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Carvel Suprien
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CARACTERIZAÇÃO DAS MANIFESTAÇÕES CLÍNICAS, E RESPOSTA AO TRATAMENTO EM CRIANÇAS COM LEISHMANIOSE CUTÂNEA.
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Leader : EDGAR MARCELINO DE CARVALHO FILHO
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MEMBRES DE LA BANQUE :
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EDUARDO MARTINS NETTO
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EDGAR MARCELINO DE CARVALHO FILHO
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LUIZ HENRIQUE SANTOS GUIMARAES
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Data: 4 févr. 2019
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Afficher le Résumé
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CHARACTERIZATION OF CLINICAL MANIFESTATIONS, AND RESPONSE TO TREATMENT IN CHILDREN WITH CUTANEOUS LEISHMANIASIS. Cutaneous leishmaniasis (LC) caused by Leishmania braziliensis is characterized by a well limited ulcer with raised borders. The disease occurs predominantly in young male adults and there are a limited number of studies on CL in the pediatric population. The aim of the present study was to compare the clinical presentation and response to antimonial therapy in children versus adult population. The participants were 571 patients diagnosed with CL at the Health Clinic of Corte de Pedra, Brazil, in 2016 and divided into 3 groups: 1. Age between 0-12 years, children (129 cases - 22.6%); 2. Age between 13 and 18 years, adolescents (83 cases - 14.6%); 3. Age greater ≥ 19 years, adults (359 cases -62.8%). The children had a shorter duration of disease, a higher incidence of head injuries and smaller lesions, when compared to the adults group (P <0.05). Cure was defined by complete healing of the ulcer in the absence of raised borders 90 days after initiation of therapy and failure by the presence of active ulcer or a scar with raised edges at day 90. The therapeutic failure was associated with lower age, lower duration of disease, more than one lesion and larger lesion size. After multivariate analysis, all these variables remained significant. Although the greater risk of failure due to multivariate analysis has been associated with lower age, in general, the cure rate between children (43%), adolescent (40%) and adult (48%) is similar. In conclusion, we observed that there was a significant increase in the number of children with CL compared to previous studies in the same endemic area, but with the exception of the site of the lesions, the LC presentation as well as the response to antimony therapy was similar in children and adults.
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2
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ANDRÉ LUIS BASTOS SOUSA
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LESÃO RENAL AGUDA EM NONAGENÁRIOS: INCIDÊNCIA, PREDITORES E PROGNÓSTICO
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Leader : PAULO NOVIS ROCHA
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MEMBRES DE LA BANQUE :
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MARIA OLINDA NOGUEIRA AVILA
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MARILIA BAHIENSE OLIVEIRA
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PAULO NOVIS ROCHA
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Data: 7 févr. 2019
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Title: Acute kidney injury in nonagenarians: incidence, predictors and prognosis. Background: Given the aging of the population, nephrologists are frequently assisting nonagenarians with acute kidney injury (AKI). The management of these patients presents peculiarities, including bioethical dilemmas, such as the utilization of renal replacement therapy (RRT) at this extreme age. Methods: We conducted a retrospective cohort study at a tertiary hospital. Over a 10-year period, 832 nonagenarians were hospitalized for two or more days. A random sample of 461 patients was obtained; 25 subjects were excluded due to lack of essential data. AKI was defined and staged according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results: We analyzed data from 436 patients, mean age 93.5 ± 3.3 years, 74.3% female; 76.4% required intensive care unit (ICU). The incidence of AKI was 45%. Length of hospital stay, ICU admission, vasopressors, and mechanical ventilation (MV) were independent risk factors for AKI. Overall in-hospital mortality was 43.1%. Mortality was higher in the AKI compared to the no AKI group (66,8% vs. 23,8%, p <0.001). Age, Charlson's score, vasopressors, MV, and KDIGO stage were independent predictors of mortality. Only 13 patients underwent RRT; all were critically ill, requiring vasopressors and 76.9 % in MV. Mortality for this RRT group was 100%, which was not significantly different than that observed in matched controls (96.1%, p = 1.0). Conclusions: AKI is common in hospitalized nonagenarians and carries a grave prognosis, especially in those who are critically ill requiring RRT. Our data may help guide informed decisions about the utility of RRT in this population.
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3
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SHEILA NUNES FERRAZ
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Manifestações clínicas e resposta imune em uma coorte de indivíduos infectados pelo HTLV-1 com alta carga proviral e sem evidência de mielopatia
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Leader : EDGAR MARCELINO DE CARVALHO FILHO
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MEMBRES DE LA BANQUE :
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ANTONIO DE SOUZA ANDRADE FILHO
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DAVI TANAJURA COSTA
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EDGAR MARCELINO DE CARVALHO FILHO
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Data: 11 févr. 2019
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Afficher le Résumé
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Introduction. The human T cell lymphotropic virus type 1 (HTLV-1) associated myelopathy (HAM) is the main neurologic disease caused by HTLV-1 but other neurologic and clinic manifestations associated to the virus are documented in more than 50% of infected subjects. A high proviral load (PVL) is recognized as a risk factor for HAM but there is a lack of prospective studies evaluating if HTLV-1 carriers with high PVL are at risk to develop HAM or other HTLV-1 related diseases. In this study we compare the incidence of clinic manifestations and the cytokine levels in HTLV-1 carries with high and low proviral load. Methods. Participants were 30 HTLV-1 high PVL carriers (> 50,000 copies/106PBMC) and equal number of subjects with PVL lower than 50,000 copies/106PBMC. They were followed by 3 to 16 years (median of 11 years). The PVL was measured by real time PCR and IFN-γ, TNF and IL-10 levels were quantified by Elisa in supernatants of unstimulated mononuclear cells at entry and at the end of the follow-up. Abnormalities in the neurologic examination, development of HAM, urinary dysfunction, erectile dysfunction, periodontal disease and the occurrence of sicca syndrome were recorded annually. Results. Among the self-reported symptoms in the initial evaluation, only the presence of paresthesia on hands was more frequent in the group with high PVL (p .04). The production of IFN-γ was higher in the group with high PVL group (median 1308 versus 686pg/ml, p<.011) when compared to the control group in the first assessment. During the follow-up there was a decreasing in the proviral load only among the cases. Moreover, there was no difference in the occurrence of urinary or erectile dysfunction, periodontal disease, sicca syndrome, neurologic signs between the two groups and non-patients developed HAM. Conclusion. HTLV-1 carries with high proviral load and with exaggerated inflammatory response may not progressed to HAM/TSP, indicating that other factors in addition to the proviral load are involved in the passage of HTLV-1 infected cells from the blood to the central nervous system.
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4
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PAULA MILENA MELO CASAIS
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Caracterização das lesões orais e da resposta imunológica local durante infecção aguda por Chikungunya Vírus.
