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Chronic HIV-1 infection can cause neurological illness, also known as HIV-associated neurocognitive disorders (HAND). The elevated level of pro-inflammatory cytokines and chemokines, such as C-C Chemokine Ligand 5 (CCL5/RANTES), is one of the ways of causing HIV-1-mediated neuroinflammation. C-C Chemokine Receptor 5 (CCR5) is the main coreceptor for viral entry into host cells and for mediating induction of CCL5/RANTES. CCR5 and CCL5 are part of a correlated axis of immune pathways used for effective protection against the HIV-1 virus. The purpose of this paper was to review the literary knowledge about the immunopathological relationship between this immune complex and neuroAIDS. A systematic review of the literature was conducted based on the selection and search of articles, available in English, Spanish, or Portuguese in the time frame of 1990-2022, of primary and secondary types in the PUBMED, Science Direct, SciELO, and LILACS databases through descriptors (MeSH) together with "AND": "CCR5"; "CCL5"; "neurological manifestations"; or "HIV". The methodological quality of the articles was assessed using the JBI Checklists and the PRISMA 2020 writing guidelines were followed. A total of 36 articles were included in the final composition of the review. The main cells of the CNS affected by neuroAIDS are: neurons; microglia; astrocytes; and oligodendrocytes. Molecular devices and their associations with cellular injuries have been described from the entry of the virus into the host's CNS cell to the generation of mental disorders. Furthermore, divergent results were found about the levels of CCL5/RANTES secretion and the generation of immunopathogenesis, while all condensed research for CCR5 indicated that elevation of this receptor causes more neurodegenerative manifestations. Therefore, new therapeutic and interventional strategies can be conditioned on the immunological direction proposed in this review for the disease.
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INTRODUCTION: COVID-19 in Brazil has already caused, and it still causes, several impacts on health, economy, and education. The risk factors for death involved those with cardiovascular diseases (CVD), which were prioritized for the vaccination of COVID-19. OBJECTIVE: To investigate the clinical characteristics and outcomes between vaccinated and unvaccinated patients with cardiovascular diseases hospitalized for COVID-19 in Brazil in the year 2022. METHODS: A retrospective cohort was analyzed from the year 2022, with cases being hospitalized by COVID-19 being drawn from SIVEP-GRIPE surveillance. We compared clinical characteristics, comorbidities, and outcomes between CVD carriers and non-carriers, and we also compared vaccinated with two doses vs. those that are unvaccinated in CVD carriers. We performed chi-square, odds ratio, logistic regression, and survival analysis. RESULTS: We included, in the cohort, 112,459 hospital inpatients. An amount of 71,661 (63.72%) of the hospitalized patients had CVD. Regarding deaths, 37,888 (33.69%) died. Regarding vaccination against COVID-19, 20,855 (18.54%) people were not vaccinated with any dose among those with CVD. Death p- < 0.001 (OR 1.307-CI 1.235-1.383) and fever p- < 0.001 (OR 1.156-CI 1.098-1.218) were associated with the unvaccinated CVD carriers, and diarrhea p-0.015 (OR 1.116-CI 1.022-1.218), dyspnea p-0.022 (OR 1.074-CI 1.011-1.142), and respiratory distress p-0.021 (OR 1.070-CI 1.011-1.134) were also recorded. Those patients who possessed predictors of death, including invasive ventilation (p- < 0.001 (OR 8.816-CI 8.313-9.350)), were admitted to the ICU p- < 0.001 (OR 1.754-CI 1.684-1.827), and some had respiratory distress p- < 0.001 (OR 1.367-CI 1.312-1.423), dyspnea p < 0.001 (OR 1.341-CI 1.284-1.400), O2 saturation < 95% p- < 0. 001 (OR 1.307-CI 1.254-1.363), they were unvaccinated against COVID-19 p- < 0.001 (OR 1.258-CI 1.200-1.319), they were of male sex p- < 0.001 (OR 1.179-CI 1.138-1.221), they had diarrhea p-0.018 (OR 1.081-CI 1.013-1.154), and they may have been old p < 0.001 (OR 1.034-CI 1.033-1.035). Survival was shorter for the unvaccinated p-0.003, and p- <0.001. CONCLUSIONS: We highlight the predictors of death for those unvaccinated against COVID-19 in this research, and we evidenced the benefits of the COVID-19 vaccine in reducing deaths in hospitalized CVD patients.
