Hospital Universitário Regional de Maringá

O objetivo deste estudo foi identificar e discutir fatores desencadeantes do uso de drogas em mulheres. Estudo qualitativo de caráter descritivo com 12 mulheres provenientes de três municípios do Paraná, notificadas a um centro de assistência toxicológica nos anos 2008 a 2010. Os dados foram coletados da ficha de Ocorrência Toxicológica dos prontuários, e do roteiro para entrevista semiestruturado aplicado durante visita domiciliar e analisados por conteúdo temático. A maioria era da raça/cor parda, estava entre 17 e 33 anos e convivia em união estável. Os fatores desencadeantes do uso de drogas estavam relacionados às características individuais das mulheres e aspectos socioculturais. Destacaram-se a faixa etária precoce, baixa escolaridade, baixa inserção no mercado de trabalho, conflitos intrafamiliares e o uso e tráfico de drogas pelos companheiros e parentes. Verificaram-se vínculo afetivo fraco, com dinâmica familiar inadequada. Amigos, familiares e companheiros favoreceram o comportamento aditivo.

OBJECTIVE: To conduct a geospatial analysis of suicide deaths among young people in the state of Paraná, southern Brazil, and evaluate their association with socioeconomic and spatial determinants. METHODS: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Data on suicide mortality rates (SMR) were extracted for three age groups (15-19, 20-24, and 25-29 years) from two 5-year periods (1998-2002 and 2008-2012). Geospatial data were analyzed through exploratory spatial data analysis. We applied Bayesian networks algorithms to explore the network structure of the socioeconomic predictors of SMR. RESULTS: We observed spatial dependency in SMR in both periods, revealing geospatial clusters of high SMR. Our results show that socioeconomic deprivation at the municipality level was an important determinant of suicide in the youth population in Paraná, and significantly influenced the formation of high-risk SMR clusters. CONCLUSION: While youth suicide is multifactorial, there are predictable geospatial and sociodemographic factors associated with high SMR among municipalities in Paraná. Suicide among youth aged 15-29 occurs in geographic clusters which are associated with socioeconomic deprivation. Rural settings with poor infrastructure and development also correlate with increased SMR clusters.

Oropharyngeal candidiasis is the most common fungal infection among patients infected with the human immunodeficiency virus. It can be treated with either systemic or topical antifungal agents, which are indicated empirically on the basis of clinical data. The objective of this study was to determine the frequency of yeast in mouthwashes from HIV-positive patients, compare the results between patients presenting different states of immunodeficiency, and investigate the susceptibility profile of the species isolated in relation to antifungal agents, with the aim of evaluating whether the treatments used in clinical practice are able to reach the majority of the species identified. Yeasts were isolated from 58% of the mouthwash samples collected. Candida albicans was the most (93%) frequent species. Resistance or dose-dependent susceptibility in relation to the antifungal agent tested was registered in approximately 17% of the samples. The significant variability of responses suggests that there are limitations regarding the effectiveness of the empirical therapies instituted.

Objetivou-se analisar os fatores associados à intoxicação em crianças, a partir de casos registrados no Centro de Controle de Intoxicações do Hospital Universitário Regional de Maringá. Estudo exploratório descritivo, com busca retrospectiva em registros de intoxicação em crianças atendidas em 2008. Os resultados evidenciaram como fatores associados à intoxicação infantil o sexo masculino e a faixa etária entre zero e quatro anos; como fator predisponente, a residência, em que presença do adulto no momento do acidente não impediu a ocorrência da intoxicação; e entre os fatores desencadeantes o acesso facilitado a medicamentos e a via de exposição oral. Considerando a intoxicação infantil um agravo evitável, o foco está na prevenção, com orientações sobre acondicionamento de agentes tóxicos, vigilância das famílias com conscientização dos riscos do ambiente doméstico, bem como apoio estatal, com implantação de embalagem de proteção à criança, com tampa inviolável e disponibilização de doses fracionadas para extinguir as "farmácias caseiras".