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Leader : VIVIANE SAMPAIO BOAVENTURA DE OLIVEIRA
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MEMBRES DE LA BANQUE :
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CEUCI DE LIMA XAVIER NUNES
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CRISTINA RIBEIRO BARROS CARDOSO
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VIVIANE SAMPAIO BOAVENTURA DE OLIVEIRA
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Data: 13 févr. 2019
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Afficher le Résumé
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Background: Chikungunya is a disease caused by the alphavirus Chikungunya (CHIKV), transmitted by Aedes aegypti and Aedes albopictus. In addition to fever and arthritis, Chikungunya disease (CHIKD) can lead to the appearance of oral lesions. Objective: To characterize the oral lesion in acute CHIKV infection, related to the presence of virus and immune response in saliva. Methods: Cross-sectional study with 228 patients enrolled in the municipalities of Campo Formoso, Itabuna, Senhor do Bonfim and Maranguape (Ceará) between March 2016 and June 2017. Patients suspected of acute arbovirus infection underwent clinical evaluation by physician otorhinolaryngologist and odontologist, with a questionnaire containing signs and symptoms of the disease, including data on oral lesions. The diagnosis of CHIKV infection was confirmed by positive PCR in urine, blood and / or saliva samples or the presence of specific serum IgM. In addition, the expression of chemokines and cytokines IL-1β IL-6, TNFa, CCL2 e CXCL10 in saliva samples was determined by RT-qPCR. The distribution of the variables was tested using the Kolmogorov Smirnov test. The non-parametric tests, with respect to the outcome, were chi-square, Fisher's exact test and Mann Whitney's test Results: Of the 228 patients evaluated, 105 were diagnosed exclusively as CHIKD and had disease time of less than 10 days at the time of evaluation. Oral lesions were detected in 34% of the cases, being more frequent in women (OR = 3.2). In most patients the lesions were painful (72%) causing difficulty in feeding (59%). The main sites were tongue (44%), gums (44%) and lips (37.5%) but also found in the jugal mucosa (22%). Mucosal lesions presented as rounded ulcers with circumscribed margins and halo-erythematous (37.5%) or edematous-erythematous regions in the marginal gingiva (3%). Patients with CHIKD who presented with oral lesions showed more frequent systemic symptoms of rash, pruritus, myalgia, edema and retroocular pain (p <0.05). In an analysis of ordinal logistic regression, there was an association between the presence of oral lesion and skin rash (OR = 7.817 p <0.05). CHIKV was detected in the saliva of 13% of the evaluated individuals. There was a positive correlation between the presence of viral RNA and IL-1beta expression in saliva (p = 0.01), but there was no association between the presence of the oral lesion and detectable virus in the saliva. Conclusions: Oral lesions are frequent in the acute phase of CHIKD, especially in polysymptomatic patients and contribute to the morbidity of the disease. The appearance of the lesion is not related to the presence of the virus or the secretion of inflammatory mediators in the saliva, but the virus in the saliva seems to induce a pro-inflammatory response in the oral cavity.
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5
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JOAO MARCOS DA SILVA CARVALHO
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RADIOGRAPHIC ASPECTS IN INDIVIDUALS INFECTED BY TYPE 1 (HTLV-1) HUMAN T-CELL LYMPHOTROPIC VIRUS
WITH COMPLAIN OF JOINT PAIN
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Leader : EDGAR MARCELINO DE CARVALHO FILHO
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MEMBRES DE LA BANQUE :
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EDGAR MARCELINO DE CARVALHO FILHO
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MARIA OLIVIA AMADO RAMOS BACELLAR
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CESAR AUGUSTO DE ARAUJO NETO
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Data: 18 févr. 2019
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Afficher le Résumé
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Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1) was the first human retrovirus identified. It is estimated that the number of people infected by HTLV-1 is around 10 to 20 million worldwide. In addition to adult T-cell leukemia / lymphoma (ATLL) and HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/ TSP), several other diseases or clinical manifestations have been associated with HTLV-1 infection, such as overactive bladder, dry syndrome, polymyositis, periodontitis, arthropathy and erectile dysfunction. The occurrence of arthritis in patients infected with HTLV-1 has been reported, but to date, there is no definition about joint manifestations in patients with HTLV-1 associated arthropathy (HAAP), the radiographic aspects of joint involvement in these patients are unknown, and there are no diagnostic criteria for HAAP. Objective: To describe the radiographic aspects in individuals infected by HTLV-1 that present joint pain. Methods: This is a controlled cross-sectional study with the participation of HTLV-1 infected individuals that had joint chronic pain complaint in activity at last year, with age range from 18 to 75 years old, both genders and a control group composed of HTLV-1 seronegative individuals with hip, knee and/or ankle osteoarthritis. All subjects with HTLV-1 and controls were evaluated by a rheumatologist, all answered a questionnaire and made conventional X-rays from the hips, knees and ankle/feet. Results: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis diagnosis have taken part of the study. There was no difference between groups related to age and gender (p > 0.05). The prevailing standard of the joint involvement in the HTLV-1 positive group was polyarticular and symmetrical while in the control group it was oligoarticular and asymmetrical (p < 0.0001). While osteophytes and the joint space narrowing were predominant findings in patients with osteoarthritis (p < 0.0001), in HTLV-1 infected patients the frequency of enthesophytes was greater than in control group (p < 0.03). In reference to the presence of enthesophytes and the presence of joint space narrowing and/or osteophyte, enthesophyte without space reduction and without osteophyte was only observed in HTLV-1 infected individuals (p = 0.001). Conclusions: The HTLV-1 associated arthropathy is clinically characterized by a symmetrical polyarthralgia being the main radiological finding the occurrence of enthesophytes in the absence of osteophytes and joint space narrowing. The occurrence of signs of synovitis is very low in individuals infected with HTLV-1 with joint complaints, and arthralgia is a relevant joint manifestation in this population. There was no difference between the clinical forms of HTLV-1 infection and radiographic findings.
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6
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KEITH FROÉS ORRICO
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FREQUÊNCIA DE DISFUNÇÃO SEXUAL ENTRE MULHERES INFECTADAS PELO VÍRUS LINFOTRÓPICO DA CÉLULA T HUMANA TIPO 1
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Leader : EDGAR MARCELINO DE CARVALHO FILHO
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MEMBRES DE LA BANQUE :
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EDGAR MARCELINO DE CARVALHO FILHO
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EDUARDO MARTINS NETTO
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ROSANA CRISTINA PEREIRA DE ANDRADE
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Data: 18 févr. 2019
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Afficher le Résumé
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Introduction: Human T-lymphotropic virus type 1 (HTLV-1) is the main agent of myelopathy associated with HTLV-1 or tropical paraparespatic (MAH / PET). Clinical and neurological manifestations in patients infected with HTLV-1 without myelopathy are documented at a higher frequency in HTLV-1 carriers than in seronegative controls, but little is known about the ability of this virus to cause female sexual dysfunction. These manifestations can negatively affect the sexual life of these women. Objectives: To assess the frequency and main manifestations of sexual dysfunction (DS) in HTLV-1 infected women, correlating them with pro-viral load and neurological impairment. Methods: Cross-sectional study carried out at the HPLES Multidisciplinary Outpatient Clinic of HTLV. Data collected by the Female Sexual Function Index (FSFI) questionnaire and the form containing socio-demographic and clinical variables. A total of 140 women between 20 and 55 years of age and with sexual interest were included, matched by age, 70 in each group. Results: There was no difference between the groups regarding age, self-reported color, income, type of delivery, age of coitare and menopause. It was found that 73% of the cases presented DS in relation to 27% of the control (p <0.001) and that the HTLV-1 group had 6.65 more chances to present DS. Women with HTLV-1 infection had less desire (p <0.001), arousal (p <0.001), lubrication (p <0.001), sexual satisfaction (p <0.001), orgasm (p <0.001) than the control. Sexual satisfaction was significantly lower in HTLV-1 carriers, and the correlation between neurological impairment and DS (R = 0.33, p <0.01) and between pro-viral load and DS (R = 0.38, p <0.001) was weak and moderate, respectively. Conclusion: DS is more common in women infected with HTLV-1 than in controls, and in addition to neurological involvement, other factors may play a role in DS associated with HTLV-1 infection.