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The northern region of Brazil is already vulnerable to other infectious diseases and it was no different in COVID-19. However, cardiovascular diseases still lead the causes of death. Thus, the objective of this study is to identify the clinical predictors and outcome of severe COVID-19 in hospitalized patients with and without CVD in this region of the Amazon. A retrospective cohort, referring to the notifications from January 1 to December 31, 2020, including cases confirmed by molecular testing. The study consisted of 9223 confirmed cases for COVID-19. Of these, 6011 (65.17%) did not have cardiovascular disease and 3212 (34.83%) had some cardiovascular disease. The significance of deaths was in the age group of < 1 to 59 CVD carriers (< 0.001). Predictor of mortality were invasive ventilation for patients with CVD, (OR 23,688 CI 18,180-30,866), followed by chronic kidney disease (OR 2442 CI 1568-3740), dyspnea (OR 2312 CI 1817-3941), respiratory distress (OR 1523 CI 1210-2919), cough (OR 1268 CI 1005-1599), Lower oxygen saturation 95% (OR 1281 CI 1039-1579), diabetes mellitus (OR 1267 CI 1050-1528) and age (OR 1051 CI 1044-1058). Carriers of CVD had a lower survival rate (< 0.0001). The order of the predictors of death differed among the non-carriers, as well as the high odds ratio in the predictors of CVD, only cough was an independent predictor. The age group under 59 years was associated with deaths. We also show the shorter survival in CVD carriers, as well as the higher cardiovascular morbidity rate than other studies in the literature.
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COVID-19 , Doenças Cardiovasculares , Humanos , Pessoa de Meia-Idade , COVID-19/epidemiologia , COVID-19/terapia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/etiologia , Estudos Retrospectivos , Tosse/complicações , Brasil/epidemiologia , Dispneia/complicaçõesRESUMO
The city of Ananindeua, State of Pará, Brazil, is a hyperendemic area for tuberculosis (TB). The present study describes the population characteristics and epidemiological indicators of TB cases from Ananindeua, from 2018 to 2020. The TB cases were screened from the Municipal Health Department of Ananindeua database, and the secondary data were obtained from the Brazilian Notifiable Diseases Information System (SINAN). A high percentage of cases did not undergo a rapid molecular test (74.9%) or culture (84.8%) for diagnosis of TB; a chest X-ray examination for diagnosis of TB was performed in 74.47% of new cases. The SINAN form data was incomplete on susceptibility test results (<0.01−92.7). Sputum smear microscopy for monitoring treatment was recorded in the follow-up form in 34.3% and after the 6th month in 61.1% of cases. The cure rate (60.31%) was below the recommendation by the Brazilian Ministry of Health. The quality indicators showed many weaknesses: (I) lack of availability of smear microscopy as a diagnostic test in a hyper-endemic area; (II) low availability of specific exams such as culture and rapid molecular test (RMT); (III) low adherence to smear microscopy to monitor the evolution of cases during treatment; (IV) absence of drug susceptibility test data; (V) failure to fill in essential variables for TB surveillance.
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The Brazilian Northern region registered a high incidence of COVID-19 cases, particularly in the state of Pará. The present study investigated the risk factors associated with the severity of COVID-19 in a Brazilian Amazon region of 100,819 cases. An epidemiological, cross-sectional, analytical and demographic study, analyzing data on confirmed cases for COVID-19 available at the Brazilian Ministry of Health's surveillance platform, was conducted. Variables such as, municipalities of residence, age, gender, signs and symptoms, comorbidities were included and associated with COVID-19 cases and outcomes. The spatial distribution was performed using the ArcGIS program. A total of 100,819 cases were evaluated. Overall, patients had the mean age of 42.3 years, were female (51.2%) and with lethality reaching 4.79% of cases. Main symptoms included fever (66.5%), cough (61.9%) and sore throat (39.8%). Regarding comorbidities, most of the patients presented cardiovascular disease (5.1%) and diabetes (4.2%). Neurological disease increased risk of death by nearly 15 times, followed by obesity (5.16 times) and immunodeficiency (5.09 time). The municipalities with the highest incidence rate were Parauapebas, Canaã dos Carajás and Jacareacanga. Similarity between the Lower Amazon, Marajó and Southwest mesoregions of Pará state were observed concerning the highest morbidity rates. The obtained data demonstrated that the majority of cases occurred among young adults, females, with the classic influenza symptoms and chronic diseases. Finally, data suggest that the highest incidences were no longer in the metropolitan region of the state. The higher lethality rate than in Brazil may be associated with the greater impacts of the disease in this Amazonian population, or factors associated with fragile epidemiological surveillance in the notification of cases of cure.