This exploratory-descriptive study aims at elaborating a protocol, using therapeutic play, for the preparation of preschool children to venous puncture and also at testing its efficiency and applicability. The children that attended the play session were more cooperative when they were punctured. They understood the need and technical aspects of this clinical procedure; manifested their feelings, elaborated familiar and hospital situations that resulted in a better relationship with the other children and the nursing team. Authors concluded that this protocol is feasible and useful and suggested that it should be incorporated in the nursing care plan to hospitalized children.

Sexually transmitted infections (STIs) represent a global health problem with variable prevalence depending on the geographical region and the type of population. Human papillomavirus (HPV) encompasses widespread virus types related to cervical carcinogenesis. The present study investigated the molecular prevalence of HPV and seven other important STIs in asymptomatic women working or studying at a Brazilian university. A secondary aim was to assess cytological abnormalities associated with HPV and other STIs coinfections. We recruited 210 women from a Brazilian university. HPV was detected using a single-round polymerase chain reaction (sPCR) followed by a viral genotyping by restriction fragment length polymorphism (RFLP-PCR). The presence of seven STIs: Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1 and HSV-2 was detected by multiplex PCR (M-PCR). Furthermore, cytological findings and epidemiological characteristics were evaluated.The mean age of the participants was 27.1 years old. HPV prevalence was 33.8%, and HPV16 was the most frequently detected papillomavirus genotype. Moreover, multiple HPV infections were common (42.2%). We detected at least one STI agent in 11.4% of the tested women, most frequently C. trachomatis (6.7%). Among HPV-positive women, 14.1% were coinfected with other STI agents. Cytological abnormalities were observed in 9.5% of smears, and HPV-DNA, high-risk HPV (HR-HPV), HPV16 and HPV multiple infections were associated with abnormal cytological findings. There was a high prevalence of HPV, and C. trachomatis was the most prevalent STI agent, with low rates of cytological abnormalities. These findings highlight the need of timely STI diagnosis in young asymptomatic women and of a public policy design for STI prevention.

Este estudo retrospectivo teve por objetivo caracterizar as tentativas de suicídio entre idosos e registradas de janeiro de 2004 a dezembro de 2010 em um Centro de Informação e Assistência Toxicológica do Paraná. Os dados foram coletados das fichas de ocorrências toxicológicas de 66 tentativas de suicídio; as variáveis sociodemográficas e clínicas foram processadas no software Statistics 7,0®, e o teste do qui-quadrado foi aplicado ao nível de 5% de significância. As tentativas de suicídio entre em idosos representaram 2,47% do total de tentativas registradas, ocorreram em indivíduos com idade entre 60 a 69 anos, com até 8 anos de estudo, aposentados, procedentes de Maringá e região metropolitana. A tentativa se deu pelo emprego de agrotóxicos ou medicamentos de uso para tratamento psiquiátrico. Conclui-se que a caracterização das tentativas de suicídio nesta população permite o planejamento de ações preventivas desta ocorrência.

O presente trabalho objetivou operacionalizar o procedimento de vigilância epidemiológica de evento sentinela a partir da internação de jovens com diagnóstico de intoxicação aguda ou efeitos secundários decorrentes do uso de drogas de abuso. O estudo, do tipo retrospectivo, exploratório descritivo, foi desenvolvido no município de Maringá - PR, com jovens internados e cadastrados no Centro de Controle de Intoxicações, nos meses de fevereiro a julho de 2006. As fontes de dados foram a ficha de ocorrência toxicológica, o prontuários hospitalar de pacientes e um roteiro para entrevista domiciliar. A análise foi feita por meio de estudo de casos múltiplos, utilizando o modelo de investigação de eventos sentinela. Foram investigados 10 casos. Fatores de risco em várias áreas e a interface entre políticas de educação, segurança pública, assistência social, economia e saúde, inadequadas e deficientes, parecem determinar a ocorrência do uso de drogas de abuso nos casos investigados.

