Ana Maria Revoredo da Silva Ventura

This study aims to learn about the cardiovascular complications of COVID-19 and the clinical, laboratory and imaging predictors of myocardial injury and dysfunction resulting from SARS-CoV-2 infection, with a view to developing a plan of measures to reduce the risk of death from COVID-19 in people with cardiovascular disease. This is an integrative literature review carried out in electronic databases: PubMed, LILACS, Embase, Scopus, WOS and CINAHL, with the descriptors: Cardiovascular system; risk factors; Comorbidity; Cardiovascular diseases; Heart injury and Covid-19 with the inclusion of original studies in the period 2019-2022. The search resulted in 44 articles, in English, which highlighted the risk factors and/or comorbidities associated with cardiovascular complications potentiated by COVID-19; prognosis and increased mortality from cardiovascular causes induced by COVID-19. It is concluded that cardiovascular impairment can determine the severity and contribute to death in individuals with COVID-19, potentiated by pre-existing cardiovascular disease or cardiometabolic risk factors, affecting the need for ventilatory and hemodynamic support.

Vários estudos sugerem a importância da vitamina D – 25(OH)D – na evolução clínica dos pacientes com malária. Entretanto, a prevalência de deficiência de 25(OH)D na população amazônica é pouco conhecida, havendo também poucos estudos com pacientes diagnosticados com malária. Assim, o objetivo deste estudo foi avaliar os níveis séricos de 25(OH)D em pacientes com malária e sua relação com dados epidemiológicos, parasitológico e provas de função hepática. Para tanto, foi realizado um estudo transversal analítico com um grupo de pacientes com malária e um grupo controle no município de Itaituba (PA), Brasil, no período de janeiro de 2018 a outubro de 2019. Elaborou-se um protocolo para avaliação dos dados sociodemográficos, parasitológicos e laboratoriais, adotando-se o nível de significância de 5%. A prevalência de deficiência de 25(OH)D foi observada nos pacientes com malária (28,5%) e no grupo controle (24,6%), sem diferença estatística; porém, entre os residentes no garimpo, os níveis séricos foram estatisticamente menores nos pacientes com malária. Os níveis séricos de transaminase glutâmico-pirúvica (TGP) apresentaram correlação inversa com os de 25(OH)D. As provas de função hepática foram significativamente maiores no grupo com malária. Dessa forma, este estudo evidenciou a deficiência de 25(OH)D em Itaituba. Alterações hepáticas pela infecção plasmodial podem ter contribuído para a correlação inversa observada entre os níveis de TGP e 25(OH)D.

Palavras-chave: Micoses; Imunocompetência; Vírus da Imunodeficiência Humana

Some studies have suggested the importance of vitamin D [25(OH)D] in malaria clinical practice. The prevalence of 25(OH)D deficiency in the Amazon population is not well known, and there are few studies in patients with malaria. This study aimed to evaluate 25(OH)D serum levels in patients with malaria and determine their relationships with epidemiological, clinical, laboratory, and parasitemia data. An analytical cross-sectional study of 123 patients with malaria and 122 individuals without malaria was performed in Itaituba, Pará, Brazil, from January 2018 to October 2019, by evaluating sociodemographic, clinical-epidemiological, parasitological, and laboratory data and adopting a 5% significance level. Parametric tests (Student's t-test), non-parametric tests (Mann-Whitney U), and Spearman’s correlation ([r_s], for non-parametric variables) were used according to the nature of the distribution of the variables. For the qualitative variables, Pearson's chi-square test, Fisher's exact test, and the G test were used. Spearman's correlation was used to compare the results of the 25(OH)D levels and blood counts performed among patients and the control group. Malaria patients residing in a mining area had 25(OH)D serum levels that were significantly lower than those in the control group residing in the mining area, though both were within normal levels. Red blood cell counts had an inverse correlation with parasitemia (Plasmodium falciparum), and platelet levels had an inverse correlation with parasitemia (Plasmodium vivax). 25(OH)D deficiency was evidenced in Itaituba, in the state of Pará, which is an endemic area of malaria in the Amazon region.

