Introdução: A sífilis em gestantes é um problema de saúde pública, com casos crescentes a cada ano. O tratamento do parceiro sexual da gestante com sífilis, é de suma importância, pois a falta de tratamento deste pode invalidar todas as medidas de controle instituídas durante o cuidado pré-natal. Objetivo: Descrever a ocorrência de tratamento do parceiro sexual e avaliar fatores maternos que favorecem a realização do tratamento do parceiro sexual das gestantes com sífilis gestacional atendidas no Hospital Fêmina (HFE). Método: Estudo transversal descritivo onde foram descritos os casos de pacientes com diagnóstico de sífilis gestacional atendidas no Serviço de Obstetrícia do HFE no período de 01 de janeiro de 2007 a 31 de dezembro de 2014, e seus respectivos parceiros. A coleta de dados foi realizada através dos dados encaminhados pelo Serviço de Controle de Infecção Hospitalar do Hospital Fêmina à Vigilância em Saúde do Município de Porto Alegre em sífilis, em conjunto com os prontuários das pacientes estudadas. O projeto teve aprovação do Comitê de Ética em Pesquisa do Grupo Hospitalar Conceição com protocolo de número 47914815.2.0000.5530. Resultados: Foram identificados 771 casos de sífilis em gestantes, e desses 570 não tinham informações sobre o tratamento do parceiro sexual da gestante. Dos 201 casos de gestantes com informações sobre o tratamento do parceiro sexual, 25 (12,44%) parceiros foram adequadamente tratados. Na análise univariada comparando gestantes com parceiros tratados para sífilis e não tratados, identificaram-se características associadas à ocorrência de tratamento adequado do parceiro em relação a mulheres que apresentaram sífilis gestacional: a) mais de oito anos de estudo (p=0.022), b) acompanhamento pré-natal adequado (p=0.010) e diagnóstico da sífilis no pré-natal (p=0.003). Conclusão: Escolaridade, diagnóstico precoce de sífilis, e a realização de pré-natal adequado parecem ser fatores determinantes para o adequado tratamento do parceiro e prevenção da transmissão vertical da doença. / Introduction: Syphilis in pregnant women is a public health problem, with increasing cases each year. Treatment of the sexual partner of the pregnant women with syphilis is very important because the lack of treatment may invalidate all control measures imposed during prenatal care. Objective: to describe the occurrence of treatment of the sexual partner and evaluate maternal factors that favor the realization of the treatment of the sexual partner of pregnant women with gestational syphilis treated in Hospital Fêmina. Method: This is a cross-sectional descriptive study, in which were described the cases of patients diagnosed with gestational syphilis in the Obstetrics Department of Hospital Fêmina, and their partners, from January 1st 2007 to December 31st 2014. Data collection was done through the data sent by the Department of Infection Control to Department of Health Surveillance of Porto Alegre in syphilis, along with the records of patients. Ethical principles will be were respected. The project had approval of the ethics committee of Grupo Hospitalar Conceição under protocol number 47914815.2.0000.5530. Results: 771 cases of syphilis in pregnant women were identified. No information on the treatment of the sexual partners was available in 570 of these cases. Among the 201 cases presenting information about the partners treatment, 25 (12.44%) of them were adequately treated. In the univariate analysis comparing women whose partners were treated for syphilis with those untreated demonstrates the associated characteristics as: a) more than eight years of study (p =0.022); b) adequate prenatal care (p= 0.010) and diagnosis of syphilis in prenatal care (p= 0.003). Conclusion: The years of study, the early diagnosis of syphilis and an adequate prenatal care appear to be determining factors for appropriate partner treatment and prevention of the vertical transmission of the disease.

published_or_final_version / Community Medicine / Master / Master of Public Health

IT2018

Boston University. University Professors Program Senior theses. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-02

Thesis (Ph.D.)--McMaster University, 2004. / Advisor: S. R. Saunders. Includes bibliographical references (leaves189-209). Also available online.