Lungs are among the main sites affected by paracoccidioidomycosis. However, the alterations are not always easy to differentiate from other respiratory disorders. The objectives of the present study were to investigate the frequency of lung impairment in paracoccidioidomycosis cases and to investigate whether any clinical-radiological association exists. A retrospective study was carried out from March 1996 to November 2006, among patients with paracoccidioidomycosis at the Regional University Hospital of Maringá, Paraná, Brazil. Over this period, 45 cases were confirmed, of which 79.5% presented radiological abnormalities on chest X-rays, and four of them also presented pulmonary tuberculosis. Out of the total of 40 patients with paracoccidioidomycosis alone, 57.5% presented respiratory clinical manifestations, whereas 77.5% presented radiological abnormalities, thus demonstrating clinical-radiological dissociation. On the other hand, 80.6% of the patients who presented radiological abnormalities said that they smoked. We concluded that although morphological abnormalities in the lungs are frequent, they do not always correspond to respiratory signs and symptoms and cannot easily be attributed exclusively to paracoccidioidomycosis.

The purpose of the present study was to identify, according to the mothers' perspective, the benefits related to her permanence and participation in the care for her child hospitalized at a Pediatric Intensive Care Unit (PICU). The theoretical framework was Cross-cultural Nursing Theory, and the methodological framework was the assistant convergent research approach. Data was collected from six mothers of children hospitalized at a PICU of a University Hospital, in the period from January to May 2007, through interviews and active observation. Analysis was conducted following four generic processes: collection, synthesis, theorization and application. The results evidenced that the mothers' presence and care increased the attachment between mother and child, increased mothers' confidence, and made the child calmer. This produced positive feelings such as joy and satisfaction for being able to care for their child. Nurses should review their behavior toward the mothers accompanying their child at the hospital, and adopt attitudes that support her participation in the care for her hospitalized child.

OBJECTIVE: to describe the profile of poisoning leading to children's hospitalizations, as registered at the Maringá Regional University Hospital Poisoning Control Center in the period 2006 to 2011. METHODS: this was a descriptive epidemiological study using secondary data from Intoxication Incident Report Forms, involving poisoned children aged between 0 and 14 years, hospitalized for at least 12 hours. RESULTS: 694 hospitalizations due to poisoning were registered, with medication poisoning accounting for 42.4% of cases; the 1-4 age group was the most affected (66.7%); males accounted for a higher number of hospital admissions in all age groups; most poisoning cases occurred in the morning (55.6%). CONCLUSION: medication was the main cause of poisoning; younger children and males were predominant among hospitalized victims.

Objective To identify the prevalence of risk related to drug use among workers of a construction company and to evaluate how it relates with sociodemographic variables. Methods A cross-sectional study conducted with 418 workers who were given the Alcohol, Smoking and Substance Involvement Screening Test. Multinominal logistic regression was used as a measure of association. Results Tobacco, alcohol, cannabis, cocaine and inhalants were the most used drugs. Moderate and high risks were related, respectively, to the use of tobacco (32.5% and 5.7%), alcohol (26.8% and 6.9%), cannabis (2.6% and 2.4%) and cocaine (1.2% and 0.5%). Conclusion Tobacco and alcohol were the main drugs used by workers. The level of risk related to the use of tobacco, alcohol, cannabis and cocaine were high when compared to that of the general population.

