Mestrado em Medicina Tropical e Saúde Pública (IPTSP)
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Navegando Mestrado em Medicina Tropical e Saúde Pública (IPTSP) por Por Orientador "Araújo Filho, João Alves de"
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Item Histoplasmose disseminada em pacientes com AIDS: características clínico-epidemiológicas e análise espacial em hospital de referência de uma metrópole do centro- oeste brasileiro(Universidade Federal de Goiás, 2015-05-21) Ferreira, Bianca da Silva; Araújo Filho, João Alves de; http://lattes.cnpq.br/3769452101687074; Araújo Filho, João Alves de; http://lattes.cnpq.br/3769452101687074; Zapata, Marco Tulio Garcia; Telles Filho, Flávio de QueirozThe histoplasmosis is an important endemic mycosis caused by Histoplasma capsulatum. It’s is an AIDS-defining illness. It causes in patients with AIDS, especially when LT-CD4 + <100 cells./mm³ the disseminated form and has high letality rates. Although In the metropolitan area of Goiânia a high rate of disseminated histoplasmosis is observed in patients with AIDS, the real incidence and risk factors are unknown. Objectives: Describe the clinical-epidemiological characteristics and the spatial distribution of cases of histoplasmosis in patients with AIDS in the city of Goiânia and Aparecida de Goiânia. Methods: A descriptive ecological study conducted in patients from Tropical Diseases Hospital Dr. Anuar Auad, from January 2003 to July 2014. A standardized survey was applied to medical records of patients with AIDS and disseminated histoplasmosis with laboratory confirmation from Goiânia and Aparecida de Goiânia. A statistical analysis and description of the epidemiological clinical data was performed with georeferencing, production of maps and spatial analysis. Results: The disseminated histoplasmosis in AIDS patients has a high incidence in the metropolitan area of Goiânia and Aparecida de Goiânia, with a total of 166 cases. Most of the patients were young men with low income and low education level. Histoplasmosis was AIDS-defining illnesses in 68 patients, and the average LTCD4+ was 70 cels./mm³ to histoplasmosis diagnosis. The main symptoms were: respiratory, gastrointestinal and cutaneous. The spatial location of the cases were predominantly aleatory in both cities studied, however two important regions were detected: one in the east and another in western of Goiania, both close to water sources. Conclusions: Histoplasmosis is an urban disease with very high incidence in Goiânia and Aparecida de Goiânia. All cases presented a serious clinical features and high mortality rates. The treatment is applied in an irregular manner and does not follow the guidelines recommendations. The cases found are related to areas of environmental degradation and uncontrolled urbanization. They were also related to green areas and waterways.Item Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade(Universidade Federal de Goiás, 2014-07-08) Silva, Claudia Neto Gonçalves Neves da; Araújo Filho, João Alves de; http://lattes.cnpq.br/3769452101687074; Araújo Filho, João Alves de; Kipnis, André; Pereira, Milca SeverinoStenotrophomonas maltophilia is a Gram-negative bacillus found in natural and in hospital environments. S maltophilia’s high level intrinsic resistence to antibiotics and heavy metals justifies the importance of this bacteria in the nosocomial environment. The aim of this study was to describe the clinical and epidemiological characteristics, and the outcome of infection due to S. maltophilia; describe the antibiotic sensitivity and the genetic relatedness from this bacteria from january 2010 to july 2013 in Hospital das Clínicas – UFG (HC/UFG). Clinical and epidemiological data were obtained from medical records of patients; antimicrobial sensitivity was determined by the methodology Vitek 2®; and the genetic similarity was determined by Pulsed-Field Gel Eletrophoresis (PFGE). Over the study period, 75 isolates of S. maltophilia were indentified in 56 patients, with mean of 1.34 isolates per patient (range 1-8). Among the total, 34.6% were in the clinical intensive care unit, and 17.3% in the clinical infirmary. The 3 intensive care unit accounted for 56% of all isolates. The mean age of patientes was 45.75 years (range 0-83 years), and 51.8% were male. All cases of infection were considered health care-associated. The most comom coexisting condition were haematological malignancy, in 18 (32.1%) patientes. The most frequent clinical manifestations was fever in 47 (83.9%) patients, and leukocytosis or leukopenia in 31 (55.4%). Invasive devices were frequently used, and central venous cateter, and mechanical ventilation were the most. Most patients (94.6%) used broad spectrum antibiotics before the acquisition of the bacteria. The most frequent type of infection was ventilator-associated pneumonia (42.9%) followed by cateter-associated bacteremia (16.1%). Trimethoprim-sulfamethoxazole was the treatment of choice in 32 (57.1%) patients. The outcome of infection due to S. maltophilia was infection-related death in 62.5%. The risk factors related to mortality in this study were shock, acute renal failure, use of mechanical ventilation, use of urinary device and feeding tube. Trimethoprim-sulfamethoxazole resistance, the treatment of choice for infection by S. maltophilia, and levofloxacin resistence were detected in HC / UFG. Twenty isolates were assessed for genetic variability by pulsed-field gel eletrophoresis (PFGE) with observation of high variability between strains. We conclude that S. maltophilia is a nosocomial bacteria of clinical importance mainly due to high associated mortality, and few therapeutic options. Resistance to trimethoprim/sulfamethoxazole was low, but must be monitored in HC / UFG.Item Óbitos por tuberculose em hospital terciário em Goiânia, Brasil: estudo descritivo(Universidade Federal de Goiás, 2013-03-13) Tavares, Camila; Kipnis, Ana Paula Junqueira; Araújo Filho, João Alves de; http://lattes.cnpq.br/3769452101687074Tuberculosis (TB) remains a serious global public health problem, being the main cause of deaths in patients with the acquired immunodeficiency syndrome, and the third cause of death by infectious diseases throughout the world. This situation is surprising because it is a disease that if treated properly displays high rates of healing. It is therefore important to characterize these patients to identify target populations for specific measures seeking to reduce TB deaths. We performed a retrospective descriptive study to analyze the cases of TB deaths in a State public hospital, reference for treatment of infectious diseases, located in the Central-West region of Brazil, in the period of January 1st, 2008 to December 31th, 2009. There were 283 diagnosed and reported cases of TB between 2008 and 2009, and 39 recorded deaths occurred, resulting in a lethality index of 14%. Mean age of 42 years and a median age of 37 years. Pulmonary TB was the most common form of TB (51.3% of the patients). Of the 39 TB patients who died, 56.4% (n = 22) were co-infected with HIV. The main immediate causes of death were acute respiratory failure (n = 12) and sepsis (n =8). Anemia and hypoalbuminemia were prevalent in this group, and 27 patients required mechanical ventilation. This study found that hospitalized patients who died had the following characteristics: bilateral pulmonary disease, low levels of hemoglobin and hematocrit, albumin, and those co-infected with HIV that has been admitted to the ICU required MV. Prospective studies aiming to analyze the risk factors for death from TB are needed to better understand this process.