Submitted by Oliveira Santos Dilzaná (dilznana@yahoo.com.br) on 2016-03-15T12:36:36Z No. of bitstreams: 1 TESE RICARDO DOS SANTOS BATISTA.pdf: 4766222 bytes, checksum: 3dd9b32a590a9a39f71573f0f801ece6 (MD5) / Approved for entry into archive by Ana Portela (anapoli@ufba.br) on 2016-03-28T18:53:50Z (GMT) No. of bitstreams: 1 TESE RICARDO DOS SANTOS BATISTA.pdf: 4766222 bytes, checksum: 3dd9b32a590a9a39f71573f0f801ece6 (MD5) / Made available in DSpace on 2016-03-28T18:53:50Z (GMT). No. of bitstreams: 1 TESE RICARDO DOS SANTOS BATISTA.pdf: 4766222 bytes, checksum: 3dd9b32a590a9a39f71573f0f801ece6 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Este trabalho tem como objetivo analisar o processo de Reforma Sanitária ocorrido na Bahia a partir de 1920, quando foi criado o Departamento Nacional de Saúde Pública e, consequentemente, uma Legislação Sanitária Nacional, até o ano 1945, quando se encerraram as políticas centralizadoras do Estado Novo. Destaca-se que esse momento foi marcado pela vigência do federalismo, advindo da Proclamação da República, que dava autonomia aos estados e municípios para a tomada de decisões relativas aos seus territórios. As ações da Inspetoria de Profilaxia da Lepra e Doenças Venéreas, responsável pelo combate à sífilis, grande flagelo que atingia os sertões do Brasil desde fins do século XIX até a década de 1940, foram eleitas como foco de análise. Ao longo da segunda década do século XX, as viagens realizadas pelos pesquisadores do movimento sanitarista haviam denunciado a situação de analfabetismo e apatia da população do interior do país, considerando-os degenerados não pela mistura racial, mas pela situação de doença em que se encontravam: sifilíticos, tuberculosos, leishmaniosos, abandonados pela ação estatal. As ações médicas, no sentido de saneamento dos sertões, estavam orientadas pelas novas descobertas científicas para o período, notadamente a concepção bacteriológica. Mas, ao se colocar em prática o projeto, inúmeras tensões se revelaram, especialmente em relação à intervenção do poder central num estado marcado pelas elites coronelistas que, inclusive, utilizavam a saúde como instrumento de negociação. Para o desenvolvimento desta pesquisa, foram colocadas em diálogo informações de relatórios médicos, legislação nacional e estadual, jornais, teses da Faculdade de Medicina da Bahia, entre outras fontes, no intuito de compreender os conflitos de ordem política, as articulações entre elites médicas e os empecilhos encontrados no processo de reforma. Considera-se que a política-sanitária conseguiu atingir o estado da Bahia, inclusive lugares distantes da capital, por meio dos centros de saúde e da ação de médicos que enfrentaram adversidades no combate às enfermidades, como a falta de verbas e de material e as grandes distâncias entre as cidades. Ao fim de 1945, um novo quadro se configurava com a consciência da necessidade de acabar com o uso indevido de recursos públicos na esfera privada: destinavam-se verbas específicas para o funcionamento dos postos de saúde e proliferavam-se instituições sanitárias por todo o sertão da Bahia. This study analyzes how a National Public Health Policy initiated in 1920, with the creation of the National Department for Public Health and of a National Public Health Legislation, was implemented in Bahia until 1945, when centralizing policies under the 'Estado Novo' period were terminated. It is important to note that this moment was marked by the prevalence of federalism, originating from the Proclamation of the Republic, which provided autonomy for states and municipalities regarding decisions over their respective territories. The actions carried out by the Inspectorship for the Prevention of Leprosy and Venereal Diseases, responsible for the fight against syphilis, a significant scourge that affected the Brazilian backcountries ('sertões') from the end of the nineteenth century up to the 1940's, were selected as the focus of analysis within this study. Throughout the second decade of the twentieth century, trips carried out by researchers from the sanitarian movement denounced the situation of illiteracy and apathy within the countryside population, considering it degenerate not because of racial mixing, but for the context of illness which poor populations were facing, abandoned by state policies. Medical actions concerning the sanitation of the backcountries were oriented by the new scientific discoveries from the period, notably the bacteriological perspective. However, within the project's implementation process, numerous tensions emerged, especially concerning the intervention from a central power in a state marked by the presence of 'coronelista' elites which also used healthcare as a negotiation tool. For the development of this research, a dialogue amongst information from medical reports, national and state legislations, newspapers, theses from the Medical School of Bahia and other sources was developed, in order to comprehend the conflicts and articulations among medical elites, and the obstacles faced during this reform process. It is deemed that the sanitation policy could reach the state of Bahia, even in places located far from its capital city, throughout primary healthcare centers and actions from medical professionals who faced adversities in the fight against diseases, such as the lack of economic and material resources and the significant distances between cities. In the end of 1945, a new paradigm was in place, with consciousness about the necessity to erradicate the undue utilization of public resources within the private sphere. Besides that, specific financial resources were allocated to the functioning of primary healthcare facilities, and sanitation institutions proliferated throughout all of Bahia's backcountries.

