Doutorado em Doenças Infecciosas
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- ItemAnálise da retenção à terapia antirretroviral de pessoas vivendo com HIV e fatores associados no Brasil de 2014 a 2022(Universidade Federal do Espírito Santo, 2025-03-26) Freitas, Marcelo Araújo de; Pascom, Ana Roberta Pati ; https://orcid.org/0000-0002-2646-3383; http://lattes.cnpq.br/1066727701162204; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462; https://orcid.org/0000-0002-0763-233X; http://lattes.cnpq.br/9275784580459018; Mesquita, Fábio Caldas de; https://orcid.org/0000-0002-8297-0224; http://lattes.cnpq.br/5238492147032062; Oliveira, Maria Cristina Pimenta de ; https://orcid.org/0000-0002-4205-9786; http://lattes.cnpq.br/4908168036177095; Teixeira, Carlos Graeff ; https://orcid.org/0000-0003-2725-0061; http://lattes.cnpq.br/0464152494769261; Cerutti Junior, Crispim ; https://orcid.org/0000-0002-9485-4191; http://lattes.cnpq.br/4257067087979999INTRODUCTION: Retention in antiretroviral therapy (ART) is essential for controlling HIV/AIDS and reducing mortality rates worldwide. In Brazil, although ART is widely accessible, challenges remain in maintaining individuals in treatment over time. This study aimed to analyze trends in ART retention from 2014 to 2022 in the country. METHODS: This population-based study used national antiretroviral dispensing databases from the Ministry of Health to assess retention at 6, 12, 24, 36, 48, and 60 months after treatment initiation. The analysis included individuals aged 15 years or older, defining retention as a delay in medication dispensing of no more than 28 days. Additionally, a multivariate analysis was conducted for 60-month retention in the year 2022. RESULTS: The study observed over 3.4 million ART dispensations, revealing that retention steadily declined over time, with the lowest proportions observed at 60 months (71% in 2022). Men had consistently higher retention compared to women (79% vs 73% in 2022). Lower retention was found among younger age groups (74% in 2022), indigenous populations (67% in 2022), individuals with lower education levels (72% in 2022), and those residing in northern (74% in 2022) regions of Brazil. The multivariate analysis of 60-month retention in 2022 found a higher likelihood of retention among individuals without tuberculosis coinfection (OR: 1,26; IC95% 1,17 – 1,36; p=0,000). CONCLUSIONS: The study highlights significant challenges in retention, especially after prolonged ART use, with notable disparities across demographic and regional groups. The findings suggest the need for targeted interventions to improve ART retention, particularly among vulnerable populations, and may support public health policies to strengthen continuous HIV care in Brazil
- ItemRelação entre doença periodontal e doenças crônicas não transmissíveis em usuários do sistema público de saúde - Vila Velha - ES(Universidade Federal do Espírito Santo, 2024-10-08) Mendonça, Gustavo Vital de; Feitosa, Alfredo Carlos Rodrigues ; https://orcid.org/0000-0003-4090-4760; http://lattes.cnpq.br/2076852367700539; Cerutti Junior, Crispim ; https://orcid.org/0000-0002-9485-4191; http://lattes.cnpq.br/4257067087979999; https://orcid.org/0000-0002-4314-9708; http://lattes.cnpq.br/1083615409753183; Pinel, Roberta Gracelli Batitucci ; https://orcid.org/; http://lattes.cnpq.br/2362742785781750; Szpilman, Ana Rosa Murad ; https://orcid.org/0000-0003-1399-3753; http://lattes.cnpq.br/0758783435748999; Pandolfi, Margareth ; https://orcid.org/0000-0001-8921-9356; http://lattes.cnpq.br/6133806025978916; Delatorre, Edson Oliveira ; https://orcid.org/0000-0002-5746-0820; http://lattes.cnpq.br/9814839314541002Periodontal disease (PD) encompasses gingivitis and periodontitis. Gingivitis or inflammation of the gums, which leads to bleeding gums, is considered an early form of periodontal disease. Periodontitis develops over time, with accumulation of dental plaque, bacterial dysbiosis, formation of periodontal pockets, gingival recession, tissue destruction and alveolar bone loss, which can lead to tooth loss. In the late 1980s, dental journals published several observational studies that identified systemic diseases in patients with PD. In the 1990s, the term “periodontal medicine” was introduced. In the early 21st century, dentists began to warn their patients about the potential relationship between PD and a number of systemic diseases. Therefore, we carried out this study with the objectives of describing the relationship between the occurrence of periodontal disease and the prevalence of chronic non-communicable diseases, as much as the influence of the severity of periodontal disease on the prevalence of such chronic conditions. Another objective was to demonstrate the relevance of multidisciplinary care in the public health service. The study