). Conclusion: No significant changes were observed in the hematological and serum biochemical parameter values among sheep infected with N. caninum. Analyzing the hematological and serum biochemical parameters of sheep naturally infected with Toxoplasma gondii and Neospora caninum would not aid in diagnosing these diseases.
Isolation and genotyping of Toxoplasma gondii in sheep meat from Northern Parana state, Brazil
Introduction: Toxoplasmosis is caused by Toxoplasma gondii, an intracellular protozoan that can infect humans and all warm-blooded animals. Objective: The present study aimed to isolate and genetically characterize T. gondii in sheep meat. Methods: The study was conducted in a sheep slaughterhouse, and samples of masseter muscles, tongue, heart, diaphragm, and blood were collected from 50 sheep. The sheep sera were subjected to an indirect immunofluorescence assay (IFA) to detect anti-Toxoplasma gondii IgG antibodies. The cutoff point used was 1:64. Tissue samples from seropositive animals were subjected to mouse bioassay. Inoculating mice determined the virulence of isolated strains. Genotyping was performed using multilocus PCR-RFLP with 11 genetic markers. Kaplan-Meier was used to build a survival curve. Results: IFAT showed 12% (6/50) of seropositivity, and the antibody titers were 64 (4/50, 8%) and 256 (2/ 50, 4%). The isolates were named TgShBrPr01 and TgShBrPr02. Genetic characterization of the isolate TgShBrPr01 showed the genotype ToxoDB #183. The isolated TgShBrPr02 did not amplify all markers; however, the available typing data indicate a new genotype. The survival curve of TgShBrPr01 showed a high virulence strain and killed all the Swiss Webster mice infected with 102 and 103 T. gondii tachyzoites. Conclusion: This study isolated two new atypical (nonclonal) T. gondii strains from sheep, underscoring the potential risk of this transmission source to humans, especially when meat is consumed raw or undercooked.
Epidemiological profile of gestational and congenital toxoplasmosis in the Federal District, Brazil, 2019 to 2023
Introduction: Toxoplasmosis is a globally prevalent disease, affecting approximately 25% to 30% of the population. Despite its high prevalence, clinical manifestations are rare. Diagnosing Toxoplasma gondii infection during pregnancy is crucial, even in asymptomatic cases, with the primary goal of preventing congenital toxoplasmosis and its potential long-term sequelae. Objective: To describe the epidemiological profile of gestational and congenital toxoplasmosis in the Federal District, Brazil, from 2019 to 2023. Methods: This study is a descriptive, retrospective analysis of gestational and congenital toxoplasmosis, utilizing secondary data obtained from the Notifiable Diseases Information System (Sinan-Net) database. Results: During the study period, 370 cases of gestational toxoplasmosis and 253 cases of congenital toxoplasmosis were confirmed. The cumulative incidence was 35 per 100,000 women of childbearing age and 79.7 per 10,000 live births, respectively. Notably, the incidence of congenital toxoplasmosis increased by 143.8% over the study period. Among pregnant women, prevalence was highest in the second trimester and in those aged 20 to 29 years. In both groups, individuals of brown race/color and those residing in urban areas were most affected. The highest cumulative incidences were observed in the Structural Administrative Region for gestational toxoplasmosis and the Fercal Administrative Region for congenital toxoplasmosis. Conclusion: The incidence of both gestational and congenital toxoplasmosis increased during the study period. Gestational toxoplasmosis was more frequently observed in the second trimester of pregnancy and among young women. Cases of congenital toxoplasmosis were evenly distributed between sexes but were more prevalent among children of brown race/color residing in urban areas.