Made available in DSpace on 2014-06-11T19:29:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-23Bitstream added on 2014-06-13T21:00:20Z : No. of bitstreams: 1 kawaguchi_ial_me_botfm.pdf: 129396 bytes, checksum: 244de82b96a6aaee3004656ae0aac435 (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / A sífilis congênita apresenta elevada morbidade e mortalidade. Permanece com altas taxas de transmissão no Brasil e representa um desafio para a saúde pública, apesar do tratamento acessível de baixo custo. O objetivo deste trabalho foi descrever o perfil terapêuticoassistencial da sífilis congênita na SES/DF. Trata-se de um estudo descritivo, com dados secundários, a partir das identificações dos casos em 2008, pelos hospitais selecionados para o estudo e notificados junto a Diretoria de Vigilância Epidemiológica da SES/DF (DIVEP/DST/AIDS/DF), com a identificação dos 81 casos, buscou-se nos hospitais e centros de saúde, as informações relativas à sífilis congênita, dados obstétricos e epidemiológicos da mãe. Foram encontradas, 87,5% gestantes que fizeram o pré-natal, 17,3% gestantes que não realizaram VDRL no pré-natal. O tratamento dos RN foi inadequado quanto ao manejo clínico em 51,7%. Observou-se inconstância na realização dos exames: radiológico, hemograma e líquor cefalorraquidiano, encontrado campos em branco ou ignorados em fichas de notificação compulsória, prontuários da mãe e da criança. Quanto ao acompanhamento das crianças até os 18 meses de vida e o seguimento terapêutico, não foi possível avaliar a aplicação do Protocolo do MS, devido a não localização de registros. Conclui-se que há falhas no controle da transmissão vertical da sífilis, nas intervenções terapêuticas e o seguimento das crianças com SC requer ações ordenadas, capacitação profissional, integração entre os serviços de assistência e vigilância / Congenital syphilis has high morbidity and mortality. Remains with high transmission rates in Brazil and as a public health challenge, despite the affordable low cost treatment. The objective of this study was to describe the therapeutic -assistant profile of congenital syphilis in the SES / DF. It is a descriptive study ,using secondary data ,from the identification of cases in 2008, of hospitals selected for the study and reported along with the Directorate of Epidemiological Surveillance SES / DF (DIVEP / STD / AIDS / DF). With the identification of 81 cases, we seek at hospitals and health centers, information on congenital syphilis, obstetric and epidemiological data from the mother ,were surveyed, and then, with this, a profile of children with CS was made. Were found 87.5% pregnant women who received prenatal care, 17.3% women were not performed in this pregnancy VDRL, and treatment of newborns were inadequate and the clinical management in 51.7%. There was inconsistency in the examinations: X-rays, blood counts and cerebrospinal fluid, finding fields in blank or ignored in compulsory notification forms, such as charts of mother and child. The monitoring of children up to 18 months and therapeutic treatment witch the implementation of the Protocol to the MS was not possible to due to not finding records. We conclude that there are flaws in the control of vertical transmission of syphilis, in the therapeutic interventions in children. The class of SC requires actions ordered, professional capacitation, and integration of care services and supervision