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7
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ANDREZA SANTOS DÓREA
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AVALIAÇÃO DO PAPEL DOS DIFERENTES ISOLADOS DE Leishmania braziliensis E DOS MONÓCITOS NA PATOGÊNESE DA LEISHMANIOSE DISSEMINADA
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Leader : MARIA OLIVIA AMADO RAMOS BACELLAR
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MEMBRES DE LA BANQUE :
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CAMILA INDIANI DE OLIVEIRA
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MARIA OLIVIA AMADO RAMOS BACELLAR
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NATALIA BARBOSA CARVALHO
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Data: 20 févr. 2019
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Afficher le Résumé
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Introduction: Disseminated Leishmaniasis (DL) caused by Leishmania braziliensis is characterized by the presence of 10 or more papular, acneiform and ulcerated lesions. Some studies have shown that evidence of polymorphism of leishmania parasites and L.braziliensis isolated from patients with DL, cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML) are polymorphic,presenting a genetic diversity that is associated with clinical forms of ATL. The soluble antigen obtained from L.braziliensis isolates from DL patients induced a greater inflammatory response when compared to antigen obtained from isolates of patients with CL in cells of patients with CL and DL. Studies have shown that monocytes / macrophages from patients with CL and ML behave differently against infection with L.braziliensis when compared to cells from healthy controls (HS). There are no studies about the behavior of monocytes in DL. Objective: To evaluate the role of monocytes and isolates of Leishmania braziliensis genotypically different in the inflammatory response in DL. Methods: Monocytes from patients with DL (n=12) and from patients with CL (n=12) were infected with L. braziliensis isolates from patients with DL and isolated from patients with CL at a ratio of 5:1. The evaluation of the degree of infection and the parasite load was evaluated after cytospin preparations by optical microscopy. To analyze the survival of different L. braziliensis isolates in monocytes from DL and CL patients, the number of viable promastigotes was quantified on the culture supernatant by optical microscopy. The evaluation of oxidative radical production was performed by oxidation of Dihydrorhodamine 123 (DHR-123) and analyzed by flow cytometry. Expression of TLRs and cytokines / chemokines was assessed by flow cytometry. Results: The monocyte frequency of DL patients infected with DL isolate and parasite load was higher than that observed in monocytes infected with the CL isolate after 48 hours of infection. The same was observed in the cells of patients with CL. The number of viable promastigotes in the monocyte supernatant infected with the DL isolate was higher when compared to the CL isolate in both groups. The same was observed in CL monocytes. Oxidative burst production by DL monocytes and CL monocytes infected with DL isolate was higher when compared to CL isolates in DL monocytes and CL monocytes. TLR2 expression was higher in DL monocytes after infection with DL isolate when compared to CL isolate. The production of CXCL9 was higher after infection with the DL isolate when compared to the CL isolate. Conclusions: These results suggest that the genotypic differences of L.braziliensis causing DL and CL can influence the behavior of this parasite in human monocytes and contribute to the pathogenesis of the disease.
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8
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Jamile Souza do Lago
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CANINE INFECTION BY Leishmania braziliensis IN THE ENDEMATIC AREA OF PEDRA-BAHIA CUTTING
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Leader : MARIA OLIVIA AMADO RAMOS BACELLAR
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MEMBRES DE LA BANQUE :
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MARIA OLIVIA AMADO RAMOS BACELLAR
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DEBORAH BITTENCOURT MOTHE
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RICARDO RICCIO OLIVEIRA
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Data: 25 févr. 2019
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Afficher le Résumé
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Background: Cutaneous leishmaniasis (CL), caused by Leishmania braziliensis, is the most important presentation of tegumentary leishmaniasis (TL) in Latin American. While the role of dogs as reservoirs of Leishmania infantum, and the clinic features of canine visceral leishmanisis are well described, little is known about the importance of dogs in the transmission of L. braziliensis to humans. In the present study, we determine the frequency of L. braziliensis infection in dogs with cutaneous and mucosal ulcers in an endemic area of CL. We also describe the clinical manifestations and histopathologic features, and determine if the parasites isolated from dogs are genetically similar to those found in humans. Methods: This is a cross sectional study in which 61 dogs living in an endemic area of CL and presenting ulcerated lesions were evaluated. Detection of L. braziliensis DNA by polymerase chain reaction (PCR) in skin biopsies, serology and leishmania skin test (DTH) with soluble L. braziliensis antigen were performed. The clinical and histopathologic features were described, and we compared the genotypic characteristics of isolates obtained from dogs and humans. Results: The ulcers were well limited and with raised borders as observed in humans. The sensitivity of all the three tests together to detect exposure was 89% and the concordance between the tests was high. The skin lesions were most frequent in the ears, followed by testicles. The PCR was positive in 41 (67%) of animals, and the lesions in the snout, followed by the testicles and ears were the sites where parasite DNA was most detected. The histopathologic findings were a moderate inflammatory reaction with lymphocytes and macrophages. There were genotype similarities between isolates from dogs and humans. Conclusions: The high frequency of L. braziliensis infection in dogs with ulcers and the similarities between the isolates of L. braziliensis and cutaneous leishmaniasis in dogs and humans in an endemic area of TL, raise the possibility of an important role of dogs in the transmission chain of L. braziliensis.
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MAURÍCIO TEIXEIRA NASCIMENTO
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CONTRIBUTION OF EPA AND DHA POLINSATURATED FATTY ACIDS IN REGULATING THE INFLAMMATORY RESPONSE OF PATIENTS WITH SKULL LEISHMANIOSIS CAUSED BY L. braziliensis
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Leader : LUCAS PEDREIRA DE CARVALHO
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MEMBRES DE LA BANQUE :
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ADRIANO QUEIROZ SILVA
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LUCAS PEDREIRA DE CARVALHO
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VALÉRIA DE MATOS BORGES
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Data: 25 févr. 2019
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Afficher le Résumé
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Background: American Cutaneous Leishmaniasis is an infectious disease caused by several protozoan species of the genus Leishmania. Leishmania (Viannia) braziliensis is the species that causes a broad spectrum of different clinical manifestations, the most common being cutaneous leishmaniasis (CL). Analyzes of lesions fragments of patients with CL present an intense inflammatory process with high frequency of lymphocytes and macrophages, with few parasites being observed. Inflammatory cytokines are important for the increase in leishmanicidal activity of mononuclear phagocytes, but high TNF and IL-1β production contribute to tissue damage and ulcer emergence. Recently, increased attention has been given to the polyunsaturated fatty acids of the omega-3 family, EPA and DHA, due to their anti-inflammatory properties. However, the role of these fatty acids in leishmaniasis, especially in cutaneous form caused by L. braziliensis has not been investigated. Objective: To evaluate the immunoregulatory effects of EPA and DHA polyunsaturated fatty acids on the inflammatory response of patients with CL caused by L. braziliensis Methods: Lesions fragments were obtained from patients with CL and skin from healthy individuals for analysis of genetic expression by the RNAseq technique. Serum were obtained from patients with CL and healthy individuals for measurement of total omega 3, cytokines TNF, IL6, IL1β and eicosanoids PGE2 and LTB4 by the ELISA technique. Peripheral blood mononuclear cells were obtained from patients with LC and cultured for 72 hours in the presence or absence of SLA, LPS, Pam3Cys, EPA, DHA or EPA + DHA. In addition, monocytes from CL patients were cultured for 7 days for differentiation into macrophages and infected with L. braziliensis (5: 1), after infection the cells were cultured in the presence or absence of EPA, DHA or EPA + DHA for 2, 48 and 72 hours. Supernatants from the PBMC and macrophages cultures were used to quantify the cytokines TNF, IL-6, IL-1β and eicosanoids PGE2 and LTB4 by the ELISA technique. Results: An increase in the expression of the genes NF-κβ, IL-6, TNF, IL-1β, COX2, ALOX5 and PGE2 and LTB4 receptors was observed. Regarding the genes involved in the regulation of inflammation PPARG, RXRA, ALOX12 and ALOX15 were repressed in the lesion of patients with CL when compared to IS skin. We found that patients with CL exhibit high circulating levels of TNF, IL-6, IL-1β, PGE2 and LTB4 compared to IS. The addition of EPA and DHA to SLA stimulated PBMC cultures modulated the production of IL-6 and IL-1β and the association of these PUFAs was potentiated in the regulation of TNF, IL-6 and IL-1β cytokine production. We also observed that DHA and EPA + DHA induced the production of LTB4 in SLA-stimulated PBMC. We have also found that PPAR-γ is directly involved in the synthesis of PGE2 and LTB4 and the effects of EPA and DHA on cytokine modulation are nuclear receptor dependent. In addition DHA boosted the production of LTB4 in the absence of PPAR-γ; finally, we found that exogenous EPA and DHA contribute to the destruction of Leishmania by macrophages, through the production of LTB4. Conclusion: Our results suggest that in vitro supplementation with EPA and DHA have beneficial effects in the resolution of LC inflammation and infection, opening new perspectives for the adjuvant treatment of this disease.