Toxoplasmosis; Toxoplasma; Toxoplasmosis, Congenital; Gestational Toxoplasmosis; Epidemiological Monitoring
Brasília Letter: Proposal for Toxoplasmosis Control in Brazil with a Multidisciplinary Approach and a Pan-American Cooperation Perspective
A diverse group of professionals gathered in Brasília for the VI Brazilian Symposium on Toxoplasmosis and III International Symposium on Toxoplasmosis from October 17 to 19, 2023. Guided by the ‘One Health’ concept, the event addressed toxoplasmosis in its human, animal, and environmental dimensions. Participants discussed strategies to improve the prevention, diagnosis, and treatment of the disease in Brazil, also emphasizing a Pan-American cooperation. The resulting document, the Brasília Letter: Proposal for Toxoplasmosis Control in Brazil with a Multidisciplinary Approach and a Pan-American Cooperation Perspective, synthesizes the specialists’ concerns and proposes actions for the development of public health policies in Brazil and other countries in the Americas. This initiative aims to promote significant advances in toxoplasmosis control, benefiting society’s health on a continental and global scale.
Leila Maria de Carvalho Alves dos Santos
Copyright (c) 2025 Archives Health Sciences https://creativecommons.org/licenses/by-nc-sa/4.0
The diagnostic context of individuals with mild autism
Introduction: Asperger's Syndrome (AS) is a neurodevelopmental disorder; part of the diagnosis defined as Autistic Spectrum Disorder (ASD), also considered as mild autism, according to the new classification of the Statistical Manual and Diagnosis of Mental Diseases (DSM- 5). Individuals with AS have social deficits and stereotyped behaviors. Objective: To Investigate the context and trajectory of AS diagnosis, from the age of symptom perception, age of the first clinical evaluation, diagnostic hypotheses that preceded the conclusive diagnosis, time between symptom perception and conclusive diagnosis, = mainly the professional who performed the diagnosis and main recommendations received at diagnosis. Casuistics and Methods: Forty-four individuals, 38 men and six women were investigated through clinical evaluation and semi-structured interview. Results: The age of a behavioral discrepancy perception ranged from one to nine years old (mean=3.2 years) and the first to notice this were the parents (57%), and health professionals were the last (7%). The first diagnostic evaluation was carried out between one and 15 years of age with the most common initial diagnosis as Attention Deficit Hyperactivity Disorder (34.1%) performed mostly by the neurologist (54.5%). The average time between the perception that there was something different in the child's development and the diagnosis of AS was 7.8 years performed by a psychiatrist in most cases (61.3%). The main recommendations were attending regular school (68.1%), undergoing Psychotherapy (59%), using medication (56.8%), undergoing Speech Therapy (38.6%) and genetic evaluation (36.3%). Conclusion: The results have showed that the context of AS diagnosis is late; even the behavioral phenotype considered milder is complex. Most health professionals are not enough prepared for early detection of AS, consequently, compromising immediate intervention, that is essential in these cases.
Asperger Syndrome, Early Diagnosis, Autism Spectrum Disorder.
Copyright (c) 2023 Archives Health Sciences https://creativecommons.org/licenses/by-nc-sa/4.0/deed.pt-br
Indications for tracheostomy in an intensive care unit
Introduction: Tracheostomy is a surgical procedure and a safer alternative for patients with prolonged intubation time or failure in ventilatory weaning, because it facilitates weaning, allowing a shorter time of mechanical ventilation. Objective: To document patients on invasive mechanical ventilation who required tracheostomy and to verify the relationship of the procedure with the clinical condition of the patients who underwent it. Methods: Quantitative, descriptive and cross-sectional research carried out from the collection of data from medical records of patients who underwent tracheostomy in an Intensive Care Unit (ICU) during the months of November 2019 to August 2020. Results: We included 67 patients of both genders admitted to an Intensive Care Unit who remained under orotracheal intubation for 48 hours or more, divided into two groups: surgical and clinical. Regarding the days of mechanical ventilation before tracheostomy, this period was shorter in the surgical group than in the clinical group (respectively: median = 8 and 12.5 days; interquartile range 6-12 and 8-14.5; p=0.0109). The main indication for the procedure in the surgical group was early tracheostomy for diagnosis with the prospect of prolonged mechanical ventilation (42.4%) and in the clinical group was inadequate level of consciousness for extubation (47.1%). There was no difference between groups (p=0.3102) regarding days of mechanical ventilation after the procedure, surgical group (median = 5 days; interquartile range 2-8) and clinical group (median = 4 days; interquartile range 2-7). Conclusion: Inadequate level of consciousness for extubation and the option for early tracheostomy in pathology with the prospect of prolonged mechanical ventilation were the main indications for the procedure in our Unit. The time of invasive mechanical ventilation before tracheostomy was longer in the clinical patients group than in the surgical patients group.