Objetivo: Avaliar os níveis séricos de 25(OH)D em pacientes com malária e sua relação com dados epidemiológicos, estado nutricional e consumo de vitamina D. Metodologia: Estudo transversal analítico com 123 pacientes com malária e 122 do grupo controle com avaliação de dados epidemiológicos, estado nutricional, consumo de vitamina D, fatores de exposição solar e aspectos laboratoriais (parasitemia, lipidograma, provas de função hepática e renal), no período de janeiro/2018 a outubro/2019, no município de Itaituba, Pará, Brasil. Resultados: A prevalência de deficiência de 25(OH)D entre os pacientes com malária (28,5%) e aqueles do grupo controle (24,6%) foi similar (p>0,05), entretanto, os indivíduos com malária e residentes em garimpo apresentaram níveis significativamente menores do que aqueles sem malária, também residentes em garimpo (p< 0,01). O tipo de pele, tempo e horário de exposição solar e uso de protetor solar não influenciaram os níveis de 25(OH)D. O consumo alimentar de vitamina D (diário) foi significativamente superior nos indivíduos com malária. Conclusão: Observou-se que o sobrepeso/obesidade e hipertrigliceridemia foram fatores de risco e o tempo de evolução da doença (dias) foi fator de proteção para hipovitaminose D. Níveis séricos de CT, HDL, LDL foram significativamente inferiores nos indivíduos com malária em relação aos do grupo controle, com influência da parasitemia (P. vivax). O aumento de TG se associou de forma inversa com os níveis séricos de 25(OH)D.

Plasmodium malariae infections are often asymptomatic and long-lasting. Mixed infections are often underdetected in areas where P. malariae, P. vivax, and P. falciparum are coendemic. In this study, we described the occurrence of these species circulating as single or mixed infections in Pará state, Brazil, in the Amazon region, with the purpose of clarifying the impact of misidentification of parasite species based only on morphological description using thick blood smear. By using real-time polymerase chain reaction based on the amplification of the mitochondrial DNA, we detected a prevalence of 46% (58/126) mixed infections with 33.3% P. malariae/P. vivax which were read as P. vivax monoinfections by microscopy detection. Our findings confirmed the high circulation of P. malariae in a malaria endemic area in the Brazilian Amazon region.

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.

A Leishmaniose Visceral (LV), é uma infecção sistêmica que afeta pessoas no mundo todo. É endêmica no Pará. Objetivo: Analisar as características espaciais, clínico-epidemiológicas, laboratoriais, tratamento e letalidade de crianças com LV em hospital de referência do Pará. Método: Estudo retrospectivo-analítico, transversal, com abordagem quantitativa dos prontuários de crianças com LV internados entre 2012 e 2016. Resultado: Os casos predominaram na zona rural (77,1%) e infecção primária (86,5%). Os menores de 6 anos e do sexo masculino foram os mais acometidos. A distribuição espacial dos casos foi heterogênea, predominando o Nordeste Paraense (80,2%). A confirmação laboratorial foi a mais utilizada (86,5%). N-metil glucamina foi a terapêutica de eleição (89,3% dos casos). Conclusão: Houve cura em mais de 90% dos casos. A letalidade associou-se à sangramentos, à plaquetopenia, à falha no tratamento inicial, ao tempo de tratamento e ao maior escore sistema de avaliação de risco de vida (SARV).

This research aims to determine whether the combination of epidemiological and clinical features can predict malaria. Diagnostic investigation detected 22.3% of individuals with Plasmodium vivax (P. vivax) malaria, with significant predominance of the male gender. The malaria triad (fever, chills and headache) had a more expressive frequency (81.1%) in individuals with positive thick blood than those with negative thick blood smear (65.1%), although there was no statistical significance. Among the variables analysed as predictive for positive thick blood smear, it was observed that personal history of travel to an endemic malaria area and past malaria infection (PMI) were significantly associated with malaria, even in multiple logistic regression. Fever had the higher sensitivity (94.6%) and past malaria history had the greater specificity (68.2%), with accuracy of 23.5% and 67.5%, respectively. In combined analysis, fever with chills had the highest sensitivity (91.9%), but low accuracy (38.5%). High specificity (91.5%) was found in the association of malaria triad, PMI and history of travel to endemic malaria area (which along with anorexia, was higher 94.6%), with good accuracy (80.7%), suggesting that the screening of patients for performing thick blood smear can be based on these data. The epidemiological features and the malaria triad (fever, chills and headache) can be predictors for identification of malaria patients, concurring to precocious diagnosis and immediate treatment of individuals with malaria.