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10
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EUGENIA MARIA TEIXEIRA DE ARAUJO CAMPOS
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CLINICAL AND RADIOLOGICAL CHARACTERIZATION OF HTLV-1 ASSOCIATED ARTHROPATHY
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Leader : EDGAR MARCELINO DE CARVALHO FILHO
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MEMBRES DE LA BANQUE :
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ARGEMIRO D OLIVEIRA JUNIOR
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EDGAR MARCELINO DE CARVALHO FILHO
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SILVANE MARIA BRAGA SANTOS
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Data: 25 févr. 2019
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Afficher le Résumé
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Introduction: In the past, systemic rheumatic diseases were identified as being more frequent among HTLV-1-infected individuals; however, recent studies have not confirmed this association. Nevertheless, articular pain and, specifically, polyarthralgia are more frequent in HTLV-1-infected individuals than in seronegative controls. Objective: To clinically characterize HTLV-associated arthropathy and relate articular manifestations to immune response and proviral load. Methods: Ninety-eight HTLV-1-infected individuals participated in the study with history of articular pain over a period of at least two weeks, over one year, without HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), rheumatoid arthritis, HIV virus infection, hepatitis B and C virus, and spondyloarthropathy, and 30 individuals with seronegative osteoarthritis for HTLV-1. Patients completed a specific questionnaire and a full physical exam was undertaken. The frequency of compromised articulations was determined, as well as the occurrence of crepitation, synovitis and compromised articular mobility. Radiographs were taken of the articulations of the pelvis, knees and tibio-tarsal articulations, and complementary evaluation to determine inflammatory evidence, antinuclear antibodies (ANA) and rheumatoid factor. Proinflammatory cytokines TNF, IL-17 and IL-23 in the non-stimulated supernatant of mononuclear cells after 48 hours in an incubator at 37°C, 5% CO2 were dosed, and viral load was determined. Results: The presence of articular crepitation was greater in patients with seronegative osteoarthritis for HTLV-1 than in HTLV-1 patients. Both inflammatory evidence and ANA had low positivity frequency. While in osteoarthritis patients’ pain was more frequent in the knees, in patients with HTLV-associated arthropathy, pain occurs with more frequency in tibio-tarsal articulations, and the major radiologic find is the presence of low reduction of the articular space. Conclusion: Articular pain and enthesopathy are the main characteristics of arthropathy associated with HTLV-1.
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11
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HULIANA MOURÃO CARVALHO
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Relationship between systemic inflammatory response and pro-viral load with HTLV-1 associated to periodontal disease
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Leader : EDGAR MARCELINO DE CARVALHO FILHO
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MEMBRES DE LA BANQUE :
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EDGAR MARCELINO DE CARVALHO FILHO
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SILVANE MARIA BRAGA SANTOS
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ADNA CONCEICAO BARROS
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Data: 25 févr. 2019
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Afficher le Résumé
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Introduction: HTLV-1 is associated with the occurrence of periodontitis. The reason why individuals infected by HTLV-1 develop periodontal disease is not known. Objectives: To evaluate the association between proviral load and inflammatory cytokines and periodontal disease in HTLV-1 infection. Methods: Cross-sectional study realized in the HTLV-1 Multidisciplinary Ambulatory of Professor Edgard Santos University Hospital Complex Immunology Service (Com-HUPES). The patients periodontium was evaluated by probing and we used the cytokine dosage and the latest proviral load registered in the database available in the Immunology Service Multidisciplinary Ambulatory (COM-HUPES. Results: Eighty HTLV-1 infected subjects were included in this study and 40 patients presented periodontal disease and 40 subjects without periodontal disease. The median proviral load and interquartile range in subjects without and with periodontal disease were 14915.0 (IQ 1333.750- 47195.900) and 18863.5 (IQ 1348.750-68631.250), respectively, p>0.5. The production of TNF in controls without periodontal disease was 17.0 pg and in patients with periodontal disease was 43.0 pg with p>0.5. The production of IFN was 362.5 pg and 885.0 pg respectively p>0.5. There hasn’t also been difference related to the production of IL-10 and the occurrence of periodontal disease, p>0.5. It hasn’t been observed difference between proviral load, IFN, TNF and IL-10 in relation to the periodontal disease gravity.Conclusion: The lack of relationship between inflammatory response or proviral load with periodontal disease associated with HTLV-1 indicates that other factors in addition to pro-viral load and immune response are involved in the migration of HTLV-1 to the periodontium.
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12
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JOSEANE SANTOS SEIXAS ROSA BOUZON
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OROMIOFUCIONAL DISORDER IN CHILD WITH MICROCEPHALIA ASSOCIATED WITH ZIKA VIRUS INFECTION
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Leader : JAMARY OLIVEIRA FILHO
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MEMBRES DE LA BANQUE :
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JAMARY OLIVEIRA FILHO
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FEDERICO COSTA
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DANIEL DOMINGUEZ FERRAZ
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Data: 15 mars 2019
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Afficher le Résumé
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Introduction: Children with congenital Zikavirus syndrome (CZS) may have a high risk of orofacial myofunctional disorders (OMD), especially after the fourth month of life, when they are transitioning from reflex to voluntary swallowing. However, the clinical complications of OMD have not been studied. Objective: To evaluate the prevalence of OMD in children with CZS and determine the predictors of enteral nutrition or respiratory tract infection (RTI). Methods: Hospital-based cohort of babies born during the Zikavirus outbreak. We identified CZS by head circumference at birth (less than 2 standard deviations below Intergrowth standard), excluding other TORCH infections by serological assays. Two independent speech therapists evaluated anatomical structures for OMD both before and during nutrition. Cox regression was performed searching for predictors of the combined outcome of RTI or enteral nutrition on follow-up. Results: We evaluated 71 children, mean age 21.1 (+/-6.5) months. We detected OMD in the following anatomical structures: tongue in 54 (76%), buccinators in 52 (73%), lips in 38 (53%). Dysphagia was detected in 52 (42%) children: 39 (36%) for liquid consistency, 8 (11.3) for pasty consistency, 2 (0.8%) for solid and 3 (4.22%) global (both consistencies). After a mean 16.5 (+/-7.4) months of follow-up, 8 (11.3%) required enteral nutrition, 23 (32.5%) required antibiotics for RTI and 20 (28.6%) were admitted due to RTI. Combined outcome occurred in 24 (33.8%) children. In multivariable analysis, predictors of the combined outcome were: head circumference percentile at birth (OR=0.82 per Z-score increase; 95% CI=0.70-0.97, p=0.016) and type of dysphagia (global vs absent OR=5.18; 95% CI=1.01-26.62, p=0.049). Conclusions: Children with CZS frequently present with OMD. Those with more severe microcephaly or with early dysphagia for more than one type of consistency are at high risk for RTI or enteral nutrition.