Tracheostomy; Respiration, Artificial; Physical Therapy; Intensive Care Units; Extubation.
Outcome of patients co-infected with the human immunodeficiency virus and the new coronavirus: Integrative Review
Introduction: The new coronavirus emerged in the city of Wuhan, China, and quickly spread to several countries, being considered a pandemic. This disease leads to several symptoms that are usually aggravated in people who have some type of comorbidity and/or are immunosuppressed, such as people living with HIV/AIDS. Objective: To evaluate in the scientific literature the outcome and clinical characteristics of people with HIV when co-infected with SARS-CoV-2. Methods: An integrative review of studies published in the PubMed and LILACS databases on March, 2021 was performed. 127 studies were identified; out of these 16 articles were included for analysis. Demographic and clinical data of 616 patients were collected and stored into Microsoft® Office Excel 2016 software; therefore, continuous variables were summarized using mean and standard deviation and categorical variables, by frequency and percentage. Results: Of the total number of individuals included in the study; 82.6% of the participants were male and 51.6% had some type of comorbidity; in addition, 84.6% had some type of symptom related to COVID-19. Despite this, 66% were using antiretrovirals, and 87% had a CD4+T lymphocyte count greater than 200 cells/µL. Furthermore, the clinical picture of COVID-19 ranged from mild to moderate in 77% of patients; mostly (96.6%) evolved to cure. Conclusion: The clinical outcome of HIV/SARS-CoV coinfected patients is favorable, as more than 90% of participants evolved to cure, even those who had some type of associated comorbidity and/or showed clinical symptoms of the disease.
COVID-19; SARS-CoV-2; HIV; Prognosis; Antiretroviral Therapy.
Bacterial profile, antimicrobial resistance and secondary infections in patients with covid-19: an integrative review
Introduction: The patients have been affected by COVID-19 are susceptible to secondary bacterial infections with consequent clinical impact and death. Objective: Analysis of the literature in respect to the bacterial profile, bacterial resistance and the main secondary infections in adult patients with COVID-19. Method: An integrative review of the literature conducted in March 2021 in LILACS, BDENF, IBECS and MEDLINE databases via the Virtual Health Library portal, including original publications and case reports available in Portuguese, English or Spanish. Results: Of the 162 articles found; 18 were included in the research. Of these, 10 (55.6%) reported antimicrobial resistance in Staphylococcus aureus and in Klebsiella pneumoniae. Eleven and 10 Gram-positive and Gram-negative bacteria were isolated, respectively. In a total, 550 secondary infections were identified, mainly respiratory infections reported in 11 articles (61.1%), followed by hematological infections in 7 productions (38.9%). Conclusion: It was observed that patients hospitalized for COVID-19 are vulnerable to the occurrence of secondary infections as well as colonization by multidrug-resistant bacteria, mainly Staphylococcus aureus and Klebsiella pneumoniae.
Infections; Coinfection; Drug Resistance, Bacterial; COVID-19; Adult Health.
Demographic and clinical factors associated with congenital and gestational syphilis
Introduction: Congenital and gestational syphilis is a systemic infectious and contagious disease, of compulsory notification, with chronic evolution and caused by Treponema pallidum. The increase in cases of syphilis in pregnant women and congenital occurred with the widespread of the rapid test, reduction in the use of condoms and the shortage of penicillin. Objectives: To identify, describe and evaluate the demographic, clinical, laboratory and treatment factors associated with cases of syphilis in pregnant women and congenital in the Health Surveillance Group GVS XXX; Jales, located in the Northwest of the state of São Paulo, Brazil, between 2013 and 2017. Methods: An exploratory descriptive study conducted in the databases of the Notification Disease Information System and Live Birth Information in which 153 pregnant women with syphilis and 55 cases of congenital syphilis were analyzed. Results: Cases of syphilis in pregnant women occurred in young women with low education and increased from 13 cases in 2013 to 43 cases in 2017. Most pregnant women underwent treponemal and non-treponemal tests. The number of treated partners was greater than that of untreated partners. The incidence of syphilis in pregnant women was 10.37 cases/1000 live births, and that of congenital syphilis was 3.73 cases/1000 live births. Conclusion: There was a considerable increase in cases of syphilis in pregnant women as well as congenital in the investigated period. The results of this study have showed that there is still a long way to go to achieve WHO´s target of eliminating syphilis as a public health issue.