Infection by the protozoan Toxoplasma gondii during pregnancy demands greater attention from the health authorities due to the risk of placental transmission, which can have devastating consequences to the foetus and newborn. This study was conducted in a high-risk prenatal care outpatient clinic of a university teaching hospital. Pregnant women screened for specific IgM and IgG anti -T. gondii, attended from January 2009 to August 2018 were included. From 530 suspected patients, 218 were followed up and they presented positive IgM and IgG anti- T. gondii. From these patients, 83 (38.0%) had low IgG avidity, 39 (18%) seroconverted in the second or third trimester of pregnancy, 19 (8.7%) had no avidity test, 69 (31.6%) had high IgG avidity after 16 weeks of gestation, five had recurrent chorioretinitis (2.2%) and three (1.3%) were seropositive to HIV. Complementary diagnoses were made in 30/48 (62.5%) of the patients revealing the presence of specific IgA antibodies raised to T. gondii; 3/63 (4.8%) peripheral blood samples and 1/57 (1.8%) amniotic fluid sample. There were eight foetal deaths, one case of neonatal hepatomegaly and one case of T. gondii DNA detected in a peripheral blood sample. Of the 139 newborn deliveries at the teaching hospital, there was a 38% loss of follow-up. The prevalence of congenital toxoplasmosis was 1.2 cases/1,000 live births in this study area, according to the retrospective survey of cases. Prenatal treatment may have helped to reduce the risk of vertical transmission.

INTRODUÇÃO: No ambiente hospitalar, são frequentes as infecções por leveduras do gênero Candida spp., o que torna esse assunto um importante alvo de estudos. OBJETIVO: Avaliar o perfil de suscetibilidade aos antifúngicos de espécies de Candida de pacientes internados no Hospital Universitário Regional de Maringá-PR (HURM). MATERIAL E MÉTODOS: As amostras foram submetidas ao teste de microdiluição em caldo (MD), segundo o documento M27-A3 para determinação da concentração inibitória mínima (CIM), e ao teste de difusão em disco de acordo com o documento M44-A2, ambos do Clinical Laboratory Standarts Institute (CLSI). RESULTADOS E DISCUSSÃO: Foram obtidos 91 isolados provenientes de amostras de urina, hemocultura, ponta de cateter, secreção orotraqueal, entre outros, sendo 38 Candida albicans, 23 C. tropicalis, 16 C. gabrata, 10 C. parapsilosis e quatro C. krusei. Dos antifúngicos testados, anfotericina B, voriconazol e anidulafungina foram os mais eficazes. CONCLUSÃO: A comparação entre as metodologias de microdiluição em caldo e disco difusão (DD) mostrou boa correlação para fluconazol para a maioria das espécies de Candida spp., sendo possível destacar que a DD é útil para triagem dos principais antifúngicos usados na prática clínica. No entanto, casos de resistência detectados por DD devem ser confirmados por meio do método de MD, evitando, assim, resultados falsos resistentes, melhorando a eficácia e a segurança do tratamento.

O Ministério da Saúde define Diabetes mellitus como síndrome de etiologia múltipla, decorrente da falta da insulina e/ou da incapacidade da insulina exercer adequadamente seus efeitos. Essa doença vem apresentando incidência com proporções cada vez maiores em nosso meio. Assim, nesse estudo, nosso objetivo foi compreender os sentimentos suscitados pelos cuidadores informais que cuidam de crianças menores de 12 anos com Diabetes mellitus tipo 1. Para tanto, optamos por um estudo qualitativo, embasado nos princípios da fenomenologia existencial. A pesquisa foi realizada em uma cidade do Noroeste do Paraná, nos meses de junho e julho de 2007. Os seis entrevistados foram inquiridos com a seguinte questão: “O que significa para você cuidar de uma criança diabética?". Da análise emergiram quatro categorias: descobrindo o diagnóstico do filho; convivendo com a doença; vivenciando a necessidade de compartilhar seu pesar e; a importância da espiritualidade para o entendimento da situação. Depreendemos que vivenciar esta situação é um fardo difícil de ser abarcado pelos cuidadores e que o impacto da doença pode causar crises de adaptação no enfrentamento da família. Portanto, devemos estar atentos ao modo como o portador de diabetes e seus familiares sentem, enfrentam e interpretam o diabetes e seu tratamento.