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MARIA LÚCIA DA COSTA E SILVA LAGE
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Achados clínicos, neurofisiológicos e de neuroimagem em crianças com microcefalia associada a infecção congênita pelo vírus Zika
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Leader : CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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MEMBRES DE LA BANQUE :
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CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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GUILHERME DE SOUSA RIBEIRO
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NAYARA SILVA ARGOLLO
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Data: 8 avr. 2019
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The Zika virus infection (ZIKV) appered at the Basil in 2015, causing an unprecedented epidemic outbreak with severe brain disorders in fetuses. Objective: to describe the clinical, neuroimaging and neurophysiological findings of children with microcephaly associated with congenital ZIKV infection (CZS) Study design: retrospective, descriptive, cross-sectional study. Methods: review of electronic records of children diagnosed with microcephaly at birth, and probable CZS, admitted to a child rehabilitation center in the city of Salvador, Brazil. The chil-dren were evaluated following standardized procedures and were submitted to neuroimaging and neurophysiological studies during follow-up with an interdisciplinary team. Results: In the 102 children in this study the most mothers (81%) reported symptoms of ZIKV during the first trimester of pregnancy. Microcephaly was severe in 54.9% of the cases. Cerebral atrophy (92.1%), ventriculomegaly (92.1%), malformation of cortical development (85.1%) and cor-tico-subcortical calcifications (80.2%) were observed in all children. Abnormalities in neuro-logical examinations were found in 97.0% of the cases, and neurophysiological findings evi-denced epileptogenic activity in 56.3% of auditory deficit in 17.3% and visual impairment in 14.1% related to this infection during pregnancy. Arthrogryposis was found in 10.8% of chil-dren. Conclusion: This group of children presented clinical and radiological criteria for CZS. High frequency of brain abnormalities and signs of early neurological disorders were found, epileptogenic activity and signs of sensorineural changes were common. This suggests that mi-crocephaly may be associated with a worse spectrum of neurological manifestations related to this infection during pregnancy.
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DÉBORA DAIANA OLIVEIRA SOUTO
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RADIOLOGICAL ASPECTS AND AETIOLOGY OF COMMUNITY-ACQUIRED PNEUMONIA: A PROSPECTIVE STUDY.
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Leader : CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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MEMBRES DE LA BANQUE :
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CEUCI DE LIMA XAVIER NUNES
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CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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REGINA TERSE TRINDADE RAMOS
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Data: 12 avr. 2019
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Background: community-acquired pneumonia (CAP) remains one of the main causes of death and a common cause of hospital admission in children under-5 years worldwide. Objective: to assess radiological findings among children with CAP with bacterial or exclusively viral infection. Methods: prospective cross-sectional study, conducted at the Paediatric Emergency Department of the Federal University of Bahia Hospital, in Salvador, Brazil. Children under-5 years hospitalized with radiologically-confirmed CAP were evaluated. Collection of nasopharyngeal aspirate, acute blood culture, buffy-coat and paired serum samples (2-4 weeks apart) to investigate aetiology (11 viruses, 8 bacteria). Chest radiograph (CXR) was obtained upon admission, when clinical data were collected. CXR was read by an independent paediatric radiologist blinded to clinical and aetiological information. Results: of 165 patients, 158 (95.8%) and 18 (10.9%) had pulmonary infiltrate and pleural effusion, respectively. Pulmonary infiltrate was classified as alveolar (n=152) or only interstitial (n=6). Patients with only interstitial infiltrate did not have pleural effusion. Hyperinflation (7.9%), atelectasis (7.3%), enlarged lymph nodes (3.6%), abscess (0.6%), and pneumatocele (0.6%) were described. Overall, median (IQR) age and length of disease were 18 (9-28) months and 7 (4-12.5) days, respectively and bacterial (n=86; 52.1%) and exclusively viral (n=79; 47.9%) infections were diagnosed. Among 152 patients with alveolar infiltrate, 53.3% and 46.7% had bacterial or exclusively viral infection, respectively. Among 6 patients with only interstitial infiltrate, 33.3% and 66.7% had bacterial or exclusively viral infection, respectively. No significant difference was found when the frequency each radiological finding was compared between children with bacterial or exclusively viral infection. Conclusion: no radiological finding is associated with bacterial or viral infection.
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PALOMA LIMA DE ARAÚJO VENTURA
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MOTOR DEVELOPMENT OF CHILDREN WITH CEREBRAL PALSY AND MICROCEFALIA DUE TO PROBABLE CONGENITAL ZIKA VIRUS INFECTION
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Leader : CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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MEMBRES DE LA BANQUE :
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CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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RITA DE CASSIA SALDANHA DE LUCENA
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SUMAIA MIDLEJ PIMENTEL SÁ
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Data: 17 mai 2019
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Afficher le Résumé
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BACKGROUND: Current research indicates that the Zika virus (ZIKV) congenital infection can lead to cerebral palsy (CP). OBJECTIVE: To assess the gross motor development of children at risk for ZIKV infection during gestation, over the first 2 years of their lives. METHODS: Seventy-seven children were assessed at the median ages of 11, 18 and 24 months, using the evaluative instrument Gross Motor Function Measure (GMFM- 66). At the third assessment, the children with diagnoses of CP were classified by severity through the Gross Motor Function Classification System (GMFCS) and the motor development potential was estimated based on GMFM-66 scores. RESULTS: At 2 years of age, all children had the diagnosis of CP. Seventy-four (96.1%) presented gross motor skills similar to those of children aged 4 months or less according to the World Health Organization’s standard. They were classified in GMFCS level V according to the median GMFM-66 score. The majority of children was quadriplegic and GMFM-66 showed significant change scores between 11 and 18 months (P=0.001) and between 11 and 24 months (P<0.001). No significant difference (P=0.076) was found between 18 and 24 months. CONCLUSIONS: Despite showing some gross motor development during the initial 18 months of life, children at risk of ZIKV infection during gestation and with diagnosis of CP experienced severe motor skill impairment and presented low GMFM-66 scores at 2 years of age. We observed a tendency of children with lower motor development potential to reach their limit more quickly than children with higher potential.
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RUTH KELLY OLIVEIRA DOS SANTOS
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FREQUENCY AND SEASONALITY OF RESPIRATORY VIRUSES AMONG CHILDREN ATTENDED IN A READY UNIT IN RAILWAY SUBVERSION OF SALVADOR-BA
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Leader : CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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MEMBRES DE LA BANQUE :
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CRISTIANA MARIA COSTA NASCIMENTO DE CARVALHO
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HELI VIEIRA BRANDAO
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SELMA ALVES VALENTE DO AMARAL LOPES
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Data: 31 mai 2019
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Afficher le Résumé
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BACKGROUND: Acute respiratory infections (ARI) impose a considerable burden among children worldwide. Respiratory viruses are recognized to be the most frequent causative agents of ARI. However, the frequency of distinct viruses in tropical regions is scarcely reported. OBJECTIVES: to estimate the frequency of distinct respiratory viruses among children with ARI in a tropical city and to assess their seasonality. Methods: This retrospective cross-sectional study was conducted in Salvador, Brazil, between July 2014 and June 2017(age ≤ 18 years). Respiratory viruses were searched by direct immunofluorescence and real-time polymerase chain reaction for the detection of common respiratory viruses, including respiratory syncytial viruses (RSV), influenza viruses (Flu) A and B, Adenovirus (ADV) and parainfluenza viruses (PIV) 1, 2 and 3. Data were registered in a standardized questionnaire, then entered and analyzed in the software SPSS and STATA. Seasonal distribution of infection by respiratory viruses was evaluated by Prais-Wisten regression. RESULTS: Of 387 cases, the median age was 26.4 (10.5-50.1) months and 229 (59.2%) were male. Respiratory viruses were found in 106 (27.4%) cases. RSV was the most common one (19.6%), followed by Flu A (2.8%), Flu B (1.8%), ADV (1.3%), PIV 1 (1.3%), PIV 3 (0.8%), and PIV 2 (0.3%). Two samples had co-detections found: RSV and Flu A, Flu A and PIV 1. Overall, 92 (23.8%), 105 (27.1%), 75(19.4%) and 115 (29.7%) cases with RTI occurred and 24 (26.1%), 45 (42.9%), 14 (18.7%) and 23 (20.0%) respiratory viruses were detected in summer, fall, winter and spring, respectively (p<0.001). Frequency of RSV (b3=0.626; p=0.003), PIV 3 (b3= -0.148; p=0.002), Flu A (b2= -0.224; p= 0.030), Flu B (b3= -0.163; p=0.031), and ADV (b3= -0.175; p= 0.005) had different seasonal patterns. CONCLUSIONS: RSV was the most frequently detected virus and RSV, Flu A, Flu B, ADV and PIV 3 showed seasonal distribution.
