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Impacto da vacinação com a PCV10 na morbidade hospitalar por pneumonia no Brasil: análise de série temporal interrompida
(Universidade Federal de Goiás, 2015-08-19) Afonso, Eliane Terezinha; Bierrenbach, Ana Luiza; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4763149D7; Andrade, Ana Lúcia Sampaio Sgambatti de; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4783408H2; Andrade, Ana Lúcia Sampaio Sgambatti de; Nishioka, Sérgio; Weckx, Lly Yin; Siqueira Neto, João Bosco; Habahi, Marcelo
BACKGROUND: Pneumonia causes substantial morbidity and mortality in all age groups around the world. The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the routine infant immunization in Brazil, free of charge, in March 2010. The aim of this study was to evaluate the impact PCV10 vaccination on rates of all cause pneumonia hospitalizations one year and three years after its introduction in Brazil. METHODS: We conducted two interrupted time series analysis studies. The first evaluated only the direct effect of PCV10 vaccination, in five Brazilian cities (Belo Horizonte, Curitiba, Porto Alegre, São Paulo and Recife), and was conducted one year after starting the vaccination. The second study evaluated the direct and indirect impact (individuals not vaccinated) of PCV10 vaccination in Brazil, and was conducted three years after vaccination. We used data from the Brazilian Hospitalization System from 2005-2013. The main outcome was monthly rates of all-cause pneumonia hospitalizations identified by ICD-10 codes J12-J18. We used hospitalization rates for congenital malformations and non-respiratory causes as a comparison groups. The time-series analysis was based on a generalized linear model. Pneumonia rates observed in the pre-vaccination period were used to estimate the hospitalization rates in the post-vaccination period of each study, adjusting for seasonality and secular trends. To estimate the direct (2-23 months of age) and indirect (≥5 years of age) impact of PCV10 vaccination, we calculated the percentage change in hospitalization rates, as the observed divided by the predicted rates of hospitalization in the post-intervention period minus one, with respective 95% CI and p values. The number of all-cause pneumonia hospitalizations averted by vaccination was calculated taking into account the difference between the predicted and observed number in the PCV10 post vaccination period. RESULTS: One year after introduction of PCV10 in Brazil, significant declines in hospitalizations for pneumonia in children aged 2-23 months were noted in Belo Horizonte (28.7%), Curitiba (23.3%), and Recife (27.4%). After three years of the introduction of PCV10, 461,519 pneumonia hospitalizations were averted in Brazil, and a significant decrease in rates of pneumonia hospitalization was observed in unvaccinated individuals aged 5-39 years, ranging from 14.1-17.4% (p<0.05). In contrast, an increased trend in pneumonia hospitalizations (p=0·004) was observed for elderly (≥ 65 years). CONCLUSION: Vaccination with PCV10 in Brazil was associated with reduction of pneumonia hospitalizations in vaccinated individuals. Herd effect was observed in individuals aged 5-39 years after three years of vaccination. Potential reasons for the increased trend in pneumonia hospitalization rates in the elderly should be investigated.
Enfermidades infecciosas em comunidade indígena Terena de Mato Grosso do Sul
(Universidade Federal de Goiás, 2008-08-02) AGUIAR, José Ivan Albuquerque; NETTO, Joaquim Caetano de Almeida; http://lattes.cnpq.br/3444498706763045
The health conditions of Brazilian indigenous population are few recognized with limited information available. A survey was carried out among indians Terena, people that inhabit on the municipalities of Sidrolândia and Dois Irmãos do Buriti, Estado de Mato Grosso do Sul, Brazil. Was studied the prevalence of infection by intestinal parasites, infection markers for viral Hepatitis A, B and C, and for antibody against the viral diseases; Poliomyelitis 1, 2 and 3, Measles, Yellow Fever and Hepatitis B. The results were stratified by age and revealed that the parasitic infection affects 73.5% of the population studied, with high prevalence of the Blastocystis hominis. In the population above 10 years, more than 90% showed reactivity to the anti-HAV, absence of infection markers for Hepatitis B and C, respectively HBsAg and anti-HCV, and a rate of 16.7% (95% CI 12.6-21.3) for the anti-HBs. The prevalence of neutralizing antibodies against the measles virus and yellow fever virus was 96.7% (95% CI 93.9-98.3) and 91.4% (95% CI 88.0-94.7) respectively. The polio results showed that 62.2% (95% CI 56.5-67.6) 71.7% (95% CI 66.2-76.6) and 63.5% (95% CI 56.5-69.6) had antibodies against the types 1, 2 and 3, respectively, showing vulnerability to B Hepatitis, Yellow Fever and Poliomyelitis.
Infecção pelo vírus da hepatite B em pacientes com tuberculose em hospital de referência em Goiânia-GO
(Universidade Federal de Goiás, 2011-11-28) Aires, Rodrigo Sebba; Martins, Regina Maria Bringel; http://lattes.cnpq.br/2582896795892370
Hepatitis B and tuberculosis (TB) are important public health problems. This study aimed to investigate the epidemiological and molecular profile of the hepatitis B virus (HBV) infection among patients with TB who were attended at the reference hospital for infectious diseases in Goiânia, Goiás. A total of 402 patients were interviewed for socio-demographic characteristics, risk factors for HBV infection and previous hepatitis B vaccination. Blood samples were collected and sera were tested for HBsAg, anti-HBc, and anti-HBs markers by an enzyme-linked immunosorbent assay (ELISA). HBsAg reactive samples were tested for HBeAg e anti-HBe markers by ELISA. HBV DNA was detected in HBsAg and anti-HBc reactive samples by polymerase chain reaction (PCR). HBV DNA positive samples were genotyped by restriction fragment length polymorphism (RFLP) and sequencing of the Pre-S/S region. The overall HBV prevalence infection was 25.6% (95% CI: 21.5-30.2). Age higher or equal 50 years old and injecting or non-injecting drug use were risk factors associated with HBV infection. HBV DNA was detected in ten (76.9%) HBsAg reactive samples. Of these, eight were genotyped as genotypes A (n = 7) and D (n=1). HBV occult infection rate of 14.4% was found among anti-HBc reactive patients. Only 10.9% had serological evidence of previous HBV vaccination. The high prevalence and risk factors such as injecting or non-injecting drug use, in addition to the low HBV vaccine coverage found, should indicate that there is a need for interventions aimed at improving hepatitis B prevention and control in patients with tuberculosis.
