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OBJETIVO: Investigar aspectos clinicos, de laboratorio y epidemiologicos de los pacientes internados con malaria en el Hospital Universitario Joao de Barros Barreto (Belem, Estado de Para, Brasil), hospital de referencia en infectologia en la Amazonia. METODOLOGIA: Se realizo un estudio transversal y retrospectivo, con informaciones obtenidas de la revision de los prontuarios de los enfermos, internados de 1o de enero de 2000 a 31 de julio de 2011. Fueron considerados todos los registros de 289 pacientes internados con hipotesis diagnostica de malaria y examinadas las historias clinicas correspondientes, descartando las ilegible y las no disponibles. RESULTADOS: Luego del descarte de los casos sin confirmacion diagnostica, la casuistica arrojo como resultado 188 historias clinicas. Predominaron los individuos del sexo masculino (61,2%; 115/188) y la franja etaria de 30 a 50 anos (33%; 62/188); hubo mas internaciones en los meses de agosto (13,5%; 24/188) y octubre (12,4%; 22/188). El que tuvo mas incidencia fue Plasmodium vivax, con 56,9% (107/188) de los casos, habiendo 41,5% (78/188) casos de P. falciparum. Las principales manifestaciones clinicas halladas fueron fiebre (97,3%; 183/188), cefalea (58%; 109/188) y escalofrios (54,8%; 103/188). La manifestacion clinica mas frecuente relacionada a la malaria grave fue la ictericia (38,3%; 72/188). Con relacion al perfil de laboratorio, 86,2% (162/188) presentaron baja hematimetria; 93,6% (176/188) bajo hematocrito; 73,9% (139/188) evidenciaron plaquetopenia. CONCLUSION: En la poblacion estudiada, la malaria fue mas incidente en los meses de agosto y octubre, en hombres y en la franja etaria de plena actividad laboral. Las principales manifestaciones clinicas y de laboratorio fueron las tipicas de la enfermedad y la ictericia se destaco como principal manifestacion grave de la malaria

In order to study the prevalence of hepatitis B (HBV) and D (HDV) viruses in the Parakanã Indians and to evaluate the impact of hepatitis B vaccination beginning there in 1995, 258 serum samples were analyzed in the year 2004 for hepatitis B and D serological markers using immunoenzymatic techniques; the results showed a moderate endemic pattern, with a total prevalence of HBV infection of 55.7% and 5.4% of virus carriers in the Apyterewa village and 49.5% with 1.1% of HBV carriers in the Xingu village; 31.4% of anti-HBs+ as an isolated marker in both villages and no detection of positive serological tests for HDV among HBV carriers. The laboratory analysis thus showed the presence of chronic HBV carriers, absence of HDV carriers, and an emerging vaccine profile among susceptibles, confirming the effectiveness and need to maintain vaccination, especially in the first year of life, and the need to implement effective epidemiological surveillance for early detection of HDV infection among HBV carriers.

The objective of this investigation was to study the prevalence of hepatitis C virus infection and to identify possible risk factors for its transmission, in 406 adult patients with HIV/AIDS who attended at public health services, in Belém city, Pará, Brazil. The anti-HCV was performed by third generation immunoenzymatic technique, and the HCV RNA by polymerase chain reaction. The overall prevalence of hepatitis C virus was 16% (CI: 12.4 - 19.6). Multivariate analysis showed association between virus C infection and age, with significant risk in the group about fifty years old or more (OR=9.75), blood transfusion (OR=4.74) and use of injecting drugs (OR=149.28). The hepatitis C virus infection was detected in 83.7% of intravenous drug users and 22.1% of transfused patients. These data indicate the efficient transmission of the virus through the percutaneous exposition and reaffirm the high risk to hepatitis C among injectable illicit drug user.