Syphilis. Pregnancy. Epidemiology. Bacterial Infections. Treponemal Infections.
In silico evaluation of pharmacokinetic properties of antileukemic compounds published by scientific journals
Introduction: The development of new anticancer drugs comprises hard-working steps of in vitro testing; evaluation of pharmacokinetic properties and in vivo testing. The use of in silico tools, i.e. by computer simulation, can save considerable time and effort in anticancer drug development, allowing a higher probability of clinical success. Objective: To evaluate, in silico, the pharmacokinetic properties (ADMET) of compounds with antileukemic potential published in the scientific literature. Methods: A literature search was conducted on SciELO, PubMed and Virtual Health Library (VHL) databases. Eleven publications (12 molecules) and Etoposide (control) were listed for analysis of pharmacokinetic parameters using the pkCSM software. The results obtained were analyzed by assigning weights according to scores of the different parameters evaluated by pkCSM. Results: The compounds with the best profile were TC1 (Ortho-Qinone derivatives) and DHA (Dihydroartemisinin), showing better pharmacokinetic properties than Etoposide; a drug already used in cancer treatment. However, such compounds still exhibit important undesirable pharmacokinetic characteristics such as solubility and toxicity. Conclusion: Evaluating the pharmacokinetic properties (ADMET) of the compounds under study shows the importance of screening analyses of molecules as well as their bioactive derivatives as an initial step in the search for new drugs. In silico assessments performed before and during in vitro assays can save resources and time in the search for new drugs.
Antineoplastic Agents. Pharmacologic Actions. Computer Simulation. Chemical Actions and Uses.
Prevalence of pathologies associated with impacted wisdom teeth in a subpopulation in northern Brazil: a radiographic study
Introduction: Dental impaction is an anomaly in which the tooth does not erupt in the dental arch based on clinical and radiographic features. A wisdom tooth can have a variety of positions and levels of retention, which can result in a range of associated pathologies, the most common of which are: caries; root resorption of the adjacent tooth; alveolar bone loss and increased space in the pericoronary space. Objective: To evaluate the prevalence of pathologies in radiographically impacted wisdom tooth in a subpopulation in the North of Brazil. Method: 1192 digital panoramic radiographs of patients seen in a Dentistry Course in Northern Brazil were evaluated. The age range was 18 to 76 years and the radiographic findings observed were: caries, radicular resorption, alveolar bone loss and an increase in the pericoronary space greater than 4 mm. Results: The prevalence of associated pathologies was 67.5%. The alveolar bone loss of the adjacent tooth of more than 5 mm had the highest frequency of pathology, 507 (50.3%), root resorption of the adjacent tooth, 222 (22.0%), caries, 157 (15.6%) and increase in the periconary space, 121 (12.0%). Conclusion: Early detection of pathologies associated with wisdom tooth is essential for effective treatment. The study showed that the prevalence of pathologies in impacted wisdom tooth was 67.5%. The most common pathology was alveolar bone loss, followed by root resorption of the adjacent tooth, an image suggestive of caries and an increase in the pericoronal space.