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LILIAN SILVA MEDINA
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EVALUATION OF THE PROTEASE GP63 POLYMORPHISM IN A POPULATION OF Leishmania Viannia braziliensis causing AMERICAN TEGUMENTARY LEISHMANIASIS
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Leader : NICOLAUS ALBERT BORGES SCHRIEFER
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MEMBRES DE LA BANQUE :
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ADRIANO FIGUEIREDO MONTE ALEGRE
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BARBARA DE CASTRO PIMENTEL FIGUEIREDO
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DANIELA LUZ AMBROSIO BREISCH
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LUCAS PEDREIRA DE CARVALHO
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NICOLAUS ALBERT BORGES SCHRIEFER
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Data: 26 févr. 2019
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Afficher le Résumé
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Introduction: Leishmania (Viannia) braziliensis is the main cause of American Cutaneous Leishmaniasis (ACL) in Brazil. Corte de Pedra (CP) in Bahia L. (V.) braziliensis causes the three clinical forms of leishmaniasis: cutaneous leishmaniasis (LC), mucosal leishmaniasis (LM) and disseminated leishmaniasis (LD). Leishmanolysin, or GP63, is an important leishmania surface protease capable of hydrolyzing a wide variety of substrates both in the parasite and in the host. Its products are involved in the adhesion and internalization of these parasites in the host macrophages and have been related to the resistance of the parasite to the lysis by the complement system and the increase of the virulence of L. (V.) braziliensis. Goal. To evaluate the effects of conserved GP63 segments on the interaction of Leishmania (V.) braziliensis with host macrophages and their immunogenicity. Methods: Forty-five alleles of gp63 were identified in the endemic area for LTA of Corte de Pedra, Bahia. The conserved SRYD, PAVGNIPA, HEVAH and KAREQYGC segments of the GP63 molecule have been found to interact with the host cell. Based on the sequence of these segments, four peptides were synthesized. Macrophages from healthy donors were used in the in vitro evaluation of the ability of these peptides to stimulate the host cell and to inhibit the internalization of L. (V.) braziliensis by these cells. Macrophages were incubated with medium, peptides, Leishmania and Leishmania + peptides in parallel for 4 hours at a ratio of 2: 1 (Leishmania: macrophages). The percentage and number of amastigotes per cell was evaluated by microscopy. An enzyme-linked immunosorbent assay (ELISA) was performed to investigate antibodies in LTA patients for the conserved segments and inhibition assays for analysis of gene expression by RNAseq. Results: Stimulations with synthetic peptides with human macrophages showed that the segments inhibited the internalization of Leishmania in host cells with a p˂0.0001. The ELISA assays showed presence of antibodies against the conserved segments in all clinical forms. And the more severe forms were more associated with antibodies against the segments. Conclusion: Preserved segments of GP63 are naturally immunogenic in populations infected with L. (V.) braziliensis and synthetic peptides (PAVGNIPA, SRYD, HEMAH, and KAREQYGC) of GP63 protein; inhibit the internalization of L. (V.) braziliensis in MDM.
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TECIA MARIA SANTOS CARNEIRO E CORDEIRO
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HEPATITES VIRAIS POR ACIDENTES DE TRABALHO NO BRASIL, 2007-2014
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Leader : ARGEMIRO D OLIVEIRA JUNIOR
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MEMBRES DE LA BANQUE :
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ARGEMIRO D OLIVEIRA JUNIOR
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CARLITO LOPES NASCIMENTO SOBRINHO
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JORGANA FERNANDA DE SOUZA SOARES
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SIDELCINA RUGIERI PACHECO
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TANIA MARIA DE ARAUJO
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Data: 26 févr. 2019
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Introduction: Viral hepatitis are transmissible diseases with an endemic epidemiological profile in Brazil. They are transmitted during work activities through work accidents. Viral hepatitis and occupational accidents are among the diseases and aggravations of compulsive compulsion, and viral hepatitis due to occupational accidents must be exterminated after an epidemiological diagnosis. Objective: To analyze the epidemiological aspects of viral hepatitis due to occupational accidents in Brazil, 2007-2014. Methodology: This is an epidemiological study that allows analyzing the types of crosssectional, ecological data and data quality evaluation. Statistical analyzes were performed. The professor was approved by the Research Ethics Committee. Results: Quality of life classification is classified as complete (>25.1% of incomplete data) and is considered a measure of difficulty of choice (>15%). The associated factors such as viral hepatitis due to work accidents were: female sex, age over 35 years, contact with the patient with the virus and exposure to accidents with biological materials (P<0.05). In relation to the time trend of the selections, it was increasing in the Center-West (P= 0.02) and decreasing in the states of Sergipe (P= 0.03) and Tocantins (P= 0.04). The great majority of the cases were carried out in the Southeast and South regions and very high in the state of São Paulo. This is more difficult when compared to the periods 2007-2010 and 2011-2014. The data solution was important for viruses. Regarding the degree of hepatitis A, it was 62.5% for hepatitis B and 8.7% for hepatitis A, and anti-HBs were not found by 31.0% of those vaccinated against hepatitis B. Final considerations: Observe the ability to perform health professionals / prolong the lives of patients without filling out the notification forms, as well as action actions in the workplace for the prevention of viral hepatitis, in addition to the requirement of the vaccine card as a passport for the job.
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3
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GILMARA DE SOUZA SAMPAIO
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Dispersion, prevalence and dynamics of Zika virus transmission from 1947 to 2018
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Leader : EDUARDO MARTINS NETTO
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MEMBRES DE LA BANQUE :
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ANA CRISTINA RODRIGUES SALDANHA
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CARLOS ROBERTO BRITES ALVES
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CÉLIA REGINA MAYORAL PEDROSO JORGE
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EDUARDO MARTINS NETTO
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JUAREZ PEREIRA DIAS
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Data: 21 mars 2019
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Introduction: The Zika virus is a flavivirus belonging to the family Flaviviridae, transmitted by Aedes mosquitoes. Its circulation was restricted to the African and Asian continents for six decades, where it caused small outbreaks with mild clinical presentations, similar to dengue. After migrating to the Pacific and the Americas, Zika virus infection became remarkable and caused major epidemics with burgeoning clinical manifestations, which required a better understanding of the changes that occurred over time. Objective: To describe the dynamics of the Zika virus from 1947 to 2018 and to analyze its prevalence in the metropolitan region of Salvador/Bahia during and up to two years after the epidemic phase. Methods: This thesis is divided into three chapters, the first presents a literature review focusing on the evidence of transmission and dispersion of the Zika virus from 1947 to 2018; the second chapter is an analysis of prevalence among various populations in the metropolitan region of Salvador/Bahia/Brazil and a retrospective analysis of cryopreserved sera from an HIV-infected population within this region. The third chapter presents the results of a new serology for the Zika virus from three subpopulations, seen in the previous chapter, carried out 1,5 to 2 years after the epidemic. Results: Since its first identification in 1947 in the Zika forest region, in Uganda, the virus has migrated to the Asian continent where it has caused mild clinical manifestations similar to dengue. Sixty years later, it reached the Pacific islands, the
Zika virus became more aggressive and rapidly spread among local populations, which reached high prevalence rates, such as Mali (52%) and Yap Islands (73%). In addition, it was noted that the Zika virus caused devastating clinical consequences, probably due to genetic mutations occurred between 2000 and 2005. Later, in 2013, Zika reached the Americas, including the metropolitan region of Salvador, where a prevalence of 63% was recorded in the examined population. Although there were no major risk factors for the infection of the disease, a higher prevalence was observed among people from lower socioeconomic strata. Two years after the epidemic peak, the same individuals were reassessed. A significant decrease in antibody levels was observed, with up to one third of these individuals presenting negative serology, without seroconversion. Conclusion: The expansion of the Zika virus had two phases. The first presented slow expansion, without clinical severity, and the second had rapid expansion, with serious clinical consequences, such as microcephaly, probably as a result of virus mutations. After the peak of the epidemic, some regions, including the metropolitan region of Salvador, reached a high prevalence in the population and had the transmission cycle blocked. The levels of antibodies recorded in this area declined significantly after two years and the consequences of this reduction are still unknown.