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COVID-19/diagnóstico , COVID-19/epidemiologia , Adulto , Área Sob a Curva , Brasil/epidemiologia , COVID-19/mortalidade , Comorbidade , Tosse/epidemiologia , Estudos Transversais , Coleta de Dados , Feminino , Febre/epidemiologia , Geografia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise de Regressão , Risco , Fatores de Risco , SARS-CoV-2 , Adulto JovemRESUMO
Malaria is an acute febrile infectious disease that represents an important public health problem in the Brazilian amazon region. The present study described the socio-epidemiological and spatial characteristics of malaria in a population from the Tapajós mining areas, Pará, Brazilian Amazon. A cross-sectional study, including individuals from Itaituba city, an area under mining activity influence, was conducted. The geographic coordinates were obtained in the field using the Global Positioning System (GPS) Garmin 78csx; for spatial analysis, we used the Kernel Density Estimator with the application of scanning statistics with the SaTScan software. Of the 908 individuals, 311 were positive for malaria. Most of the malaria cases were associated with male individuals, gold miners and with a monthly income of 4-6 salaries. Binary logistic regression analysis demonstrated that gold miners were nearly five times more likely to acquire malaria. In addition, a context of risk for sexually transmitted infections, substance abuse and poor support conditions was observed, worsening the healthcare scenario in this endemic area for malaria. The spatial distribution of malaria cases is irregular in the municipality with hotspot areas located in the Amana Flona that coincide with areas of illegal mining and high human mobility. Finally, the presented socio-epidemiological and spatial distribution data may aid in the development of more effective control measures for malaria in the area.
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Malária , Mineradores , Brasil/epidemiologia , Estudos Transversais , Humanos , Malária/epidemiologia , Masculino , MineraçãoRESUMO
Klebsiella pneumoniae appears as one of the most prevalent pathogens among cancer patients. The present study investigates the clinical, epidemiological and microbiological aspects related to infections caused by K. pneumoniae in cancer patients treated at an oncology referral center in the state of Pará, Amazon region, Brazil. Between July 2017 to July 2019, an epidemiological, observational, cross-sectional study, with a descriptive and analytical approach was conducted, including patients with confirmed diagnosis of cancer who acquired infection by K. pneumoniae 72 h after hospital admission. K. pneumoniae isolates included in the study were obtained from different clinical materials (blood, urine, catheter tip and bladder catheter, orotracheal secretions, oncological and surgical wounds). Antimicrobial susceptibility testing and molecular detection of the carbapenemase-encoding genes were performed. A high prevalence of MDR K. pneumoniae isolates was observed, including two colistin-resistant isolates and seven isolates harboring blaKPC-1 gene. To conclude, our findings provide the firsts insights into the epidemiology and infection by K. pneumoniae in the state of Pará, Brazil, and may be useful on treatment guidance and establishment of strategies to control the spread of resistance strains of K. pneumoniae in the region.
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Objetivo: Descrever a satisfação dos usuários dos serviços de saúde de uma Estratégia Saúde da Família, de um município do estado do Pará. Método: Pesquisa de campo descritiva, com abordagem qualitativa. A coleta de dados se deu por meio de entrevista semiestruturada com 20 usuários homens e mulheres adultos, no mês de setembro de 2019. A análise de conteúdo seguiu orientação de Bardin. Resultados: Emergiram do estudo três categorias temáticas: Tema 1- A satisfação dos usuários com o acesso ao atendimento na unidade. Tema 2 - A Satisfação dos usuários com o atendimento terapêutico na unidade e o Tema 3 A satisfação dos usuários com as relações interpessoais na unidade. Conclusão: Os usuários estão satisfeitos quanto acessibilidade e atendimento na unidade; que compreendem sobre seu problema de saúde e o que deve ser feito para seu controle; que as relações interpessoais são importantes para que se sintam bem acolhidos.(AU)
Objective: To describe the satisfaction of the users of the health services of a Family Health Strategy, of a municipality in the state of Pará. Method: Descriptive field research, with qualitative approach. Data were collected through a semi-structured interview with 20 adult male and female users in September 2019. The content analysis followed Bardin's guidance. Results: Three thematic categories emerged from the study: Theme 1- User satisfaction with access to care in the unit. Theme 2 - The satisfaction of users with the therapeutic care in the unit and Theme 3 - The satisfaction of users with interpersonal relations in the unit. Conclusion: Users are satisfied with accessibility and care in the unit; that they understand about their health problem and what should be done to control it; that interpersonal relationships are important for them to feel welcome.(AU)
