Orientadores: Clarice Weis Arns, Sandra Cecilia Botelho Costa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T16:35:45Z (GMT). No. of bitstreams: 1 Campalans-Barnier_Jacqueline_D.pdf: 1182672 bytes, checksum: 06bfe547650a3661c7baf01f2228c101 (MD5) Previous issue date: 2002 / Resumo: O vírus respiratório sincicial bovino (BRSV) causa infecção aguda do trato respiratório em bovinos e está amplamente disseminado no mundo inteiro, provocando grandes perdas econômicas aos produtores. O presente projeto visou realizar a caracterização do vírus respiratório sincicial bovino (BRSV), denominado BRSV-25-BR, isolado de bezerro de dois meses de idade, proveniente de rebanho com sintomas de doença respiratória do Estado do Rio Grande do Sul, comparando o mesmo com isolados de BRSV de outros países. O passo inicial foi adaptar os diferentes isolados virais em sistema celular e, para tanto, foram utilizados cultivos de células CER ("Chicken Embryo Related¿). A análise morfológica do isolado brasileiro foi realizada através de microscopia eletrônica por contrastação negativa e o resultado dessa análise indicou que o isolado estudado, BRSV-25-BR, é um vírion arredondado, pleomórfico, de tamanho aproximado de 100 a 300 nm, com numerosas espículas espalhadas na superfície. Foi realizada uma comparação do genoma dos isolados virais utilizando a técnica de RT-PCR dupla. Foram utilizados os iniciadores B1, B2A, B3 e B4A para a proteína F que resultou na amplificação do fragmento no tamanho esperado, 481 pb. A análise desta seqüência revelou 97% de identidade de nucleotídeos das seqüências da proteína F do isolado BRSV-25-BR com as estirpes de BRSV armazenadas no GeneBank. A RT-PCR dupla utilizando os iniciadores B5A, B6A, B7A e B8 para a proteína G, amplificaram um fragmento do genoma viral do tamanho esperado, 371 pb. A porcentagem de identidade entre a seqüência do BRSV-25-BR e o fragmento equivalente das estirpes armazenadas no GeneBank encontrada foram entre 92 e 95%. A seqüência dos aminoácidos derivados da proteína G do isolado brasileiro comparado com as seqüências dos isolados registrados no GeneBank sugere sua associação ao subgrupo B. A informação obtida nesta pesquisa a partir da seqüência da proteína G permite afirmar que o isolado do Brasil é uma estirpe de BRSV diferente daquelas atualmente circulantes nas demais partes do mundo. Esta informação contribui para uma maior compreensão da epidemiologia e para o desenvolvimento de vacinas adequadas para o nosso meio / Abstract: The bovine respiratory syncytial virus (BRSV) causes acute infection in the respiratory tract of cattle and is wide spread in the world, causing significant economic losses. The objective of this project was to characterize the BRSV, named BRSV-25-BR, isolated from a 2 months calve from Rio Grande do Sul state cattle, which presented respiratory disease symptoms. This sample was compared against BRSV strain isolates from other countries. The initial step was to adapt the viral samples in cellular culture. To achieve this purpose, a CER (Chicken Embryo Related) cell culture was used. The morphologic analysis was done through electronic microscopy using a negative stain. A genomic comparison to the viral isolates was carried out. The outcomes of the analyses indicate that the analyzed sample, named BRSV-25-BR, is an rounded, pleomorphic virion, between 100-300 nm in size and numerous spikes over the surface. The amplification of the expected size fragment, which was 481 pb, was observed through a nested RT-PCR technique, using the B1, B2A, B3 and B4A primers for the F protein. The analyses of this sequence of nucleotides revealed 97% identity between the F protein sequence of the isolated BRSV-25-BR and the strains of BRSV equivalent sequences stored in the GeneBank. The amplification of the viral genome on an expected size fragment (371 pb) was achieved using the nested RT-PCR, in which the B5A, B6A, B7A and B8 primers for the G protein were used. The identity percentage between the BRSV-25-BR sequence and the compensative fragment of the GeneBank stored strains was smaller, ranging between 92% and 95%. A probable association to the B subgroup is suggested from the deduzed amminoacid sequence of the G protein of the Brazilian sample compared to the sample sequences registered in the GeneBank. The information gathered from this research project allows to affirm that the isolated Brazilian sample belongs to a kind of BRSV different from those present in the world and contribute with a values to epidemiologic studies / Doutorado / Ciencias Basicas / Doutor em Clínica Médica