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ALEXSSANDRA MAIA ALVES
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STUDY OF SEVERE ASTHMA IN SALVADOR: COMPARISON OF INTERNATIONAL CLASSIFICATIONS OF SEVERITY AND CONTROL AND ASSOCIATED FACTORS.
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Leader : ALVARO AUGUSTO SOUZA DA CRUZ FILHO
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MEMBRES DE LA BANQUE :
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ADELMIR DE SOUZA MACHADO
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ALVARO AUGUSTO SOUZA DA CRUZ FILHO
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FRANCISCO SOARES NASCIMENTO SAMPAIO
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LUANE MARQUES MELLO
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MARCELO CHALHOUB COELHO LIMA
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Data: 26 août 2019
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Afficher le Résumé
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Background: Asthma severity and control criteria are not standardized and have been modified over time, which can compromise patient management and a comparison of study results. There is also great variability in clinical presentation and biomarkers associated with asthma severity. Objective: To compare severity and control classifications of asthma and to identify factors associated with severity, applied to a severe asthma outpatient clinic patient sample. Methods: A cross-sectional study of 473 patients followed up for ≥ 6 months, reclassified by means of severity criteria of the World Health Organization (WHO) 2010, American Thoracic Society (ATS) 2000 and European Respiratory Society. (ERS) / ATS 2014. The control definitions of the Global Asthma Initiative (GINA) ratings for 2012 and 2014 were also compared. Results: According to the 2010 WHO definition, 90% had severe asthma that was difficult to treat and only 2.5% had severe treatment-resistant asthma. 24% patients had asthma refractory by ATS 2000 and 18% had severe asthma by ERS / ATS 2014. According to the 2014 GINA control classification, 44% of the 473 individuals were classified as having controlled asthma while only 10% patients had asthma controlled by GINA criteria 2012. The Kappa statistic indicated the highest concordance of the severity classification between the ATS 2000 and ERS / ATS 2014 criteria (0.64). Patients with GERD were 2.28 times more chances to have severe asthma and those with eosinophil counts> 260 cells / mm3 were 42% less chances. Conclusion: A good concordance was found between the classifications of refractory asthma ATS 2000 and severe asthma ERS / ATS 2014. Among the other classifications, agreement was poor. The severity was associates with GERD symptoms and inverse relationship with eosinophil counts >260 cells/mm3.
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FAMIELY COLMAN MACHADO DE MACHADO
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Phonotherapeutic Intervention in Patients with Leishmaniosis Mucosal and Cutaneous sequelae.
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Leader : MARCUS MIRANDA LESSA
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MEMBRES DE LA BANQUE :
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CAROLINA CINCURA BARRETO
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DAVID GRECO VARELA
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FERNANDO PENA GASPAR SOBRINHO
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MARCUS MIRANDA LESSA
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RENATA OLIVEIRA DE BARCELOS
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Data: 26 août 2019
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Afficher le Résumé
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INTRODUCTION: Leishmaniasis is a stigmatizing disease, considered a serious public health problem. It presents three classic clinical forms, among them Cutaneous and Mucosa forms. The former affects upper and lower limbs, with ulcerated lesions, which may be multiple or unique. Second, it reaches the upper respiratory tract, with destructive lesions, which can affect the voice, swallowing and breathing of the patients. OBJECTIVES: To characterize the voice and verify the vocal response to speech therapy intervention. METHODS: The vocal emission / a: of 22 participants from each group (total of 44 cases) was collected for the computerized analysis of the voice through the Kay PENTAX® Real Time Spectrogram and the Multi Dimensional Voice Program Advanced and for perceptualaudit analysis through of the RASATI scale. RESULTS: Before the speech therapy, participants with Mucosa Leishmaniasis had a statistically significant result, where 5 (27.7%) participants presented asthenic vocal quality, and altered parameters of frequency measurements, frequency disturbance, noise and sub-harmonic measurements. Of the participants with Cutaneous Leishmaniasis, 8 (36.4%) presented grade 1 vocal instability. After the speech therapy, patients with Cutaneous Leishmaniasis showed a reduction in the degree of roughness and an improvement in acoustic parameters of frequency disturbance. The group with sequelae of Leishmaniasis Mucosa presented reduction of the measurements of sub-harmonic segments. Only the sequelae group of Cutaneous Leishmaniasis had statistically significant results regarding spectrography, with improvement of the following parameters: color intensity of the trace, presence of noise, substitution of harmonics for noise, definition and regularity of harmonics, regularity of low frequencies and the whole spectrogram and for anti-resonance. There was no statistically significant difference in the Voice Behavior Profile. CONCLUSION: Both groups presented vocal alterations in different degrees before vocal therapy, and patients with Mucosal Leishmaniasis presented more severe degrees. After speech therapy intervention, participants with Cutaneous Leishmaniasis sequela had more vocal benefits after performing the technique, possibly because they did not present lesions in the vocal tract.
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KAREN VALADARES TRIPPO
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COMPARISON OF THE EFFECTS OF EXERGAMING, FUNCTIONAL TRAINING AND STATIONARY BICYCLE ON THE MULTIDIMENSIONAL ASPECT OF PARKINSON’S DISEASE: A RANDOMIZED CLINICAL TRIAL.