Tooth, Impacted; Molar, Third; Cross-Sectional Studies; Radiography, Panoramic
Hypoglycemic effects of bean (Phaseolus vulgaris L.) in rats with diabetes mellitus
Introduction: Beans are a legume with a high content of proteins, complex carbohydrates, minerals and vitamins. Epidemiological research points out that its continuous intake is associated with a large number of health improvements, among them the reduction in the risk of developing non-transmissible chronic diseases, such as diabetes mellitus (DM). Objective: To verify in the literature the hypoglycemic effect of beans in diabetic rodents. Methods: This is an integrative review carried out in the Science Direct, PubMed and Scopus databases using the descriptors “Phaseolus vulgaris” and “diabetes mellitus”. Original articles published between 2015 and 2020 in Portuguese, Spanish and English were included. Additionally, publications that did not present the proposed subject in the article abstract, review articles, research that did not use experimentation in rodents and duplicate publications were excluded. Results: The use of beans or preparations based on this food in diabetic rodents decreased glycaemia and glucose hemoglobin, triglycerides, cholesterol, low-density lipoproteins, levels of albumin and urea in the urine, and increased insulin in the blood and clearance of creatinine. In addition, elimination of ammonium groups, regulation of inflammation, oxidative response, cell signaling and apoptosis were observed. Conclusion: The studies presented show the effectiveness of the use of beans in reducing glycemic levels in diabetic rodents. It is noteworthy that more studies should be carried out to test its benefits in humans, since the use of this food would be an alternative method in the treatment of this pathology.
Diabetes Mellitus. Phaseolus. Hypoglycemia. Nutritional Sciences. Health Promotion. Metabolic Diseases.
Viability of onychomycosis-causing fungi on nail polish
Introduction: Nail infections caused by fungi are called onychomycosis, which are increasingly frequent worldwide. Nail polish is a chemically complex lacquer applied for decorative purposes or to protect the nail plate. However, used nail polishes may be colonized by microorganisms and, consequently, constitute a risk of nail diseases. Objective: Considering the importance of onychomycosis and the increasing use of nail polish, the objective of this study was to evaluate the survival of fungi in nail polish from different colors and commercial brands. Methods: The colors tested were colorless basecoat, white, and red, from four brands, totaling 12 samples. The flasks were individually contaminated by imprinting the applicator on cultures of four fungal species (clinical isolates): Trichophyton rubrum, T. mentagrophytes, Candida albicans, and C. parapsilosis. Considering the moment of contamination, fungal viability was observed every 60 min, until the first eight hours. Further observations were after 7, 14, 21, and 28 days of the inoculation. Results: The four species showed the ability to survive in the flasks on the first eight hours after inoculation. The viability for longer periods varied by brand and color. Trichophyton rubrum survived in all brands, in at least one of the colors, for 28 days. Conclusion: The main agents of onychomycoses can remain viable in nail polish for several days. Nail polishes should be considered as potential contamination vehicles, and measures should be taken to reduce risks of transmission. Further analyses are necessary to reveal the mechanisms of fungal survival in this environment.
Virtual reality as a therapeutic resource in orthopedic and traumatological rehabilitation
Introduction: Virtual reality (VR) as an approach to rehabilitation consists of creating a totally virtual, three-dimensional environment, where the patient interacts through visual, tactile, auditory, and sensory stimuli, recreating as much of the reality as possible. In the last two decades there has been an increase in the use of VR in orthopedic and traumatological rehabilitation due to its potential for safety and efficacy when integrated with clinical practice as a therapeutic resource. Objective: To analyze the evidence in the scientific literature on the use of VR as a central or adjuvant tool in the rehabilitation of patients with trauma-orthopedic problems. Method: It is a review of the integrative literature of scientific articles, without limitation of data or language, indexed in the MEDLINE, PEDro, SciELO, and LILACS databases, which addressed the role of VR as a therapeutic resource in orthopedic and traumatological injuries. Results: An analysis was performed using 15 randomized clinical trials which applied VR in orthopedic and traumatological disorders in the shoulder, cervical spine, lumbar spine, hip, knee and ankle. Compared with traditional physical therapy, 2 studies dissipated or less, 7 studies indicated superior efficacy and 6 pointed out the benefits of VR only as an adjunct to physiotherapeutic treatment. Conclusion: The VR is a promising approach and with an acceptable potential to optimize the results obtained in trauma-orthopedic rehabilitation, although it is necessary to carry out more clinical studies that point to a consensus on the effectiveness of the method.