Class of 2013 Abstract / Specific Aims: The objectives of this project were to determine the time to appropriate antibiotic therapy for community-acquired pneumonia, evaluate the appropriateness of antibiotic changes within a 72 hour period, and to determine the rate of re-admissions for pneumonia. Methods: A retrospective chart review of patients admitted to an academic medical center in March 2012 with a diagnosis of pneumonia was performed. Subjects under the age of 18 years or who were not treated for infectious pneumonia were excluded. Relevant data were extracted from the subjects’ electronic charts and recorded onto a data collection form. Data collected included antibiotics given within the first 72 hours and times of administration, laboratory results, culture and susceptibility results, radiology results, testing for coccidiodomycosis, reason for readmissions within 30 days if applicable, and demographic information. A descriptive analysis of these data was performed. Main Results: A total 100 subjects were included in the final data analysis with a mean age of 64 years. During the first 48 hours, patients were prescribed vancomycin (52%), azithromycin (48%), ceftriaxone (41%), moxifloxacin (30%), piperacillin-tazobactam (25%), meropenem (22%), and other antibiotics (26%). The mean (+SD) number of antibiotics prescribed within the first 24 hours was 2.5 (1.1). Either azithromycin, azithromycin plus ceftriaxone, or moxifloxacin only were prescibed in 21% of subjects within the first 24 hours. Within the first day, combinations of broadspectrum antibiotics (meropenem, piperacillin-tazobactam, cefepime) or a combination of ceftrixone plus either meropenem or piperacillin-tazobactam were prescribed in 6% and 12% of subjects, respectively. The appropriateness of empiric therapy and antibiotic changes is currently in progress. A total of 53% of subjects were discharged with prescriptions for extended course oral or intravenous antibiotics. While 27% of subjects were readmitted within a 30-day period, 9% of subjects were readmitted with either a diagnosis of pneumonia or related respiratory condition. One subject was readmitted within 30 days with Clostridium difficile associated diarrhea. During the initial admission, coccidioidomycosis testing was performed in 38% of subjects. Conclusion: A variety of combinations of antibiotic agents were prescribed to subjects diagnosed with community-acquired pneumonia. Changes to antibiotic therapies were frequent and often without explanation. Readmission rates for a respiratory related illness within 30-days was approximately 9% and less than 40% of subjects were tested for coccidioidomycosis.

In this thesis I will review the current knowledge of community-acquired pneumonia, including its classification, pathogenesis, pathology, aetiology, diagnosis, and antibiotic therapy and report my experience with severe community-acquired pneumonia in patients requiring admission to our respiratory intensive care unit. The original research in this thesis comprises a prospective, descriptive analysis of 196 cases of severe community-acquired pneumonia requiring admission to the Respiratory Intensive Unit at Groote Schuur Hospital from January 1987 until December 1992, with emphasis on the influence of aetiology on the severity of pneumonia, the· aetiological diagnosis of pneumonia in severely ill patients, measures of severity of pneumonia, and an audit of ICU therapy and outcome. In addition, different aspects of novel therapies and specific aetiological varieties of pneumonia which have been investigated over the past ten years will be presented.

Abstract available in the Journal of Investigative Medicine.

No description available.

Ampicillin-sulbactam was compared with cefamandole in the treatment of bacterial pneumonia in elderly patients. Clinical improvement ard hospital discharge occurred in 25 of 26 patients in the ampicillin-sulbactam group vs. 20 of 23 in the cefamardole group (P >.06). Etiologic agents isolated from adequate sputum samples were more likely to be eradicated with ampicillin-sulbactam (24/26) than with cefamandole (15/23) (P <.05). The most common organisms isolated from elderly patients with pneumonia included Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. M. catarrhalis was eradicated from sputum in 2 of 5 patients treated with cefamandole, and these isolates had relatively high minimal inhibitory concentrations (8 to 16 μg/mL).

No description available.