Treponema pallidum ssp. pallidum is the causative agent of syphilis, a multi-stage bacterial infection, transmitted sexually or from mother-to-child, with an unparalleled range of symptoms arising from the ability of treponemes to penetrate any tissue and cross immune privileged endothelial barriers to access the brain, the eye, and the fetus. Further, without treatment T. pallidum evades immune clearance and persists within the host to establish a chronic infection. These characteristics suggest that T. pallidum may have evolved unique mechanisms for immune escape and to mediate host-cell interactions. The findings presented in this dissertation contribute to our knowledge of T. pallidum pathogenesis by investigating a previously unexplored host-cell interaction, between T. pallidum and human platelets. These results validate the hypothesis that, as a pathogen which successfully utilizes vascular dissemination, T. pallidum would not only encounter, but interact with human platelets, complex cells now viewed as vascular sentinels that participate in many host-pathogen interactions. This is the first study to demonstrate that T. pallidum interacts with human platelets and to characterize and quantify these interactions using high resolution microscope imaging techniques (video and frame analysis). These interactions were shown to be complex, reversible and mediated by motile treponemes localizing to stationary, (slide-adhered) activated platelets, versus to free-floating, inactive platelets. In addition, it was found that T. pallidum discriminates between the level of platelet activation and preferentially localized to the most activated platelet. Treponema pallidum was also able to induce platelet activation following an extended lag period. Modified chemotaxis assays quantified by flow cytometry, were used to investigate the migration of T. pallidum in response to the plasma of platelets differentially activated with infection-relevant host components (thrombin, collagen). The results herein reveal that T. pallidum discriminates between different mechanisms of platelet activation, with a significant preference towards the secretions of collagen-activated platelets (under these experimental conditions), compared with that of inactive or thrombin-activated platelets. Previously, T. pallidum chemotaxis had been investigated through genomic characterization and molecular interaction studies with recombinant proteins. This investigation is the first time live T. pallidum was utilized for in vitro chemotaxis assays and is also the first study of pathogen chemotaxis in response to the secretions of differentially activated platelets. The body of work in this dissertation provides a foundation to further investigate the role of T. pallidum-platelet interactions during infection, adding a new host-cell interaction to our understanding of T. pallidum pathogenesis. The evidence that the molecular gradients of host components can affect T. pallidum migration suggests an important role for chemotaxis during T. pallidum infection. Together, the characterization of platelet-interactions and treponeme chemotaxis in response to host components, adds to our knowledge of T. pallidum-host interactions, and eludes to additional pathogenic strategies that may facilitate T. pallidum dissemination and immune evasion. / Graduate / 2022-01-14

Objectives: Rates of maternal syphilis have increased five-fold in Brazil in the past decade. While penicillin remains the only appropriate treatment for maternal syphilis, we hypothesized that low non-treponemal titers (<1:16) may lead to reduced penicillin treatment in Brazil. Methods: Using Brazilian Ministry of Health data on women diagnosed with maternal syphilis between January 1, 2010, and December 31, 2018, we conducted a random-effects logistic regression model with a cluster correction at the state level to evaluate predictive factors of penicillin treatment. Results: We observed yearly increases in cases of pregnant women with syphilis from 2010 to 2018. There was significant variation by state: 52,451 cases were reported in São Paulo, followed by 26,838 in Rio de Janeiro. Among 215,937 cases of maternal syphilis, 91·3% received penicillin. In the random-effects model, a non-treponemal titer ≥1:16 was associated with 1·44 higher odds of receiving penicillin (95% confidence interval [CI]: 1·391·48), and prenatal care was associated with a 2·12 increased odds of receiving penicillin (95% CI: 2·022·21). Although there is an association between the absence of prenatal care and inadequate treatment for syphilis, 83·2% of women in this cohort who did not receive penicillin were engaged in prenatal care. Conclusions: Providers may inappropriately exclude low non-treponemal titers and thereby fail to use penicillin treatment in maternal syphilis. While the cause of the maternal syphilis epidemic in Brazil is multifactorial, we believe our findings can be used to develop targeted interventions throughout Brazil as well as shape public health initiatives globally. / National Institute of Mental Health / Revisión por pares

Diss. (sammanfattning) Stockholm : Karol. institutet, 2006. / Härtill 5 uppsatser.