population consisted of patients using the public health service in the city of Vila Velha, Espírito Santo. The Jardim Colorado, Divino Espírito Santo and Ataíde health units were used for the study. The CPI (Community Periodontal Index) method was selected, which is recommended by the WHO and the Ministry of Health. The number of lost dental elements was also evaluated. The systemic health assessment was carried out through careful anamnesis, with measurement of blood pressure and blood glucose, and with data self-reported by the volunteers, as well as through the analysis of the citizen's electronic medical record. The association between periodontal disease and the occurrence of chronic non-communicable diseases was verified by simple logistic regression adjusted for confounding factors (age, smoking and excess weight), using comorbidity outcomes (systemic arterial hypertension, diabetes mellitus, ischemic events, arthritis, neurological disorders and cancer) and the independent variables total periodontal index and number of missing teeth. The study population consisted of 334 volunteers. It was possible to find a significant association between the total periodontal index and systemic arterial hypertension and diabetes in patients aged 45 years or over. Also, there was a significant association between the total periodontal index and systemic arterial hypertension, diabetes mellitus and cancer in female individuals, with the participant whose total CPI was 9 to 13 being 2.8 times more likely to have systemic arterial hypertension when compared to the participant with values from 1 to 2. Our findings allow us to conclude that periodontal disease has a positive and statistically significant association with arterial hypertension and diabetes mellitus in the population over 45 years of age, regardless of confounding factors (smoking and excess weight). Severe periodontitis is also a risk factor for cancer in women, and tooth loss is also a risk factor for hypertension and diabetes in women
- ItemTransmissão vertical da infecção pelo HIV e da sífilis na faixa de fronteira terrestre do Brasil de 2010 a 2020(Universidade Federal do Espírito Santo, 2024-01-29) Lannoy, Leonor Henriette de; Co-orientador1; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador3; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador4; ID do co-orientador4; Lattes do co-orientador4; Miranda, Angelica Espinosa Barbosa ; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/0000-0002-9520-8538; http://lattes.cnpq.br/0999758340503440; Díaz Bermúdez, Ximena Pamela Claudia ; https://orcid.org/0000-0002-3771-7684; http://lattes.cnpq.br/1598351909460233; Brito, Ana Maria de ; https://orcid.org/; http://lattes.cnpq.br/0105337613337822; Teixeira, Carlos Graeff; https://orcid.org/0000-0003-2725-0061; http://lattes.cnpq.br/0464152494769261; Cerutti Junior, Crispim ; https://orcid.org/0000-0002-9485-4191; http://lattes.cnpq.br/4257067087979999; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/Introduction: Mother-to-child (MTCT) of HIV and syphilis (congenital syphilis) are diseases that persist as public health issues in several parts of the world, and have been scarcely studied at the Brazilian land border strip (LBS). Measures to prevent MTCT of HIV and syphilis are widely known and Brazil has the necessary resources and technologies available. The Brazilian LBS is the 3rd largest land border in the world and, for the purposes of planning and promoting regional development, the National Regional Development Policy (PNDR) established the division of the region into three major arcs: North, Central and South. In turn, borders are unique spaces with potential and challenges that require differentiated programmatic public policies that take into account the specificity of each territory. Understanding the epidemiological situation of the problem in the region aims to contribute to the implementation of public policies and support the strategy of eliminating MTCT of HIV and congenital syphilis. Objectives: Understand MTCT of HIV and syphilis and analyze the provision of health services at the Brazilian LBS from 2010 to 2020. Methods: A quantitative, ecological, and cross-sectional evaluation study was conducted using secondary data from cases of HIV/AIDS, HIV in pregnant women, acquired syphilis (AS), syphilis in pregnant women (PS), and congenital syphilis (CS) registered in the Notifiable Diseases Information System (SINAN) between 2010 and 2020 and living in the Brazilian border municipalities. Information from the Live Birth Information System (SINASC), the Primary Care Health Information System (SISAB), the e-Gestor and the Medicines Logistic Control System (SICLOM Managerial) were also used. The variables studied included sociodemographic characteristics, prenatal and delivery data, as well as the