Epidemiologia molecular do HIV-1, resistência aos antirretrovirais em gestantes e transmissão vertical no estado de Goiás
(Universidade Federal de Goiás, 2010-10-31) ALCÂNTARA, Keila Correia de; STEFANI, Mariane Martins de Araújo; http://lattes.cnpq.br/5581414958714905
Introduction: The spread of the aids epidemic among young women and HIV-1 mother-tochild transmission (MTCT) represent important public health issues. In this context, prenatal care represents a unique opportunity for the early diagnosis of young women and for the implementation of full preventive strategies to HIV-1MTCT. Objectives: To study immunological, virological, clinical and epidemiological characteristics and to identify factors associated with HIV-1MTCT among HIV-1 pregnant women/infants recruited in Goias State. Material and methods: Cohort 1: 41 pregnant HIV/AIDS: infant pairs (April/2000-August/2001) were recruited and prospectively followed up at two regional reference centers-Mother-Infant Hospital (HMI/SUS) and Hospital Dr. Anuar Auad (HAA/HDT/SUS). Cohort 2: 172 HIV/AIDS pregnant women and 149 exposed children were recruited at the Institute of diagnosis and prevention (IDP/APAE) and prospectively followed up at HAA/HDT/SUS. The following tests were performed: maternal viral load, CD4+ T cell counts, HIV-1env/gag subtypes by heteroduplex mobility assay/HMA (cohort 1) and pol (protease and reverse transcriptase-PR/RT) sequencing for resistance profile, subtypes identification and phylogeography analysis for subtype C (cohort 2). Infants born to HIV-1/aids mothers were evaluated by plasma viral RNA and CD4+ T cell counts. Seroreversion of exposed- uninfected children was followed by sequential ELISA tests for IgG anti HIV-1. Results: Patients from cohorts 1 and 2 presented similar social-demographic and clinical profiles. The median age was 26 years; 15-41 years), lower educational level predominated and most were diagnosed during pregnancy (90%). Over 80% received ARV prophylaxis. One case of MTCT was observed in cohort 1 which was associated with short prophylaxis and long labor period. Exposed-uninfected infants born to symptomatic mothers seroreverted earlier. Cohort 2 included 80% of all HIV-1 infected pregnant women from Goias state in that period. The early prophylaxis and undetectable viral load predominated among previously diagnosed patients (p<0.05). One ARV naive patient presented transmitted drug resistance; 10 ARV experienced patients presented secondary drug resistance: 6 under MTCT prophylaxis, 4 under HAART. MTCT was observed in 3/149 (2.01%) cases and late diagnosis, vaginal delivery, brastfeeding and lack of oral ZDV were observed. Among MTCT cases resistance mutations were not detected. HMA env/gag (cohort 1) and pol sequencing (cohort 2) results showed mostly subtype B followed by subtypes F1, C and recombinants, mainly BF1. HIV-1 subtype C was identified only among pregnant women from cohort 2 which together with recombinants BC represented around 20% of the isolates. Subtype C and BC recombinants were isolated in interior municipalities of Goias state located close to the main highways that connect south/southern to north (BR153), northeast (BR020) and South/west (BR369/BR070). Phylogenetic/ phylogeographic analysis showed a subtype C clado, clusters (aLTR ≥ 0.85) with sequences from Southern states and from Sao Paulo and evidences of multiple introductions. Conclusion: Our results indicate the importance of prenatal care for the early diagnosis/prevention of HIV-1 vertical transmission. However late diagnosis and missed opportunities to fully prevent transmission were associated with vertical transmission. Multiple introductions and the dissemination of HIV-1 subtype C by heterosexual contact in interior cities highlight the importance of monitoring the genetic diversity and the impact of subtype C dissemination in the interior of Brazil. Note: superscript + is where it appears and the program does not copy.
Caracterização epidemiológica e genômica de amostras de rotavírus humano espécie A em Goiânia-Goiás
(Universidade Federal de Goiás, 2016-09-22) Almeida, Tâmera Nunes Vieira; Cardoso, Divina das Dôres de Paula; http://lattes.cnpq.br/9770835116155857; Cardoso, Divina das Dôres de Paula; Soares, Célia Maria de Almeida; Mascarenhas, Joana D'Arc Pereira; Telles, Mariana Pires de Campos; Martins, Regina Maria Bringel
Rotavirus A (RVA) is an important causative agent of acute gastroenteritis (AGE), and vaccination is recommended for the prevention and control of this virus. In Brazil, since 2006, two vaccines have been used, with Rotarix® included in the National Immunization Program. Since its implementation, there has been a reduction in hospitalization rates and positivity for RVA. In this sense, the present study aimed to detect RVA from stool samples from children up to five years of age, with or without GEA, obtained in the period 2014-2015, in addition to characterizing the 11 genomic segments of RVA of samples obtained in pre- and post-vaccine periods and compare them to the vaccine sample. 341 stool samples were analyzed, 335 obtained in the period 2014-2015 and six archival samples positive for RVA, one from the pre-vaccine period. RVA detection was performed by polyacrylamide gel electrophoresis and G (VP7) and P (VP4) genotyping by Mulitplex-Nested-PCR. The 11 genomic segments were characterized by sequencing and molecular modeling was done for VP7 and VP4. Of the 335 stool samples (2014-2015), nine were positive for RVA with a long electropherotypic pattern, four of which were characterized as G12P[8]. Of the six archive samples, also a long standard, five were G1P[8], one of which was from the pre-vaccine period. The characterization of the 11 genomic segments was possible for three samples, two archive samples (G1P[8]), one from the pre-vaccine period and the other (G12P[8]) from the 2014-2015 period. The three samples were characterized as genogroup I. Phylogenetic analysis made it possible to differentiate lineages for VP7, VP4, VP6 and NSP4; samples G1, from the pre- and post-vaccine periods, were characterized as lineages II and I, respectively, and G12, as lineage III, and samples P[8] as lineage III. Samples I1 (VP6) were characterized as lineage IV (pre-vaccine) and I (post-vaccine) and samples E1 (NSP4) were characterized as lineage III. High nucleotide and amino acid identity was verified for the 11 genomic segments of the three samples in relation to the vaccine, being lower for VP7 and VP4 of the G12 sample P[8]. This lesser identity was evident in the protein structure, mainly in the antigenic epitopes of both proteins. In conclusion, RVA continues to circulate with the same genotype as the vaccines and with a different genotype, which reinforces the need for continuous monitoring of the agent in the context of vaccination.