Objetivo: Describir la satisfacción de los usuarios de los servicios de salud de una Estrategia de Salud Familiar, de un municipio del estado de Pará. Método: Investigación de campo descriptiva, con enfoque cualitativo. Los datos se reunieron mediante una entrevista semiestructurada con 20 usuarios adultos de ambos sexos en septiembre de 2019. El análisis del contenido siguió la orientación de Bardin. Resultados: Del estudio surgieron tres categorías temáticas: Tema 1- Satisfacción del usuario con el acceso a la atención en la unidad. Tema 2 - La satisfacción de los usuarios con la atención terapéutica en la unidad y Tema 3 - La satisfacción de los usuarios con las relaciones interpersonales en la unidad. Conclusión: Los usuarios están satisfechos con la accesibilidad y la atención en la unidad; que comprenden su problema de salud y lo que se debe hacer para controlarlo; que las relaciones interpersonales son importantes para que se sientan bienvenidos.(AU)
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Humanos , Qualidade da Assistência à Saúde , Comportamento do Consumidor , Enfermeiros de Saúde da Família , Acessibilidade aos Serviços de Saúde , Satisfação PessoalRESUMO
Acute renal failure (ARF) represents 17% of the complications of cardiac catheterization (CC), with a high death rate and longer hospitalization time. The objective of this review is to describe the most cited risk factors for acute kidney failure in the literature. It is a descriptive and exploratory Integrative Literature Review (ILR) with a qualitative approach, using articles published in the Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases between the years of 2009 and 2019 in English, Portuguese, and Spanish, including original articles, reviews, and case studies. The search was made using the following descriptors: cardiac catheterism, kidney diseases, risk factors, coronary catheterization, acute kidney injury, acute renal failure, and nephropathies. The organization and analysis of the data was through the application of a questionnaire that was structured by the authors, and the results are presented in a table. For the final sample, 10 articles were sought. The highlighted factors were being elderly, hypertensive, and diabetic; having previous kidney disease, hypotension, heart failure, higher contrast volumes, and types; the use of non-steroidal anti-inflammatory drugs associated to other risk factors; and atrial fibrillation. Atrial fibrillation was the main finding, which has recently been documented. The identification of risk factors provides health professionals with information to plan measures to prevent ARF, minimizing complications, length of stay, and mortality.
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Injúria Renal Aguda , Cateterismo Cardíaco , Injúria Renal Aguda/epidemiologia , Idoso , Cateterismo Cardíaco/efeitos adversos , Região do Caribe , Humanos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Objetivo: descrever as implicações da COVID-19 no sistema cardiovascular: prognósticos e intercorrências. Método: trata-se de uma revisão integrativa da literatura, realizada nas bases de dados, Science Direct, National Library of Medicine National Institutes of Health dos EUA (PUBMED), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cochrane Collaboration e Medical Literature Analysis and Retrieval System Online (MEDLINE) com os descritores, Cardiovascular System; Cardiovascular Diseases; Coronary Disease, e a palavra-chave Covid-19. Incluíram-se estudos originais, relatos de casos, revisões sistemáticas na série temporal 2019-2020. Resultados: a busca resultou em 13 artigos, todos na língua inglesa, emergindo os pontos-chave: potencialização das complicações cardiovasculares pela infecção por COVID-19; aumento da mortalidade de origens cardiovasculares influenciadas pela infecção por COVID-19. Conclusão: o envolvimento do sistema cardiovascular no COVID-19 pode determinar a gravidade da doença, potencializado na presença de fatores de riscos cardiovasculares, repercutindo em complicações que necessitam de tratamento intensivo e morte. De maneira geral, todos os pacientes com COVID-19 são passíveis de ter comprometimento cardiológico, fato que pode depender de antecedentes mórbidos pessoais, resposta inflamatória e liberadores bioquímicos.
Objective: to describe the implications of COVID-19 in the cardiovascular system: prognosis and intercurrences. Method: This is an Integrative Literature Review, performed in the databases, Science direct, National Library of Medicine National Institutes of Health (PUBMED), Latin American and Caribbean Literature in Health Sciences (LILACS), Cochrane Collaboration and Medical Literature Analysis and Retrieval System Online (MEDLINE) with the descriptors, Cardiovascular system; Cardiovascular Diseases; Coronary Disease, and the keyword Covid-19. It included original studies, case reports, systematic reviews in the time series 2019-2020. Results: The search resulted in 13 articles, all in English language, emerging the key points, Potentiation of cardiovascular complications by COVID-19 infection; Increased mortality of cardiovascular origin influenced by COVID-19 infection. Conclusion: The involvement of the cardiovascular system in COVID-19 may determine the severity of the disease, potentiated in the presence of cardiovascular risk factors, resulting in complications that require intensive treatment and death. In general, all patients with COVID-19 are likely to have cardiological impairment, which may depend on personal morbid antecedents, inflammatory response and biochemical liberators.