Objetivo: identificar a presença e as ações de adultos no local da ocorrência de acidentes toxicológicos infantis e os primeiros socorros realizados. Método: estudo transversal, com análise retrospectiva de fichas de ocorrência toxicológica de crianças de zero a 4 anos, arquivadas em um centro de assistência toxicológica. Resultados: analisaram-se 1.012 fichas. O perfil era: sexo masculino (54,9%), com idade de 1 a 2 anos (64,3%) e medicamentos como principais agentes (39,6%). A maioria dos acidentes aconteceu na residência (94,8%), com crianças acompanhadas dos pais ou outro responsável adulto. Imediatamente após o reconhecimento do episódio de intoxicação, 229 (22,6%) adultos realizaram socorros domiciliares e as principais ações informadas foram realização de descontaminação do local afetado por lavagem e por meio mecânico (49,3%); administração de líquidos para diluição do agente (32,8%); e indução de vômito/êmese (16,6%). Conclusão: a maioria dos socorros domiciliares realizados não teve evidência científica e estava ligada a crenças familiares.Descritores: Saúde da criança. Envenenamento. Substâncias tóxicas. Acidentes domésticos. Cuidados de enfermagem

OBJETIVO: Acompanhar o crescimento de bebês de risco no primeiro ano de vida. MÉTODOS: Estudo analítico, do tipo coorte, realizado com 237 bebês nascidos em Maringá - PR, entre 1º de maio a 31 de outubro de 2008, incluídOs no Programa de Vigilância do Bebê de Risco. RESULTADOS: As alterações de crescimento estiveram presentes em 188 (79,3%) bebês e ocorreram sobretudo, após o 1º trimestre de vida. A velocidade de crescimento abaixo da esperada apresentou associação estatística com idade materna menor que 18 anos, tempo de estudo inferior a 8 anos, presença de anomalia congênita, peso ao nascer maior ou igual a 2.500g e nascimento a termo. CONCLUSÃO: A avaliação do crescimento dos bebês de risco deve abarcar uma análise multidimensional, considerando os aspectos biológicos e maturacionais específicos a cada condição de risco e a adaptação do bebê e de sua família nesse percurso evolutivo.

O presente estudo objetivou analisar as intoxicações por saneantes comercializados clandestinamente e notificadas no Centro de Controle de Intoxicações do Hospital Universitário Regional de Maringá, em um estudo do tipo quantitativo, com análise retrospectiva de fichas epidemiológicas de pessoas intoxicadas por estes agentes, no período de janeiro de 2005 a dezembro de 2009. Dos 118 casos notificados, 75 (63,5%) ocorreu no sexo masculino, 105 (88,9%) necessitaram de assistência em unidades de atenção às urgências e internações de alta complexidade, em 14 casos (11,8%) houve necessidade de internação em Terapia Intensiva, e foram registrados cinco óbitos, todos decorrentes de intoxicação intencional. Os dados encontrados demonstram a gravidade e letalidade deste tipo de intoxicação e indicam ações para medidas urgentes de fiscalização e controle da Vigilância Sanitária e de medidas de educação de consumidores, ressaltando o papel educativo da Enfermagem

Purpose This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM). Methods Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25). Results The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates' correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher's exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively. Conclusions The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.

The objective of this study was to learn the feelings and difficulties of women with the human immunodeficiency virus (HIV) in face of not breastfeeding and the care offered to them. Thirty-six women/mothers with HIV and under follow-up at an STD/Aids outpatient clinic were interviewed. A qualitative study was conducted, using the Collective Subject Discourse method, which was represented by means of five discourses. The most relevant results show that the study participants suffer as a result of not being able to breastfeed their children and the lack of individualized care, especially regarding breast issues. The discourses evidenced beliefs that demystify the symbolism of breastfeeding, which strengthens these women to accept the fact that they cannot breastfeed. In conclusion, the care for this specific group must be individualized so as to assist them, especially, with their emotional conflicts in the non-breastfeeding process, as well as with their breast problems.