availability of services and procedures. Detection rates of AS, PS, AIDS, HIV infection in children under 5 years old, HIV in pregnant women, and the incidence of CS were calculated. The MTCT rate of HIV was estimated based on the number of children infected with HIV per year of birth divided by the number of HIV-infected pregnant women reported by year of delivery. Trends in detection and incidence rates were calculated for the analyzed period. Thematic maps were constructed for spatial distribution analysis of detection rates and incidences using Quantum GIS (QGIS) version 2.18.6, and spatial analysis was evaluated local autocorrelation (local index of spatial association—LISA) by means of Local Moran’s I index, calculated using R software version x64 3.4.0. Results: In the LBS, among pregnant women diagnosed with syphilis, 23.7% were 15 to 19 years old, 34.2% were illiterate or had 14 only primary education, 7% were black, and 47% were of mixed race. Among pregnant women with HIV infection, 15.6% were 15 to 19 years old, 34.0% were illiterate or attended only primary education, 10.1% were black, and 42.1% were of mixed race. It was verified that in 2019 and 2020 approximately 90% of pregnant women in the LBS had four or more prenatal consultations. However, in the Northern arc, this proportion was only 82% in 2019 and 79% in 2020. Information on rapid testing (RT) for syphilis in the SISAB was available on 84% of the municipalities while RT performance for HIV was available on 92% of them. Sixty-eight percent of the municipalities recorded the administration of penicillin for syphilis treatment and 17% of them had Medication Dispensing Units. The time series analysis in the LBS showed a 48% average annual increase in PS case detection rates from 2010 to 2020, being 59.6% in the Northern arc, 28.8% in the Central arc, and 67.2% in the Southern arc. Regarding CS, there was an average increase of 38.4% in the LBS, being 18.3% in the Northern arc, and 65.7% in the Southern arc. The Central Arc showed no statistically significant upward trend in the incidence of CS. The annual variation rate in the detection of pregnant women with HIV infection in the LBS was 9.1%, with an increase of 19.6% in the Northern Arc, 11.4% in the Central Arc and 6.1% in the Southern Arc. On the other hand, the AIDS trend in children under 5 years old showed a reduction in the period analyzed; in the FFT it was -16.1%, in the Northern Arc -8.3%, in the Central Arc -19.2% and in the Southern Arc -17.7%. The spatial analysis by LISA showed that in 2019 there were clusters of high PS rates in municipalities of Acre, Mato Grosso do Sul, and Rio Grande do Sul. Clusters of CS and pregnant women living with HIV in Rio Grande do Sul, and transition areas (high-low) of AIDS in children under 5 in municipalities of Pará, Amazonas, Rondônia, and Mato Grosso do Sul, were also found. Conclusion: The study's findings reveal that MTCT of HIV and congenital syphilis persist as a major problem in Brazilian LBS and disproportionately affect women with low levels of schooling, adolescents and black women. However, its distribution is not homogeneous between the arcs, especially in the control of MTCT of HIV. There is a need to expand access to prenatal care and create mechanisms to guarantee the quality of care in general. To this end, public policies that contemplate inter-sectorial practices aimed at transforming specific social determinants of each arc and supporting binational mechanisms and agreements with legal instruments of integration are essential
- ItemAvaliação clínica e tomográfica da região rinomaxilar em pessoas afetadas pela hanseníase(Universidade Federal do Espírito Santo, 2022-10-06) Santo, Rachel Bertolani do Espirito; Deps, Patrícia Duarte; https://orcid.org/0000-0002-9707-1934; http://lattes.cnpq.br/9820695143683631; https://orcid.org/0000000237560402; http://lattes.cnpq.br/6169243315709709; Teixeira, Carlos Graeff; https://orcid.org/0000000327250061; http://lattes.cnpq.br/0464152494769261; Palaci, Moises; https://orcid.org/0000000320136071; http://lattes.cnpq.br/2602694352713051; Ramos, Bernardo Faria; http://lattes.cnpq.br/0427522465155833; Gomes, Ciro MartinsContext: Hansen's disease (HD) is a chronically progressive, infectious disease that accounts for more than 200,000 new cases per year worldwide, and is more frequent in developing countries such as India, Brazil, and Indonesia. Skeletal deformities of the face and extremities are historical markers and part of the stigma of this disease. However, the underlying mechanisms of HD-induced bone damage are not completely known, although it is known that lesions in the nasal and oral mucosa are the starting point for the development and progression of facial bone changes. The term "Facies leprosa", coined in 1952 by Møller-Christensen, author of the