Impacto da vacina pneumocócica conjugada 10-valente (PCV10) na hospitalização de crianças por pneumonia em Goiânia: uso de dados primários e secundários
(Universidade Federal de Goiás, 2015-07-17) Andrade, Sabrina Sgambatti de; Andrade, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899; Andrade, Ana Lúcia Sampaio Sgambatti de; Moraes, Jose Cássio de; Berezin, Eitan Naaman; Sucasas, Paulo; Siqueira Júnior, João Bosco
Background. Anticipating the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) on childhood National Immunization Program (NIP), an active population-based surveillance on pneumonia hospitalizations was conducted as a baseline, enabling a vaccination impact study. The objectives of the present research were: (i) to assess the reliability of the Hospital Information System of the Unified Health System (SIH-SUS) as a data source for assessing PCV10 impact on pneumonia; (ii) to measure the impact of vaccination with PCV10 in reducing the incidence of clinical and X-Ray confirmed pneumonia, in children residing in Goiânia municipality. Methods. In this study, we conducted an active prospective population-based surveillance on pneumonia in the post PCV10 vaccination period (2011-2013), in all 17 pediatric hospitals of Goiânia, with similar methodology used in the previous pneumonia surveillance during the pre vaccination period (2007-2009). Children aged 2-35 months of age, admitted to hospitalization with suspected diagnosis of pneumonia, were elegible for the survey. Clinical pneumonia and X-Ray confirmed pneumonia were the outcomes. The intervention was the PCV10, introduced in June 2010 in Goiania. Probabilistic linkage was performed between the SIH-SUS database (secondary data) and the active population surveillance (primary data) for the year 2012, to measure the agreement of case identification on pneumonia hospitalization rates between both data sources. To assess the impact of PCV10, annual incidence of clinical pneumonia and X-Ray confirmed pneumonia (per 100,000 population) and respective 95% confidence interval (95%CI) was estimated for the post vaccinations period and compared to the rates obtained for the pre vaccination period. The relative risk for pneumonia and respective 95%CI were calculated based on Poisson distribution. The percentage change in rates (1-relative risk) between pre and post vaccination periods was calculated. Results. Pneumonia incidence rates obtained by the SIH-SUS were statistically similar to those obtained by active population surveillance for children 2-23meses (p = 0.184). On the PCV10 impact evaluation study, the rates of hospitalization for clinical and RXT confirmed pneumonia in children under 24 months decreased 13.1% (from 5,728/100,000 to 4,976/100,000) and 25.4% (from 2,497/100,000 to 1,862/100,000), respectively, after routine immunization.
Circulação dos vírus dengue no estado de Goiás: vigilância laboratorial (1994-2013) e perfil de anticorpos neutralizantes sorotipo específico durante o surto de 2013 em Goiânia
(Universidade Federal de Goiás, 2014-12-19) Argolo, Angela Ferreira Lopes de Teive e; Féres, Valéria Christina de Rezende; http://lattes.cnpq.br/8089054699896454; Martelli, Celina Maria Turchi; http://lattes.cnpq.br/5867052489026059; Martelli, Celina Maria Turchi; Braga, Maria Cynthia; Cordeiro, Marli Tenório; Turchi, Marília Dalva; Santos, Silvia Helena Rabelo dos
Dengue is an endemic disease in Goias state with current circulation of the four serotypes. In the last five years has been occurred a significant increase in cases, hospitalizations and deaths caused by dengue in the region. In this thesis the first manuscript analyzed data from the virological surveillance of DENV in Goias during 1994-2013. Virus isolation in C6/36 (A.albopictus) cell culture followed by indirect immunofluorescence using monoclonal antibodies were performed in LACEN-GO. During the study period the four serotypes have been identified with introduction of DENV-1 in 1994, DENV-2(1998), DENV-3(2002) and DENV-4(2011). Among 21,684 virus isolation tests performed 4,839(22.3%) were positive. DENV-1 was isolated in 3,023(62.5%), DENV-3 in 1,051 (21.7%), DENV-4 in 413(8.5%) and DENV-2 in 352(7.3%) samples respectively. There were changes in the predominance of serotypes throughout the study period with dominance of DENV-1 between 1994-2002 and 2009-2011, DENV-3 in 2003-2008 and DENV-4 in 2013. The DENV-2 was never prevalent among serotypes isolated in LACEN-GO. The time series of the virological surveillance of dengue in Goias showed the introduction and the temporal sequence of circulation of DENV in the state. This study contributes to characterize the epidemiological scenario of dengue in Goias with possible implications for epidemiological surveillance of the disease in the region. The second manuscript evaluated the presence of dengue serotype-specific neutralizing antibodies (NAb) in patients involved in a clinical dengue cohort established during epidemic of 2012-2013 in Goiania, state of Goias. Among 452 participants of the cohort we analyzed the paired samples from 60 patients classified as severe dengue (n=40) or dengue fever (n=20). The eligibility criteria were confirmation of the infection by IgM, NS1Ag and /or RT-PCR; IgG positive in at least one of the samples. Monotypic or multitypic response were defined: PRNT50≥1/20 for only one serotype or ≥1/20 for two or more serotypes simultaneously. The infecting serotype was defined by ≥4 fold increase in the title of NAb in paired samples. Overall 73.3% of patients had NAb against DENV-4, 68.3% against DENV-1, 68.3% against DENV-2 or 61.6% against DENV-3. The patients' ages ranged from 3 to 81 years. Regardless of age group 85% of patients had multitypic response while 15% had monotypic response. Patients infected with DENV-4 showed the greatest difference in NAb titers in comparison to other serotypes indicating predominance of seroconversion for serotype 4. There was no correlation among preexistent NAb and disease severity. The characterization of dengue serotype-specific immune response is important to study the relationship of preexistence of neutralizing antibodies with clinical outcomes of disease also facing the perspective of introducing of antidengue vaccines to identify protective immunity.
Identificação molecular, virulência e suscetibilidade aos antifúngicos das espécies do complexo Candida parapsilosis
(Universidade Federal de Goiás, 2014-08-26) Ataídes, Fábio Silvestre; Silva, Maria do Rosário Rodrigues; http://lattes.cnpq.br/7119226630434725; Silva, Maria de Rosário Rodrigues; Melhem, Márcia de Souza Carvalho; Camplesi Junior, Milton; Amorim, Rosália Santos Jesuino; Souza, Lucia Kioko Hasimoto e
The Candida species are associated with clinical manifestations that can characterize from superficial infections up to systemic involvement. Non-albicans species are considered emerging, and Candida parapsilosis is the main etiological agent in several casuistics. The secondary alcohol dehydrogenase (SADH) gene amplification and restriction fragment analysis by enzyme digestion BanI allows differentiation of C. parapsilosis in a species complex formed by C. parapsilosis sensu stricto, C. orthopsilosis and C. metapsilosis that may present behaviors different virulence and response to antifungal agents. Thus, this study aims to identify the species of the C. parapsilosis complex, obtained from mycology collection of the Mycology Laboratory of the Institute of Tropical Pathology and Public Health, Federal University of Goiás, using molecular methods, as well as the characterization of factors virulence and in vitro susceptibility to different antifungal agents. For the distinction between the species, was performed a polymerase chain reaction followed by digestion with restriction enzyme BanI. After the identification of 87 isolates from blood (54) and nails (33), the determination of virulence factors such as proteases, esterase, phospholipase, hemolysins, adhesion, biofilm formation and switching phenomenon were performed. The profile of in vitro susceptibility to amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole and caspofungin were performed using the Etest® method. The results showed that C. parapsilosis sensu stricto is the most common in our region (78), followed by C.orthopsilosis (5) C. metapsilosis (4). There was no difference between the behavior of virulence by the three species, but noted that there is divergence in the susceptibility to antifungal agents. Isolates of C. parapsilosis sensu stricto were less susceptible to amphotericin B, itraconazole and caspofungin compared with the susceptibility patterns of C. orthopsilosis and C. metapsilosis. A percentage of 10.2% of the isolates of C. parapsilosis sensu stricto no were susceptible to caspofungin. This paper reports the first identification of species of the C. parapsilosis complex in the state of Goiás, Brazil, and shows the importance of determining antifungal susceptibility to appropriate therapy.