The efficacies of specific Bothrops atrox-Lachesis and standard Bothrops-Lachesis antivenoms were compared in the north eastern Amazon region of Brazil. The main aim was to investigate whether a specific antivenom raised against the venom of B. atrox, the most important Amazon snake species from a medical point of view, was necessary for the treatment of patients in this region. Seventy-four patients with local and systemic effects of envenoming by Bothrops or Lachesis snakes were randomly allocated to receive either specific (n = 38) or standard (n = 36) antivenoms. In 46 cases (24 in the standard antivenom group, 22 in the other) the snake was identified either by enzyme immunoassay or by examination of the dead snake, as B. atrox in 45, L. muta in one. Patients were similar in all clinical and epidemiological respects before treatment. Results indicated that both antivenoms were equally effective in reversing all signs of envenoming detected both clinically and in the laboratory. Venom-induced haemostatic abnormalities were resolved within 24 h after the start of antivenom therapy in most patients. The extent of local complications, such as local skin necrosis and secondary infection, was similar in both groups. There were no deaths. The incidence of early anaphylactic reactions was 18% and 19%, respectively for specific and standard antivenoms; none was life-threatening. Measurement of serum venom concentrations by enzyme immunoassay (EIA) confirmed that both antivenoms cleared venom antigenaemia effectively. EIA also revealed that one patient had been bitten by Lachesis muta, although the clinical features in this case were not distinctive.

Este trabalho objetivou investigar a prevalência de infecção pelo vírus da hepatite C e identificar possíveis fatores de risco para sua transmissão, em 406 indivíduos portadores do vírus da imunodeficiência humana, maiores de dezoito anos de idade, atendidos na rede pública de saúde da cidade de Belém, Pará, situada na Amazônia brasileira. Os exames referentes ao anti-VHC foram realizados pelo método de Elisa e a pesquisa do VHC RNA através da reação de polimerase em cadeia. A prevalência de infecção, atual ou pregressa, pelo vírus da hepatite C foi de 16% (IC: 12,4 - 19,6). A análise multivariada mostrou associação do vírus C com as variáveis idade, cujo risco significante recaiu no grupo com cinqüenta ou mais anos (OR=9,75), antecedente de transfusão de sangue (OR=4,74) e uso de droga ilícita injetável (OR=149,28). A prevalência do vírus da hepatite C entre os usuários de drogas injetáveis foi de 83,7% e de 22,1% na população de transfundidos. Estes resultados indicam a efetiva transmissão do vírus C através da exposição percutânea e reafirmam o grande potencial de risco para hepatite C contido no uso injetável de drogas ilícitas. The objective of this investigation was to study the prevalence of hepatitis C virus infection and to identify possible risk factors for its transmission, in 406 adult patients with HIV/Aids who attended at public health services, in Belém city, Pará, Brazil. The anti-HCV was performed by third generation immunoenzymatic technique, and the HCV RNA by polymerase chain reaction. The overall prevalence of hepatitis C virus was 16% (CI: 12.4 - 19.6). Multivariate analysis showed association between virus C infection and age, with significant risk in the group about fifty years old or more (OR=9.75), blood transfusion (OR=4.74) and use of injecting drugs (OR=149.28). The hepatitis C virus infection was detected in 83.7% of intravenous drug users and 22.1% of transfused patients. These data indicate the efficient transmission of the virus through the percutaneous exposition and reaffirm the high risk to hepatitis C among injectable illicit drug user.

O objetivo desta pesquisa foi estudar a prevalência de infecção pelo virus da hepatite B em 406 portadores do virus da imunodeficiência humana, maiores de dezoito anos de idade, atendidos na rede pública de saúde da cidade de Belém, Pará, assim como analisar possíveis fatores de risco para a infecção. A prevalência global de infecção pelo virus da hepatite B foi de 51% (IC: 46,1 - 55,8), com 7,9% (IC: 5,3 - 10,5) para o HBsAg, 45,1% (IC: 40,3 - 49,9) para o anti-HBc e 32,3% (IC: 27,5 - 36,8) para o anti-HBs. Após ajuste por regressão logística, os marcadores sorológicos de infecção pelo vírus da hepatite B apresentaram associação com as seguintes variáveis: idade, situação conjugal e preferência sexual. A prevalência dos marcadores do vírus B nos heterossexuais foi 28,7% e 68,8% nos homossexuais/bissexuais (IC: 3,50 - 9,08; OR: 5,63; p=0,000). Quanto à situação conjugal, a categoria com companheiro fixo/casado apresentou freqüência de 31%, e foi de 58,7% a observada no grupo sem companheiro fixo (IC: 1,29 - 3,63; OR: 2,16; p=0,003). A análise multivariada não mostrou associação do vírus B com o uso de drogas ilícitas injetáveis. The objective of this investigation was to study the prevalence of hepatitis B virus infection in a sample of 406 adult patients with human immunodeficiency virus infection who attended at the public health care in the city of Belém, Pará, Brazil, as well as analyzing possible risk factors for hepatitis B virus infection. The overall prevalence of hepatitis B virus infection was 51% (CI: 46.1 - 55.8), with 7.9% (CI: 5.3 - 10.5) for HBsAg, 45.1% (CI: 40.3 - 49.9) for anti-HBc and 32.3% (CI: 27.5 - 36.8) for anti-HBs. After adjustment using logistic regression, hepatitis B serological markers were associated with the following variables: age, marital status and sexual preference. The frequency of hepatitis B markers was 28.7% in heterosexuals and 68.8% in homo/bisexuals (CI: 3.50 - 9.08; OR: 5.63; p=0.000). In married people the frequency was 31% and 58.7% in single people (CI: 1.29 - 3.63); OR: 2.16; p=0.003). Multivariate analysis showed no association between hepatitis B virus infection and illicit injectable drug use.