Food consumption and nutritional condition of schoolchildren: integrative review
Introduction: Childhood obesity is increasing in our country, being strongly related to socioeconomic changes and nutritional transition, characterizing inappropriate eating habits and changes in lifestyle, being early risk factors for comorbidity appearance. Objective: To review in the literature the habits of food consumption and nutritional condition of schoolchildren. Methods: Integrative review of scientific studies from the Scientific Electronic Library Online (SciELO), Google Scholar, PubMed (NCBI) and LILACS databases, from 2015 to 2020, in Portuguese, English, and Spanish, preferably choosing original articles. The following descriptors were used to search: “nutritional conditional and food consumption of schoolchildren”, “eating habits of schoolchildren”, “nutritional status of schoolchildren”, “food preferences”, “dietary changes”, “obesity”, “changes in body weight”, “eating behavior”, “food consumption”, “nutritional status”, and “alimentación escolar”. Results: 134 articles were found in the initial analysis of titles, in a second analysis 27 were selected by reading the abstracts and after full reading, those that did not meet the objective of the study were excluded, and 8 articles were selected to conduct the work. A varied diet, based on fresh foods, is related to normal weight schoolchildren, in contrast, schoolchildren who eat few meals per day and present diets rich in processed foods have weight changes, such as overweight and obesity. In this context, there is an increase in the prevalence of overweight and obesity in schoolchildren and a decline in malnutrition rates. The influence of school and family on dietary practices is perceived, with Nutritional Education activities being a good strategy to improve of schoolchildren’s eating habits. Conclusion: Diets rich in processed foods showed a positive correlation with changes in nutritional condition, especially excess weight in schoolchildren, interfering with development, growth, and metabolic changes, which can be predictors for Chronic Non-Communicable Diseases and consequently interfere with quality of life.
Effects of Physical Exercises in Patients Under Palliative Chemotherapy
Introduction: Ageing in Brazil moves forward with great strides, approximately 14% of the Brazilian population will be older in 2020. Associated with the aging was the increased prevalence of chronic non-communicable diseases (NCDs) responsible for the prejudice of quality of life and leading causes of death in the world. Tumors are the second most prevalent NCD and require many resources in health, starting with the variety and high cost of your treatment. Chemotherapy is one of the treatments of choice for neoplasm, and when we want to use it for the control of symptoms of the patient with a disease in advanced stage, we opt for the palliative chemotherapy. However, chemotherapy can promote different symptoms in the patient as fatigue or peripheral neuropathy, which is why physical exercises have been strongly recommended in this group of patients. Objective: To verify the effects of physical exercises on patients undergoing palliative chemotherapy. Method: A systematic review, followed by the guidelines PRISMA on electronic database’s Lilacs, MedLine, PEDro, Clinical Trial and Scielo, consulted by keywords: drug therapy, severity of illness index, rehabilitation, physical exercise, and palliative care. We have included articles in Portuguese and English with no delimitation of data, including clinical whose intervention was the application of physical exercise. The assessment of the methodological quality of these articles was made from the application of the scale Cochrane of risk of bias. Results: Ten articles were selected, and the risk of bias was evidenced as follows, (five with low risk; three with uncertain bias; and two assessed with high risk. All the studies observed significant improvement in the intervention group (physical exercise) compared with the control in the following outcomes: quality of life, controlling symptoms and autonomy. As for the type of exercise used in the studies, only five articles have compared different types of exercises (aerobic, resistance or mixed) and found no statistical difference between them. Four other articles used, only, a type of exercise and, only one study used electrostimulation as intervention. Electrostimulation did not promote progress in the level of physical activity, muscular strength of the groups tested, and in control of symptoms (pain and fatigue). Conclusion: Despite the availability of a few studies in the literature, conducting physical exercises seem to contribute to improvement of muscular strength, quality of life, symptom control and maintenance of functionality in patients undergoing palliative chemotherapy.