Toxoplasmose crônica em gestantes. Avaliação da prevalência, fatores de risco e acompanhamento de um grupo de recém-nascidos em Goiânia – Goiás
(Universidade Federal de Goiás, 2013-03-07) Avelar, Juliana Boaventura; Castro, Ana Maria dae; http://lattes.cnpq.br/9232309971000621; Castro, Ana Maria de; Avelino, Mariza Martins; Soares, Joana Darc’A. C. Herzog; Amaral, Waldemar Naves do; Rahal, Rosemar Macedo de Sousa
Toxoplasma gondii causes a parasitosis with wide distribution in nature and high prevalence in the human population, in the form of asymptomatic infection. When a pregnant woman if infects, can occur the passage of parasites through the placenta, causing an infection that varies in severity, depending on the season in which occurred the fetal disease. The fetus may die in function of the infectious process, or staying with serious sequelae (ocular or brain), but may be asymptomatic at birth, which does not necessarily imply in benign progression of the disease, because the changes may appear throughout their development. The objective of this study was to make an evaluation of serological survey on chronically infected mothers and their newborns to check the possibility of the occurrence of congenital toxoplasmosis. Blood samples were collected from 230 mothers and their newborns, originated from two public hospitals of Goiânia (GO), in the period from 2010 to 2011. The samples were submitted to techniques of IFAT and ELISA for identification of specific antibody anti- T. gondii. In addition to the testing of Avidity of IgG in 133 of these samples. In 32 samples of sera of RN was performed to search for antibodies of the IgA class and 42 blood samples from newborns were submitted to the technique of PCR for identification of the parasite by having their serologic titers higher than their mothers or have low avidity of IgG. It was found that 68.1% (188/230) of the samples had specific antibodies of the IgG class which corresponds to 51.9% among pregnant women treated at the Hospital das Clinicas (HC) in 2010, and 42.3% among pregnant women of Maternidade Nossa Senhora de Lourdes in 2011. Not if identified antibodies of the IgM and IgA in the blood of any of RN studied and it was also not possible the encounter of the parasite between RN by PCR. 14.8% (34/230) of women examined had their results of IgG negative despite having positive result in serological screening test, thus constituting the false-positive test. Despite of the results in this group of pregnant women and newborns have not shown that the congenital toxoplasmosis can happen so important in pregnant women chronically infected, during the project, was diagnosed with a case of a pregnant woman chronically infected by T.gondii, with eight months of pregnancy that had its fetus infected congenitally, causing fetal death. Were detected high titers of antibodies of the IgG class, presence of IgM and high avidity of IgG, suggesting that treat of resurgence of protozoal infection. This finding points to the importance of the advice of primary prevention measures for all pregnant women, regardless of their immune status against the parasite.
Carga epidemiológica da coqueluche e avaliação de impacto de vacinação de gestantes contra coqueluche implementada no Brasil em 2014
(Universidade Federal de Goiás, 2022-08-10) Bagattini, Ângela Maria; Toscano, Cristiana Maria; http://lattes.cnpq.br/3772312631884265; Toscano, Cristiana Maria; Morais Neto, Otaliba Libânio de; Siqueira Júnior, João Bosco; Silva, Lara Lívia Santos da; Kuchenbecker, Ricardo de Souza
Introduction: Pertussis is an acute infectious disease of respiratory transmission, with cyclical occurrence, it is endemic worldwide, represents an important global burden, particularly in children under one year of age who have more severe conditions and may progress to death. Between 2010 and 2014, a sudden and atypical increase in the number of cases of the disease was observed in several countries, including Brazil. There are several hypotheses about the factors associated with this resurgence, including disease cyclicality, replacement of whole-cell vaccines with acellular vaccines, falling vaccine coverage in children, and the effectiveness and duration of protection of vaccines in children, among others. Objectives: This study aims to characterize and estimate the epidemiological situation of pertussis in Brazil, evaluate the impact of vaccination of pregnant women with pertussis vaccine (dTpa) implemented in Brazil in 2014. Also, review the evidence about protection and duration of protection conferred by the whole cell vaccine against pertussis used for vaccination of children in the National Programs of Immunization. Methods: A study in three stages was carried out. The first stage described the epidemiological situation of whooping cough in morbidity and mortality in Brazil from 2000 to 2016. Next, the second stage with an interrupted time series ecological study was carried out with data adjusted by month and using the ARIMA model to assess the impact on cases and hospitalizations of children under five years of age with the introduction of the dTpa vaccine for pregnant women in 2014. The two stages used three independent health information systems, the Information System for Notifiable Diseases (SINAN), the Hospital Information System (SIH), the Mortality Information System (SIM) and the National Immunization Program Information System (SI-PNI), data were aggregated and evaluated by age group and federation unit. The third stage of the study was carried out through a systematic review to assess the effectiveness and duration of protection provided by the whole cell pertussis vaccine (DTPw) in children considering the vaccines currently available on the international market. Results: Pertussis showed cyclical patterns of disease burden over time between 2000 and 2016 in Brazil, in different regions with heterogeneous conditions, with a well-defined outbreak that started in 2011 and peaked in 2014, reaching mainly and more severely. children under six months, with 20,103 (54%), 19,919 hospitalizations (79%) and 565 deaths (93%). The incorporation of dTpa vaccination in pregnant women was associated with a significant reduction in pertussis cases and hospitalizations in children under six months of age when coverage is above 45%. After the introduction of dTpa, it is estimated that 2,124 cases and 1,439 hospitalizations for pertussis were avoided in children under six months of age in states with coverage above 45% between 2015 and 2016. Additionally, 12 studies with DTwP conducted between 2007 and 2020 were included for review, which have varied methodological quality and lack evidence on immunogenicity and duration of immunity indicating a short duration, less than five years. Conclusions: The analysis of different health information systems used showed consistent results throughout the period analyzed, reflecting the cyclicity of the disease and its resurgence from 2011. The incorporation of dTpa vaccination in pregnant women resulted in an impact on the reduction of hospitalizations and deaths of children when vaccination coverage above 45% is achieved. The wP vaccines currently in use have scant evidence of duration of immunity, even though they are used in over 100 countries, in most low- and middle-income countries. Relevance and Impact: The results of this work reinforce the importance of achieving and maintaining dTpa vaccination coverage in pregnant women above 45% in order to obtain a significant impact of vaccination of pregnant women in reducing hospitalizations for pertussis in children. Although wP is one of the most used vaccines globally in children in immunization programs in low- and middle-income countries, there has been an important change in the producers of these vaccines in recent decades, with large pharmaceutical companies having left the market and being replaced by producers in countries emerging technologies that today account for the totality of wP vaccines produced and used in the world. Evidence suggests that the duration of protection afforded by these vaccines in children is short. However, better quality evidence on the effectiveness and duration of immunity conferred by these vaccines is needed to support the definition of more appropriate vaccination strategies.