first paleopathology studies on HD, denominated a set of changes in the facial skeleton, being, however, replaced by rhinomaxillary syndrome (RMS), as proposed by Andersen and Manchester (1992), who systematized such changes into seven criteria. According to paleopathology, facial deformity as a sequela of HD is caused not only by the "saddle nose" but also by the regression of the maxilla. Objective: Based on this, this study aimed to evaluate the clinical and bone alterations of the rhinomaxillary region in people affected by HD through physical examination and tomographic images. Methods: In an analytical cross-sectional study, 3 groups of participants were evaluated, 2 with cases (Group 1: 16 participants with more than 35 years of HD diagnosis, treated; Group 2: 21 participants with less than 15 years of HD diagnosis, HD, treated or undergoing treatment) and 1 with controls (37 participants without a HD diagnosis). In the cases, an otorhinolaryngological evaluation was carried out with rhinoscopy and oroscopy, in addition to a clinical evaluation of the facial profile (this one, exclusively in Group 1). Participants-cases and controls underwent evaluation of CT scan of the facial bones. Based on the paleopathological RMS criteria by Andersen and Manchester (1992), the tomographic criteria for defining radiological RMS (rRMS) were established. The evaluation of the facial profile, through photos of the participants affected by leprosy, allowed the description of clinical RMS (cRMS). Results: Of the 16 participants in Group 1, 4 fully met criteria for rRMS, all had substantial facial changes that met criteria for cRMS, and another 4 had partial rRMS and did not meet criteria for cRMS. All cases with total and partial rRMS had an original diagnosis of lepromatous HD. The investigation of rhinomaxillofacial bone manifestations of HD revealed that the differences in bone changes between the three groups were mainly determined by: (i) severe resorption/atrophy, more frequent in Group 1, with the anterior alveolar process of the maxilla showing severe resorption/atrophy in 50% of the participants, a percentage that was 29% in Group 2 and 11% in the controls; (ii) nasal bones and nasal aperture with severe resorption/atrophy in 31% in Group 1, being absent in Group 2, and, in Group 3, 2.7% (nasal bone) and 5.4% (nasal opening); (iii) severe or mild to moderate changes in the nasal septum in 25% of the cases in Group 1 compared to 4.7% of the participants in Group 2 and 2.7% in Group 3. The rhinomaxillofacial bone change score was higher among participants with more than 35 years of diagnosis (Group 1, median 7, IQR 5.5-10.5) compared with those with less than 15 years of diagnosis (Group 2, median 5, IQR 3-7) and with participants without HD (Group 3, median 5, IQR 2-7). These findings are consistent with the fact that most cases in Group 1 were diagnosed and had treatment started in the preMultidrug therapy (MDT) era, and a long time has elapsed since then, which allowed greater disease progression, despite later, some have received MDT. With respect to dental data, there were no differences between participants in Groups 1 and 2, but controls had less tooth loss (mean number of missing maxillary teeth 12, IQR 4-16, p = 0.008) compared to participants with a history of HD (Groups 1 and 2 combined, median 16, IQR 14-16). The cases (Groups 1 and 2) had similar otorhinolaryngological and oroscopic scores. In Group 2, there was a strong positive correlation between the three scores (rhinomaxillofacial, otorhinolaryngological and oroscopic), with Pearson correlation coefficients ≥ 0.6 (all p ≤ 0.004). The strong correlation between otorhinolaryngological scores and rhinomaxillofacial bone alteration observed in Group 2 indicates that the first score may be a useful clinical proxy for the mentioned bone alteration. Conclusion: through this study, it was possible to make a correlation between tomographic bone alterations and those verified in the skulls in osteoarchaeological studies on HD, adapting the paleopathological criteria of RMS to clinical practice. It was also possible to characterize the changes in the facial profile corresponding to the underlying bone involvement. The results described provide further evidence that the management of the patient with HD should include a complete otorhinolaryngological evaluation, supported by imaging when necessary. The findings also indicate that oral and dental health in people affected by this disease should not be neglected, constituting part of the assessment and basic care. Such measures are inexpensive and potentially preventive to avoid the progression of rhinomaxillofacial bone changes. Therefore, they should be incorporated into clinical guidelines for patients who present as new cases of HD, undergoing treatment or follow-up.