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Leader : JAMARY OLIVEIRA FILHO
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MEMBRES DE LA BANQUE :
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ADRIANA SARAIVA ARAGAO DOS SANTOS
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GUILHERME TEIXEIRA VALENÇA
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JAMARY OLIVEIRA FILHO
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JOSÉ EDUARDO POMPEU
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LORENA ROSA SANTOS DE ALMEIDA
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Data: 25 oct. 2019
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Afficher le Résumé
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Introduction: Patients with Parkinson's disease present motor and non-motor clinical manifestations that contribute to the increased risk of falls and worsening quality of life. Physical therapy is clinically recommended in the treatment of motor disorders; however there is no consensus on the most appropriate intervention. Because it is a multifaceted neurodegenerative disorder, treatment should be appropriate to the stage of the disease and must address its multidimensional aspect (motor, cognitive and emotional). Objectives: To analyze the effects of three modalities of physical exercise on the multidimensional aspect of Parkinson's disease. The first specific objective was to compare the effects of Functional Training, Stationary Bicycle and Exergaming on the proportion of fallers, as well as to determine the predictors of fall and quality of life of elder ly with Parkinson's disease in a follow-up period of one, three and six months. The second was to compare the effects of Functional Training, Stationary Bicycle and Exergaming on the number of falls, proportion of recurrent fallers, balance, executive function, functional mobility and quality of life domains of elderly with PD. Study design: Randomized, blinded, longitudinal and prospective clinical trial (PROBE). Material and Methods: Seventy-nine elderly (≥ 60 years) with Idiopathic Parkinson's disease (modified Hoehn & Yahr 2, 2.5 or 3) were randomized into three groups: G1- Functional Training (n = 27), G2-Stationary Bicycle (n = 27) and G3- Exergaming with XBOX360 and Kinect sensor (n = 25). To the first specific objective, the primary outcome ratio of fallers was assessed by a falls diary and a blind assessor's telephone contact during a six-month follow-up. Predictors of fall and quality of life (Euroqol-5D) were determined using Cox and Linear regressions, respectively. Only variables with a significant association (p <0.05) in the univariate analyzes of both regressions were included in the respective multivariate models adjusted for the treatment group. To the second specific objective, the number of falls and the proportion of fall categories (non-fallers = 0, single fallers = 1 and recurrent fallers> 1) were compared within six months before treatment with the six months follow-up. In addition, to compare the effects of pre- and post-intervention exercise modalities, we assessed the secondary outcomes: balance (Balance Evaluation Systems Test - BESTest), executive function (Front Assessment Battery - FAB), functional mobility (Timed Up and Go Test -TUG) and quality of life domains (Parkinson Disease Questionnaire-39 - PDQ39). Quantitative variables were expressed as median and interquartile range and categorical variables were expressed as proportion. Wilcoxon Signal tests were used for intragroup comparisons and Kruskal-Wallis to compare intergroup results of continuous variables. For categorical variables we used the Wilcoxon Signs test and Fisher's exact test for intragroup and intergroup comparisons, respectively. The level of significance was 5%. Results: In article 1, fall outcome occurred in 19 (24.1%) patients, with a G1 fall rate of 5.12 falls/100 patient-months, G2=5.48 and G3=4.26. Predictors of fall: disease duration (HR=1.16/year, 95% CI=1.03-1.29) and lower limb muscle strength (improvement in Sit to Stand Test, HR=1.14/second 95% CI=1.01-1.28), regardless of initial balance measurements. Quality of life predictors: disease severity (effect=-0.01 point on Euroqol-5D per point increase in Unified Parkinson's Disease Rating Scale; 95% CI -0.01 to -0.002) and gait performance (effect = - 0.03 points at Euroqol-5D per second increase in cognitiveTUG; 95% CI -0.05 to -0.01). In article 2, G2 and G3 significantly reduced the proportion of fallers to 26% (22% single fallers and 4% recurrent fallers, p=0.008) and 20% (12% single fallers and 8% recurrent fallers, p=0.021), respectively, during follow-up. G2 significantly reduced in 60% the number of falls (p=0.005) in follow-up. Improvements in balance and executive function have been demonstrated in G1 and G3. G3 significantly improved the domains stigma and activity of daily living. Conclusions: The three exercises did not differ in the proportion of fallers, the number and rate of falls, and the quality of life over a six month follow-up period. Falls were associated with longer disease duration and improved lower limb strength with maintenance of baseline balance values. Better quality of life was associated with lower disease severity and better gait performance. There was no difference between groups regarding secondary outcomes. However, the Exergaming group showed intragroup statistical significance in improving balance, executive function, functional mobility, and the stigma and daily life activity domains of quality of life. Exergaming may be a multisensory and multidimensional therapy for fall prevention.
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TIAGO LANDIM D'AVILA
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Coinfections between cutaneous leishmaniasis, HIV, HTLV and intestinal parasites: prevalence in an endemic area of leishmaniasis
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Leader : LUCAS PEDREIRA DE CARVALHO
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MEMBRES DE LA BANQUE :
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LUCAS PEDREIRA DE CARVALHO
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CLAUDIO LUCIO FERNANDES AMARAL
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MARCOS LÁZARO DA SILVA GUERREIRO
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PEDRO DANTAS OLIVEIRA
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RAFAEL ARAUJO GOMES JUNIOR
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THIAGO MARCONI DE SOUZA CARDOSO
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Data: 28 nov. 2019
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Introduction: Co-infections interfere in disease progression. They could emerge a latent infections and accelerate a pathology, like HIV and visceral leishmaniasis co-infection, or induce protection, such as HBV and Plasmodium sp.. In this research, we evaluated the prevalence between Leishmania sp., HIV, HTLV and intestinal parasites co-infections and the co-infection influence on Tegumentary Leishmaniasis (TL). Methodology: Were followed 2102 individuals (507 countryside and 1595 urban) in an endemic area for TL and schistosomiasis (Jiquiriçá/BA). The study had three stages: First, were realized educational activities, mapping, socioeconomic and epidemiological survey, stool/blood obtaining, and Montenegro antigen skin test (MAST); Second, infections diagnosis (serology and confirmatory test) and immune profile evaluation for infected and co-infected with CBA; Third, data processing, results dispensation, monitoring of infected and carriers. Results: One (1) HIV-infected and others 6 (six) HLTV-infected were found in the study. In countryside individuals, previous diagnosed with TL (PDTL) were 35.8% and positive MAST were 34.0%. These variables correlation show that 8.2% individuals had negative PDTL and positive MAST. With these results, we sought immune response profile changes with CBA. Th1, Th2 and Th17 cytokines levels were not statistically significant. Eleven distinct gastrointestinal parasites were detected, characteristics of rural areas or areas with poor sanitation, which totaled 63.9% of participants. The highlighted intestinal parasites were Schistosoma mansoni (27.7%), Ascaris lumbricoides (17.9%) and Trichuris trichiura (14.9%). For those infected with any kind of intestinal parasites, 35.8% had co-infections (from 1 to 3 simultaneously). The major medical co-infection was TL and schistosomiasis with 9.1% of individuals. Thus, we sought immune responses profile changes in co-infected individuals with TL and schistosomiasis. The CBA showed that Th1, Th2 and Th17 cytokines levels were not statistically significant. This is a subproject of “MOLECULAR MARKERS AND COINFECTIONS IN INFECTOPARASITY DISEASES IN MAN” approved by FAPESB PRONEX 2010.
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MAGNO CONCEIÇÃO DAS MERCES
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BURNOUT SYNDROME AND METABOLIC SYNDROME IN PRIMARY HEALTH CARE NURSING PROFESSIONALS
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Leader : ARGEMIRO D OLIVEIRA JUNIOR
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MEMBRES DE LA BANQUE :
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ANTONIO MARCOS TOSOLI GOMES
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ARGEMIRO D OLIVEIRA JUNIOR
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JULITA MARIA FREITAS COELHO
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LUCELIA BATISTA NEVES CUNHA MAGALHAES
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MARIA LÚCIA SILVA SERVO
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Data: 13 déc. 2019
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Introduction: Burnout Syndrome (BS) is defined as a psychological syndrome that arises as a prolonged response to chronic interpersonal stressors at work. Metabolic Syndrome (MS) is defined by a set of cardiovascular risk factors. It is a combination of at least three out of five parameters evaluated: abdominal obesity, triglycerides, HDL-cholesterol, blood pressure and fasting glucose. Stressful work situations stimulate the hypothalamic-"hypophyseal" adrenal axis response leading to insulin resistance as a result of excessive cortisol production. Increased cortisol levels, in turn associated with stimulation of the adenocorticotropic hormone, would be related to abdominal adiposity. Objective: To estimate the association between Burnout Syndrome and Metabolic Syndrome among Primary Health Care (PHC) Nursing Professionals in the State of Bahia, Brazil. Materials and Methods: This is a population-based epidemiological, cross-sectional, exploratory and confirmatory study, and 1125 primary health care nursing professionals from Bahia were investigated. Results: The prevalence of BS and MS corresponded to 18.3% and 24.4%, respectively. The factors associated with BS were: race / color, residence, economic situation, satisfaction with current occupation, suffered aggression at work, rest break, technical resources and equipment, night shift, physical activity, smoking, satisfaction with physical form. Factors associated with MS were: physical inactivity, alcohol use, Acantose Nigricans, SB, age ≥ 36 years and being a nursing technician. The adjusted measurements PR adjusted 1= 3,23 (IC95%= 1,86-5,61), p-valor < 0,01 e PR adjusted 2= 1,48 (IC95%= 1,15-1,89), p-valor < 0,01, confirmed the presence of an association between Burnout Syndrome and Metabolic Syndrome. Conclusion: Strategies are necessary to identify, treat and prevent the syndromes studied. The importance of implementing occupational health programs
in the context of PHC is emphasized, emphasizing the improvement of working conditions, monitoring of safety and health of workers.
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