Este trabalho é um estudo prospectivo e descritivo dos aspectos epidemiológicos e clínicos de 72 envenenamentos por escorpiões admitidos no Hospital Municipal de Santarém, Estado do Pará, Brasil, entre fevereiro de 2000 a fevereiro de 2001. Trouxeram o animal 8,3% das vítimas, os quais foram identificados como T. cambridgei. O sexo masculino foi acometido em 83,3%. A idade das vítimas e o tempo para o socorro médico foram respectivamente de 33,6±18,3 anos e 4,6±3,2 horas em média. Os membros superiores foram acometidos em 51,5% dos casos. As manifestações locais estiveram presentes em 91,7% e as sistêmicas em 98,6% dos envenenamentos. Entre os sintomas locais encontramos: parestesia em 79,2%, dor em 52,8%, e edema em 26,4% dos casos. Nas manifestações sistêmicas predominou as queixas neurológicas em 97,2% das vítimas, sendo o sintoma de sensação de "choque elétrico" pelo corpo (88,9%) o mais freqüente. No exame neurológico os sinais mais encontrados foram: mioclonias (93,0%), dismetria (86,1%), disartria (80,6%) e ataxia de marcha (70,8%). Classificou-se como moderados 76,4% dos envenenamentos, sem nenhum caso grave. Deixaram de realizar a soroterapia 32,7% dos casos moderados, por ausência de soro específico no momento do atendimento. O escorpionismo da região de Santarém mostra um comportamento clínico regional diferente daqueles descritos no Brasil e de outros locais da Amazônia e, apresenta uma clínica predominantemente neurológica, ainda não descrita na literatura brasileira. This is a descriptive and prospective study on epidemiological and clinical aspects of 72 scorpion accidents admitted to Santarém Municipal Hospital, state of Pará, Brazil, from February 2000 to February 2001. Only 8.3% brought the animal with them, identified as T. cambridgei. The majority of victims were male (83.3%). The mean age and the time of the medical help were respectively 33.6±18.3 years and 4.6±3.2 hours. The parts of the body most affected were the superior members (51.5%). Local symptoms occurred in 91.7% cases and systemic manifestations in 98.6% of the accidents. The local symptoms included: paresthesia in 79.2% cases, pain in 52.8% and edema in 26.4%. Among the systemic manifestations neurological disorders predominated in 97.2%, and the symptom of "electric shock" occurred in 88.9% patients. The most common neurological signs were: myoclonia (93%), dysmetria (86.1%), dysarthria (80.6%), and ataxia (70.8%). The accidents were classified as moderate in 76.4% without any serious cases. The specific anti-venom serum was not administered in 32.7% of the moderate cases, due to non-availability of the anti-venom serum at the time of attendance. The victims of scorpion envenomation notified at Santarém, present a different clinical and regional behavior from previous reports in Brazil and Amazonia regions. The predominantly neurological picture has not previously been described in the Brazilian literature.

The objective of this investigation was to study the prevalence of serological markers of hepatitis B and possible risk factors for this disease in a sample of 404 people who attended a Testing and Couseling Center for HIV in the city of Ribeirao Preto, Sao Paulo State, Brazil. The overall prevalence of serologic hepatitis B markers was 14.6%, equal to that obtained for anti-HBc. HBsAg and anti-HBc IgM showed prevalences of 1%. After adjustment using logistic regression, hepatitis B markers showed association with the following variables: age, place of residence, use of injectable drugs and positivity to anti-HIV. The overall prevalence of human immunodeficiency virus infection was 6.9%. Hepatitis B markers were detected in 55.6% among intravenous drug users and in 42.9% among those who tested positive for HIV, confirming literature findings which indicates high levels of infection in these specific population groups.