Análise do polimorfismo dos genes das famílias eNOS, CYP e GST em pacientes ateroscleróticos que fazem o uso de estatinas
(Universidade Federal de Goiás, 2021-09-03) Barbosa, Andreia Marcelino; Oliveira, Sérgio Marcelino de; http://lattes.cnpq.br/7215263898606009; Moura, Kátia Karina Verolla de Oliveira; http://lattes.cnpq.br/0087299570422353; Moura, Kátia Karina Verolli de Oliveira; Reis, Paulo Roberto de Melo; Silva, Cláudio Carlos da; Costa, Iasmim Ribeiro da; Silva, Kleber Santiago Freitas e
Atherosclerosis is a chronic inflammatory disease and is one of the main causes of coronary heart disease and stroke in humans. It affects large and small arteries and is characterized by the development of lipid-rich plaques in the vascular wall. Percutaneous coronary intervention with stents may be an acceptable alternative for patients with coronary artery disease, being one of the most common procedures for the treatment of atherosclerotic lesions. Evidence has suggested that statins, in addition to low density lipoprotein reduction, exhibit atherosclerotic plaque stabilization properties and endothelial homeostasis; anti-inflammatory, antioxidant, antiproliferative and immunomodulatory effects; normalization of sympathetic flow and prevention of platelet aggregation. The search for genetic determinants of atherosclerosis has been going on for decades. Currently, this line of research is focused on identifying candidate genes involved in atherogenesis pathways and conducting association studies to assess their roles in the development of the pathology. To analyze the polymorphism of genes from the eNOS, GST, CYP families in atherosclerotic patients who use statins, analyzing a case group - those who have stents - and a control group - those who do not have stents - to perform a comparison of statins therapy. The study of allelic and genotypic frequencies showed that a population is in Hardy Weinberg imbalance and this proves the influence of evolutionary factors.
Prevalência de tipos específicos de HPV e anormalidades citológicas em mulheres quilombolas
(Universidade Federal de Goiás, 2014-10-23) Batista, José Eduardo; Nascimento, Maria do Desterro Soares Brandão; http://lattes.cnpq.br/3958174822396319; Santos, Silvia Helena Rabelo; http://lattes.cnpq.br/4994826511439492; Alves, Virgínia Farias; Dias, Fátima Ribeiro; Carneiro, Megmar Aparecida dos Santos; Saddi, Vera Aparecida
Introduction: Genital infection by human papillomavirus (HPV) is considered the most common sexually transmitted infection in several countries. The prevalence of HPV genotypes in women with or without cytological abnormalities may vary according to the studied population and the region. Objective: To detect and identify specific HPV types correlating with sociodemographic/behavioral characteristics and cytological abnormalities present in cervical smears of Maroon women. Methods: This cross-sectional study included 353 maroon women users of the unified health System of the municipalities of Maranhão for screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes by polymerase chain reaction (PCR) with primers PGMY09/11 followed by reverse line blot hybridization performed with the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association of HPV types and cytological diagnosis was investigated according to the different age groups. Results: HPV infection was detected in 13% (46/353) of the cases. Infection types with high-risk HPV were more frequent (78,3 %, 36/46) than for low-risk HPV (21,7 %, 10/46). Genotypes 68 (24,2 % - 11 /46), 58 (19,8% - 9/46), 52 and 31 (10,8% - 5/46 each), and 62 (8,8% 4/46) were the most prevalent. Only 6,6% (3/46) of the cases were positive for HPV 61. The genotypes 73, 70, 54, 53, 45, IS39 and 18, individually represented 4,4% (2/46) of all cases. The CP6 -108, 84, 72, 71, 66, 59, 56, 55, 51, 39, 33 and 16 genotypes individually represented 2,2% (1/46) of the cases. In women without cytological abnormalities, viral infections, both simple and multiple, were detected in 10,7%(35/328) of the cases. For those diagnosed with an abnormality, the prevalence of HPV infection was 24,0% (1 /46), being higher in high grade squamous intraepithelial lesion (HSIL-75,0 %), followed by atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H, 50%), low grade squamous intraepithelial lesions (LSIL-33,4 %) and atypical squamous cells of undetermined significance (ASC-US, 14,3%). The analysis showed a statistically significant association between HPV infection and the detection of cytologic abnormalities in the age groups between 31-40 years (OR = 7.40, 95 % CI :1.07 -51 ,19 , p = 0.03) and 51 to 60 years (OR = 20.4 , 95 % CI : 1.12 to 704.69, p = 0.03). None of the behavioral variables showed significant association with HPV infection, however the presence of this infection was positively associated with detection of cytologic abnormalities (OR=6,57: IC:2,772-15,606), p=0,001. Conclusion: It is possible that the results of this study are due to characteristics of the study population, geographically isolated, with conservative habits and sexual intercourse only between members of the Quilombo. This study with Maroon women allowed us to delineate the epidemiology of this HPV infection in populations living in Maranhão.