- ItemVIOLÊNCIA SEXUAL, INFECÇÕES SEXUALMENTE TRANSMISSÍVEIS E GRAVIDEZ: RETROSPECTIVA DE DEZ ANOS EM SERVIÇO DE REFERÊNCIA EM VITÓRIA, ESPÍRITO SANTO, BRASIL.(Universidade Federal do Espírito Santo, 2022-09-30) Souza, Chiara Musso Ribeiro de Oliveira; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462; https://orcid.org/; http://lattes.cnpq.br/5365777575405354; Spano, Liliana Cruz; https://orcid.org/0000000262056988; http://lattes.cnpq.br/7451382455806895; Boldrini, Neide Aparecida Tosato; https://orcid.org/0000-0003-1140-5057; http://lattes.cnpq.br/7621144748479516; Bermudez, Ximena Pamela Claudia Diaz; https://orcid.org/0000-0002-3771-7684; http://lattes.cnpq.br/1598351909460233; Menezes, Maria Luiza Bezerra; https://orcid.org/0000-0001-7001-2005; http://lattes.cnpq.br/8014227256305140Introduction: Sexually transmitted infections (STI) and pregnancy can be consequences of sexual violence. In Brazil, around 50% of women victims of sexual violence do not undergo STI prophylaxis or emergency contraception. Objectives: To describe the demographic, behavioral and clinical aspects of adolescent and adult women in situations of sexual violence, assisted at a reference clinic in Vitoria, ES, over a one decade period. Patients and Methods: This 10-year retrospective cohort study (2010-2019) describes the socio-demographic and epidemiological profile, and frequencies of clinical procedures, STI, pregnancy and legal abortion in 915 women assisted in a sexual violence assistance center in Brazil. Results: A total of 93.29% (842/915) were resident in the Metropolitan Area of the capital, brown-skinned and white 80.83% (733/915); 42.40% (388/915) were adolescents (12-17 years old), 80.44% (736/915) were single, most had no children, average of 1.8 (± 1,0 DP) children. About one-third (313/915) had not had previous sexual intercourse,1.60% (10/653) were pregnant. Rape predominated with 92% (841/915), of which 51.48% (471/915) involved a known or related aggressor, mostly an acquaintance, followed by stepfather or father. Recurrent cases were 24% (227/915). Clinical procedures: 42.62% (390/915) were attended within 72 hours; received STI prophylaxis 43.36% (392/904), emergency contraception 38.60% (394/904), blood collection 71.57% (647/904). Prevalence: syphilis 0.32% (2/653), hepatitis B 0.16% (1/653), pregnancy 1.60% (10/653). Incidences: syphilis 1.10% (7/663), hepatitis B 0.78% (5/633), hepatitis C 0.64% (4/633), pregnancy 27.17% (172/633). There were no HIV cases. Trichomoniasis 1.9% (2/108), HPV-induced cytological lesions 4.7% (5/108) and bacterial vaginosis 20% (21/108) were found on cervicovaginal samples. There were 129 legal abortions. Conclusions: The sociodemographic aspects and characteristics of aggressions in the studied population are similar to those described in Brazilian national database, including the remarkable number of adolescents, which brings reflections on early sexualization, rape culture, and adult victims’ invisibility. Both STI prophylaxis and emergency contraception were performed in less than half of the women. The frequencies of STI were low, associated with three or more aggressors, number of sexual partners and the age of coitarche. The incidence of pregnancy was high, associated with firearm use and age group, and protected by STI prophylaxis. The frequency of legal abortion was higher than national data. Public policies ensuring access to sexual and reproductive health rights and strategies to improve the quality of care for women in sexual violence situations as well education improvement may decrease vulnerability to STI and unintended pregnancies.