Drug Therapy; Rehabilitation; Severity of Illness Index; Palliative Care
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Knowledge and performance of pharmacy professionals on the dispensing of medicines
Introduction: The dispensing of medication corresponds to the delivery of medication for the patient, upon request by means of prescription. A proper dispensation contributes to safety in drug therapy. Objective: To describe the knowledge and professionals of the pharmacy about the dispensation of medicines. Methods: This is an exploratory-descriptive cross-sectional and quantitative study carried out in a maternity school in the Northeastern region of Brazil, with 25 pharmacy professionals. Results: Most of the participants reported that the pharmacy used the mixed drug distribution system (96.0%). They also reported that there is no computerized dispensing program for medicines (52.0%), and the work environment was inadequate (84.0%). Most of them (68%) have witnessed errors related to the dispensation, or they have made the error themselves (52.0%). Double checking was done by 72.0%. The majority (80%) always identify and differentiate the stock of potentially dangerous drugs from others. Those who never used sources of distraction during the analysis and dispensing of medications were 56.0% and 60% sometimes dispensed medications in verbal order. Conclusion: It was verified the need to modify the practice of the pharmacy studied through permanent education and implementation of strategies that minimize the occurrence of errors.
Knowledge; Pharmaceutical Preparations; Pharmacy
Bacterial outbreaks in a Neonatal Intensive Care Unit: a five year history
Introduction: Neonatal Intensive Care Unit (NICU) hospitalization is usually prolonged, and neonates are submitted to several risk factors, allowing the occurrence of outbreaks from time to time despite precautions. Objective: To investigate the occurrence of bacterial outbreaks in an NICU of a university hospital in the interior of Minas Gerais from January 2013 to December 2017. Methods: Data were collected from the records of outbreaks occurring in NICUs available in the documents of the Hospital Infection Control Service, including the National Healthcare Safety Network - NHSN records, memos, test results, and electronic records of outbreak descriptions. Results: Four outbreaks were observed over a fiveyear study period. The first outbreak occurred in 2013, due to infection of the bloodstream by the species Pantoea agglomerans and involved six neonates. The second occurred between November 2014 and March 2015, where six neonates were involved and there was no predominant site, Acinetobacter B being the microorganism isolated. Similarly, the third outbreak occurred in 2015 by the same agent, comprising 10 neonates. The last outbreak occurred in 2016 by Pseudomonas aeruginosa, being a predominantly colonization outbreak, where 13 neonates were affected. There were no outbreaks in 2017. Conclusion: Four epidemiological outbreaks were identified, all of them by Gram-negative bacteria. The most affected neonates were preterm and low birth-weight infants. Microorganisms resistant to carbapenems have been identified which, although few, proved to be a problem at the study site.
Outbreak; Nosocomial Infection; Neonates
Motorcycle Accidents and factors associated with driver’s licence Status
Introduction: land transport accidents represent an important cause of morbidity and mortality, and motorcycles are the vehicles most involved in the occurrences. In this sense, the driver and his preparation to drive the vehicle by means of qualification gain relevance. Objective: To verify the prevalence of accidents in motorcycle drivers and the factors associated with the driving condition. Methods: This is a cross-sectional study with a quantitative approach, with a sample composed of 281 non-probabilistically selected patients in a university hospital in the Pernambuco backwoods, from December 2015 to February 2016. Data were collected through the application of a face to face questionnaire. Variables related to the victims and the accident were used. Results: Most patients were men (91.5%), with a mean age of 34.7 years. They were married or were in consensual marriage (50.2%) and with children (68.7%). Most accidents occurred in the night shift (41.3%). Motorcycles had a cylinder capacity of 125 cc or above (88.1%), and the drivers owned 79.0% of the motorcycles. Drivers who did not have a Driver’s License were 58.7%, and they also have a low level of schooling (74.8%). The main cause of accidents was falls (48.7%) with the event occurring in the countryside (68.9%). Collisions were responsible for 64.6% of the accidents and 57.7% of them occurred in urban areas. Conclusion: We conclude that motorcycle accidents have a high prevalence in young and unskilled adult men. Considering that accidents involving motorcycles are highly prevalent in young, unskilled men, with significant difference for low education, monthly income less than one minimum wage, the occurrence rural zone. In both groups, the vehicles used were motorcycles of 125 cc or more, the drivers being the owners of the transport.
Automobile Driving; Prevalence; Accidents; Traffic
Flávia Emília Cavalcante Valença Fernandes