Conídios e blastosporos de Metarhizium spp. e Beauveria bassiana: virulência para Rhipicephalus microplus e resposta ao calor e à radiação UV-B
(Universidade Federal de Goiás, 2016-07-19) Bernardo, Cíntia das Chagas; Fernandes, Éverton Kort Kamp; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4707291J3; Fernandes, Éverton Kort Kamp; Rangel, Drauzio Eduardo Naretto; Mascarin, Gabriel Moura; Bittencourt, Vânia Rita Elias Pinheiro; Arruda, Walquíria
The current study compared the virulence of conidia and blastospores of Metarhizium anisopliae s.l. (IP 363), Metarhizium robertsii (IP 146) and Beauveria bassiana s.l. (IP 361 and GC 307) against Rhipicephalus microplus, and the tolerance to heat and UV-B radiation; in addition, it evaluated the development of conidia and blastospores of the isolates IP 146 and IP 361 on the tick cuticle by scanning electron microscopy (SEM). Larvae and engorged females of R. microplus were treated (larvae: 106, 107 or 108 propagules/mL, females: 107 propagules/mL) by immersion in conidia or blastospores suspensions of tested isolates. The higher percentage of larval mortality was obtained in the group treated with conidia of IP 361, which had lower LC50. In bioassays with engorged females, IP 146 and IP 361 blastospores, provided tick percent control superior to 90%, while conidia of the same isolates, promoted 70.97% and 63.29% of tick control, respectively. Ticks were treated topically with 50 μL of fungal suspension (107 propagules/mL) and incubated at different times from 0 to 96 hours to analyze its development on the engorged females cuticle; after each incubation time, the females were fixed and analyzed by SEM. Blastospores of both isolates have started development 4 hours after treatment, demonstrating rapid development and suggesting penetration by the tick natural openings; at 4 hours incubation, indicative of penetration of IP 361 blastospores through the cuticle was observed, but no signs of penetration was observed with IP 146 blastospores at any time evaluated. Furthermore, fungal suspensions (103 propagules/mL) were exposed to heat (45 °C) for several time periods, then inoculated in Petri plates with BDAY medium plus chloramphenicol (0.055% v/v), and incubated for 7 days at 27 °C and RH ≥ 80%. ARSEF 324 conidia (79.1%) were more tolerant to heat than conidia of IP 363 (55.5%), IP 146 (1.5%), GC 307 (0%), and IP 361 (0% ) at 2 hours exposure, as well as blastospores after 60 minutes exposure, demonstrating mean percent CFU of 100%, 12.3%, 30.7%, 55% and 0%, respectively. Fungal suspensions (103 propagules/mL) were also inoculated on BDAY in Petri plates, and exposed to UV-B radiation; after treatment, plates were incubated for 7 days at 27 °C and RH ≥ 80%. No difference in mean relative percent CFU between conidia and blastospores was observed. Suitable adjuvants which aim at protecting fungal propagules against stressful abiotic factors are required for conidia and blastospores; however, the selection of isolates with marked natural tolerance to heat and UV-B radiation may increase performance of bioproducts. Accordingly, it is suggested that blastospores are promising fungal propagules for biological control of ticks, since they were virulent against R. microplus; in addition, the rapid development of blastospores on the tick cuticle indicates they may be exposed shortly to harmful environmental abiotic factors.
Análise proteômica do fungo Paracoccidioides durante o processo infeccioso em macrófagos
(Universidade Federal de Goiás, 2014-06-06) Bonfim, Sheyla Maria Rondon Caixeta; Soares, Célia Maria de Almeida; http://lattes.cnpq.br/8539946335852637; Soares, Célia Maria de Almeida; Bailão, Alexandre Melo; Borges, Clayton Luiz; Casaletti, Luciana; Oliveira, Milton Adriano Pelli
Paracoccidioides is a fungal human pathogen that causes systemic mycosis paracoccidioidomycosis (PCM). Infection occurs via inhalation of fungal propagules by the host and macrophages are important in the initial contention of the fungus through innate mechanisms. In this study, analysis of proteomic profile of yeast cells of Paracoccidioides, isolate Pb18, recovered from infection in macrophages J774 A1 so as to identify molecules that are expressed in this condition and could represent targets for new antifungal therapies. The analysis of differential protein expression could be detected 181 proteins with induction of expression and decreased expression was observed in 245 proteins in Pb18. The data show up regulation of proteins involved in the processes on the alternative carbon metabolism such as gluconeogenesis, beta-oxidation of fatty acids and amino acids catabolism. Proteins with decreased levels of expression include those related to protein synthesis and glycolysis. Aditionally proteins involved in oxidative stress response and cell defense exhibit increased levels of expression such as superoxide dismutase, heat shock proteins, cytochrome c peroxidase and thioredoxins. A mutant was generated to assess the importance of the enzyme cytochrome c peroxidase during infection suggesting involvement in a complex system of protection against oxidative stress, reinforcing role in the survival of the fungus. The proteomic profile of Paracoccididioides sp in response to internalization in macrophages, first described, reflects significant remodeling of fungal metabolism against oxidative stress and highlighting the versatility of the fungus to adapt to the hostile environment of the macrophage seeking new strategies survival.
Caracterização de microrganismos isolados em manipuladores e dietas enterais de dois hospitais públicos de Goiânia
(Universidade Federal de Goiás, 2010-03-19) BORGES, Liana Jayme; ANDRÉ, Maria Cláudia Dantas Porfirio Borges; http://lattes.cnpq.br/1475834090578722; SERAFINI, álvaro Bisol; http://lattes.cnpq.br/9849440763539845
Enteral feeding means the nutrition for special purposes, with controlled intake of nutrients. The advantages of its use often become secondary to complications arising from its contamination, which may be associated with infectious complications. The microbial contamination of enteral feeding may occur during all steps being the handling, particularly critical. Considering the importance of enteral feeding as a therapeutic tool in hospitals and the need to guarantee the microbiological quality of the products offered to critical patients, the present work aimed to evaluate the hygienic and sanitary quality of diets and their ingredients and to identify and characterize phenotypic and genotypically, using the antibiogram and pulsed-field gel electrophoresis, strains of Escherichia coli and Staphylococcus aureus obtained from handlers hands and noses, water, module and enteral nutrition from two public hospital in Goiânia, Brazil in order to investigate the probable source of microbological contamination. A total of 80 samples were collected from enteral nutrition and 140 from hands and noses of handlers involved in the diets manufacturing in hospital 1 (H1), between october/2007 and november/2008 and 80 samples from enteral nutrition and 80 from hands and noses of handlers in hospital 2 (H2), between october/2008 and november/2008. From both hospitals were collected 40 samples from water and module. The samples were submitted to microbiological analysis to verify the presence and numbers of pathogenic and indicator microorganisms. E. coli and S. aureus strains were submitted to antibiogram and PFGE. According to antibiogram, all S.aureus isolates (15) from H1 were susceptible to oxacillin, vancomycin, ciprofloxacin and gentamicin. Resistence profile was observed in 10 (66.7%) isolates for penicillin, four (26.7%) isolates for tetracycline and nine (60.0%) isolates for erythromycin, allowing to classify the strains in six different phenotypes (A-F), but it was not efficient for the determination of the bacterial source for the diets. In the H1, all (08) E. coli strains were susceptible to trimethoprim, ciprofloxacin, cephalothin, gentamicin, ceftazidime and tetracycline. Resistence was observed in six (75.0%) isolates for ampicilin. In H2, all strains isolated (12) were susceptible to trimethoprim, ciprofloxacin, gentamicin and ceftazidime and resistence was observed in 11 isolates (91.7%) for cephalothin and 12 (100.0%) for tetracycline and ampicillin, grouping them into five different phenotypes (A-D). Microorganisms showed the same phenotypic profile from handlers and diet samples (phenotypes A and C), suggesting that in these cases, the source of microorganisms for the final product was the food handler. The genotypic typing of S. aureus strains by PFGE generated seven different DNA banding profiles and the E. coli genotyping generated five profiles. Based on the results, two E. coli strains isolated from diets were identical to one strain isolated from food handler from H2 and two of S. aureus isolated from diets were identical to one strain isolated from food handler from H1. This study shows that the enteral feedings showed unsatisfactory sanitary-hygienic conditions in both hospitals and the hand contact is probably one of the sources of greatest significance for enteral diets contamination in the hospital environment.
Avaliação de linhagens mutantes de Trichoderma harzianum na indução de resistência ao mofo branco e promoção do crescimento de feijoeiro comum (Phaseolus vulgaris)
(Universidade Federal de Goiás, 2019-12-02) Brandão, Renata Silva; Lobo Junior, Murillo; http://lattes.cnpq.br/3352833548668460; Ulhoa, Cirano José; http://lattes.cnpq.br/8368469162867277; Ulhoa, Cirano José; Kipnis, André; Monteiro, Valdirene Neves; Araújo, Leila Garcês; Filippi, Marta Cristina Corsi de
The common bean (Phaseolus vulgaris L.) is the most cultivated species among the other species of the Phaseolus genus with 95% of world production. There are several pathogens of epidemiological importance that cause economic damage to this crop, among which, Sclerotinia sclerotiorum, Which causes white mold. This pathogen can survive in seeds for more than three years and, through them, establish the disease in new areas. The fungus Trichoderma spp. stands out as an important biological control agent for S. sclerotiorum. Trichoderma mutants may be an alternative not only for biological control, suggesting that strains that overexpress aquoporins help the bioagent survive by providing protection against osmotic shock and ΔEpl-1 mutant, on the other hand, is involved in the process of mycoparasitism against phytopathogenic fungi, with responses in the protection of plants not yet defined. The aim of the study was to evaluate the physiological and biochemical aspects regarding the use of the fungus Trichoderma mutants Aquo and ΔEpl-1 in common bean plants against S. sclerotiorum. The experiment was conducted at Embrapa rice and beans and at the UFG Enzymology Laboratory. Physiological and biochemical analyzes were carried out on leaves and roots of common bean plants, produced from seeds treated with the wild isolate All 42 of Trichoderma harzianum, their strains of mutants Aquo and ΔEpl-1, and control without treatments. The Aquo treatment promoted an increase of 25% in the leaf area of the plants in relation to the control (p <0.05) and surpassed the treatments All42 and ΔEpl-1 by 28% and 91%, respectively. The specific activity of the enzyme β-1,3 glucanase was higher in plants treated with T. harzianum ΔEpl-1, in leaves and roots with 2.07 Umg-¹ and 2.57 Umg-¹, with and without inoculation of S. sclerotiorum presented 2.27 Umg-¹ and 2.34 Umg-¹, respectively, presenting a significant result on the leaf in relation to the other treatments.
Prevalência de infecções de transmissão vertical: toxoplasmose, rubéola, hepatite B, sífilis, infecção pelo citomegalovirus e pelo vírus da imunodeficiência humana em gestantes atendidas em Caxias, Maranhão
(Universidade Federal de Goiás, 2014-05-30) Câmara, Joseneide Teixeira; Castro, Ana Maria de; http://lattes.cnpq.br/9232309971000621; Castro, Ana Maria de; Vinaud, Marina Clare; Araújo, Telma Maria Evangelista de; Campelo, Viriato; Pinheiro, Valéria Cristina Soares
The vertical transmission of infection from mother to child, and may increase morbidity and mortality of both mother and child, when not diagnosed and by suitably dealest, causing a serious public health problem. This study aimed to estimate the prevalence of antibodies to toxoplasmosis, rubella, cytomegalovirus, hepatitis B, syphilis and HIV among pregnant women in Caxias, Maranhão, Brazil and identify the main factors associated with seropositivity for Toxoplasma gondii infection in pregnant women attending two referral centers Caxias, MA. Descriptive, observational, cross-sectional study of 561 pregnant women who received prenatal care at two clinics reference to prenatal high risk in the period July 2011 to December 2012, the outpatient clinics of Maternity Carmosina Coutinho (MCC) and the Specialized Center for Maternal and Child Care (CEAMI). Serological tests for toxoplasmosis, rubella, cytomegalovirus, hepatitis B were performed by a laboratory conveniado to the municipality by the same trained technician, and for syphilis and HIV were performed in the Counseling and Testing Center (ATC) in the city laboratory. And a small sample of whole blood from five pregnant IGM reagent for Toxoplasma gondii and their respective newborns was processed at the Institute of Tropical Pathology and Public Health in the Department of Parasitology UFG for performing Polymerase Chain Reaction (PCR). Statistical analysis was performed using SPSS version 20.0 Windows, using the chi-square tests of association and Odds Ratio (95%CI), considering a significance level of 5%. It was found to be positive for HIV was 0.4%, 2.0% syphilis, rubella and cytomegalovirus IgG reactivity were 93.6% and 87.8% respectively without reactive IgM, HBsAg was negative for all pregnant women in the sample tested. Regarding toxoplasmosis in 437 (77%), 124 susceptibility (22.1%) and 5 (0.9%) women with active infection. Found no significant association between toxoplasmosis susceptibility and age, location, income, education, sewerage, number of pregnancies and gestational age. Variables with significant association (p≤0.05) were seropositive pregnant women who are multiparous (p=0.036), living with dogs stuck at home (p=0.001), and consumption of raw kibbeh (p=0.036). The frequency of seropositivity of these infectious diseases of vertical transmission in pregnant women seen at antenatal care in the city of Caxias-MA is considered high, but are similar to those described in other regions of Brazil. Pregnant women who are multiparous who perform consumption of raw kibbeh and live with dogs that do not wobble on the street, had more chance of becoming infected with Toxoplasma gondii, thus guidance on primary prevention measures and quarterly serological monitoring should be strengthened these infections of pregnant women, since it is important to identify and/or prevent congenital infection measured.
Caracterização e identificação de fungos causadores de infecções nosocomiais em pacientes transplantados de células tronco hematopoiéticas
(Universidade Federal de Goiás, 2013-08-20) Camplesi Junior, Milton; Silva, Maria do Rosário Rodrigues; http://lattes.cnpq.br/7119226630434725; Silva, Maria do Rosário Rodrigues; Passos, Xisto Sena; Jesuino, Rosália Santos Amorim; Costa, Carolina Rodrigues; Fernandes, Orionalda de Fátima Lisboa
Invasive fungal infections have emerged in the last two decades as a major cause of nosocomial fungal infections, with emphasis on those caused by Candida species and Aspergillus. Invasive aspergillosis (IA) has a high mortality rate and early detection of Aspergillus is of paramount importance for the treatment and consequently prevention of patient death. The galactomannan (GM) cell wall protein component of Aspergillus species can be detected in serum, urine, cerebrospinal fluid and bronchoalveolar lavage. The detection of GM in the early stages of the disease is considered a useful marker for early diagnosis of the disease. The aim of this study was to determine the incidence of fungal infections in patients transplanted hematopoietic stem cells. In this study was verified the incidence of fungal infections in 117 patients undergoing hematopoietic stem cell transplantation (HSCT), whose data such as age, gender and underlying disease were cataloged. Blood samples of these 392 patients were collected, and tested for detection of GM using ELISA (Enzyme-Linked Immunosorbent Assay) test and cultivated in culture medium containing biphasic brain heart infusion (broth) and Sabouraud dextrose (agar) for isolation of fungal. The fungi isolated were subjected to in vitro susceptibility testing using broth microdilution method for the antifungal agents: itraconazole, voriconazole, fluconazole, caspofungin and amphotericin B. Among the data obtained from HSCT patient it has been found that the mean age was 35,7 years and the largest number belonged to the age group between 21 and 60 years; 52,2% were male, 53% had received allogeneic stem cell transplant. Leukemias (55,5%) were the main diseases responsible for transplant. Fungal isolates from clinical samples were identified as A. fumigatus (02), Aspergillus flavus (01), Fusarium sp (01), Acremonium strictum (01), Candida parapsilosis (06), Candida tropicalis (06) and Candida albicans (04). Of all patients analyzed 19,6% (23/117) had two or more positive samples for GM. According to European Organization for Research and Treatment of Cancer, invasive aspergillosis was interpreted as proven in 2,5% defined by growth of Aspergillus in culture, 5,9% as probable for the detection of GM in blood and pulmonary infiltrates and 2,5% as possible by radiological changes suggestive of aspergillosis and negative GM. The mortality rate for AI proven/probable was 60% and showed that the disease was significantly associated with the risk of death (P <0,05). The filamentous fungi were more susceptible in vitro to voriconazole, while higher susceptibility of the yeast was found to Caspofungin. Considering that the crude mortality rate of IA is very high and the early therapy may lead to improved prognosis, we could suggest that the Platelia Aspergillus GM EIA in serum of patients could be useful as screening tools for identification in patients at high risk of developing IA.
Validação da gastrostomia endoscópica percutânea realizada pela técnica de punção com o uso de uma nova variante técnica de gastropexia
(Universidade Federal de Goiás, 2010-12-16) CAMPOLI, Paulo Moacir de Oliveira; TURCHI, Marília Dalva; http://lattes.cnpq.br/3769826743537934
Percutaneous endoscopic gastrostomy (PEG) currently represents the main alternative to ensure nutritional supply in patients with prolonged or permanent inability to swallow, and yet has a functional gastrointestinal tract. PEG performed with the Pull Technique is widely used because it is easy to perform and very safe, although it is associated with high infection rates. The Introducer Technique appears to be associated with a lower infection risk, although it requires fixation of the gastric wall to the abdominal wall (gastropexy), which makes the procedure difficult to perform. This study sought to describe and validate PEG performed with the Introducer Technique with the use of a new technical gastropexy variant, besides demonstrating its benefits in relation to risk of peristomal infection. A descriptive study of the safety and feasibility of a new technical gastropexy variant with a long curved needle was performed. We then compared the two gastropexy techniques in a before-and-after design. A randomized clinical trial comparing gastrostomy tubes constructed of different materials (latex vs. silicone) was also conducted. Finally, we performed a meta-analysis evaluating peristomal infection risk between the Introducer Technique and Pull Technique. The results of these four studies are presented in four separate papers. The first study showed that the new technical gastropexy variant that uses a long curved needle is safe and feasible. The second study showed that it is associated with a lower risk of infection compared with the gastropexy technique used previously. The third study found that the silicone tubes have greater durability than latex tubes. The final meta-analysis showed that PEG performed with the Pull Technique is associated with a greater risk of infection than the Introducer Technique.
Surto de infecção após videoscopias causado por Mycobacterium massiliense em Goiânia-GO : análise molecular e determinação da suscetibilidade aos antimicrobianos
(Universidade Federal de Goiás, 2009-12-03) CARDOSO, Alessandra Marques; KIPNIS, Ana Paula Junqueira; http://lattes.cnpq.br/1252262903952987; KIPNIS, André; http://lattes.cnpq.br/4434965360286741
In recent years the number of infections caused by microbacteria non-tuberculous mycobacteria (NTM) has increased mainly due to opportunistic infections in individuals imunocompormetidos and improvement of farming techniques and identification of MTN. Mycobacterium massilienese is an emerging body associated with wound infections, abscesses and pneumonia. An outbreak of infection after videoscopy occurred between 2005 and 2007 in seven hospitals in Goiânia-GO, in central Brazil. The objective of this study was to identify NTM isolated from patients with infection after arthroscopy and lararoscopia by PCR followed by analysis of fragment length polymorphism restrção (PRA-hsp65), compared by gel electrophoresis pulsed-field gel (PFGE), sequencing of the partial rpoB gene and determination of antimicrobial susceptibility in vitro. NTM were recovered from samples (exudate abscess subcutâneio) of 18 patients involved in the outbreak. In the period leading up to this study there was no reported case of infection after videoscopy caused by MTN in Goiania. The 18 isolates were identified as M, massiliene and genotyped as a single clone, indicating that they had a common origin, suggesting a common source of infection for the patients involved in the outbreak. The epidemic isolates were susceptible to amikacin (MIC90 4 micrograms / ml) and clarithromycin (MIC90 <1 ug / ml), but resistance to ciprofloxacin (MIC90 <128g/ml), tobramycin (MIC90 32 micrograms / ml) and intermediate susceptibility to cefoxitin (MIC90 64 ug / ml). In conclusion this study demonstrated the clonality of strains of M. massiliense involved in infections after procedures videoscopes and that they are susceptible to drugs indicated for the treatment

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