MSc (Nursing), Faculty of Health Sciences, University of the Witwatersrand / The purpose of this study was to determine the knowledge of nurses working in ICU with respect to evidence based guidelines for prevention of ventilator associated pneumonia. A non experimental, descriptive, correlational and contextual two phase research design was used. The first phase of the study consisted in validating the data collection instrument for applicability to the South African context. The second phase of the study used the instrument validated in phase one to test the knowledge of nurses working in ICU. Data analysis was done by means of descriptive and inferential statistics using frequency distributions, cross-tables, means, standard deviations and Pearson correlation coefficient. The knowledge of 83 nurses working in ICU from two hospitals of the private health sector and one hospital of the public health sector in Gauteng was tested using the data collection instrument validated by ICU nursing experts. Knowledge of ICU trained and non ICU trained nurses working in ICUs of the three hospitals was found to be lacking in the evidence based guidelines for prevention of ventilator associated pneumonia. Of the 83 participants, 18 (21.69%; CI 95% 13.4% ; 32.1%) achieved a pass mark of 70% on the multiple choice part of the questionnaire and were considered to have adequate knowledge on the evidence based guidelines for prevention of VAP. The mean score of participants was 4.25 (SD 1.537 CI 95% 3.92; 4.59) on nine questions. The difference in the mean average score of ICU trained nurses and non ICU trained nurses was very similar demonstrating no statistically significant difference in the knowledge of the two groups of nurses. A weak correlation between years working in ICU and knowledge was found, but this correlation may be clinically insignificant. Recommendations to address this lack of knowledge of ICU nurses were given for clinical nursing practice, nursing education as well as for nursing research.

Paediatric community-acquired pneumonia (CAP) is common in North America. It is often treated with beta-lactam antimicrobials targeting S. pneumoniae, the most important cause of CAP in young children. Current guidelines recommend 10 days of therapy for paediatric CAP, regardless of severity; in contrast, mild CAP in adults is routinely treated with only 5 days of antimicrobials. There have been no definitive studies of 5-day vs. 10-day therapy for CAP in children. The objective of this thesis was to conduct a pilot RCT comparing 5 to 10 days of amoxicillin for the treatment of mild paediatric CAP and then design the multicentre follow-up trial. Children aged 6 months - 10 years with no significant past medical history presenting to the McMaster Children's Hospital emergency department with mild CAP were eligible for enrollment. All participants were randomized to either 10 days high-dose amoxicillin (90 mg/kg/day divided bid) or 5 days of high-dose amoxicillin + 5 days placebo. The primary outcome was clinical cure at day 14-18 post-enrollment. In total, 61 participants were recruited. The median participant age was 2.64 y. Only 60% of chest radiographs were reported by the radiologist as showing evidence of pneumonia. There were six treatment failures; one participant failed to defervesce on day 4, one participant had recurrent fevers leading to re-presentation to the emergency, and the other four participants did not meet clinical cure criteria but were essentially well at the time of follow-up. Study blinding has been maintained. The majority of previously healthy children with mild CAP who are well enough to be treated as outpatients appear to do well, regardless of duration of antimicrobial treatment. Feasibility and safety of the trial protocol have been demonstrated; the follow-up multicentre trial is slated to begin in mid-2015. / Thesis / Master of Science (MSc)

Severe infections, trauma or major surgery can each cause a state of systemic inflammation. These causes for systemic inflammation often coexist and complicate each other. Mechanical ventilation is commonly used during major surgical procedures and when respiratory functions are failing in the intensive care setting. Although necessary, the use of mechanical ventilation can cause injury to the lungs and other organs especially under states of systemic inflammation. Moreover, a course of mechanical ventilator therapy can be complicated by ventilator-associated pneumonia, a factor greatly influencing mortality. The efforts to avoid additional ventilator-induced injury to patients are embodied in the expression ‘protective ventilation’. With the use of pig models we have examined the impact of protective ventilation on systemic inflammation, on organ-specific inflammation and on bacterial growth during pneumonia. Additionally, with a 30-hour ventilator-associated pneumonia model we examined the influence of mechanical ventilation and systemic inflammation on bacterial growth. Systemic inflammation was initiated with surgery and enhanced with endotoxin. The bacterium used was Pseudomonas aeruginosa. We found that protective ventilation during systemic inflammation attenuated the systemic inflammatory cytokine responses and reduced secondary organ damage. Moreover, the attenuated inflammatory responses were seen on the organ specific level, most clearly as reduced counts of inflammatory cytokines from the liver. Protective ventilation entailed lower bacterial counts in lung tissue after 6 hours of pneumonia. Mechanical ventilation for 24 h, before a bacterial challenge into the lungs, increased bacterial counts in lung tissue after 6 h. The addition of systemic inflammation by endotoxin during 24 h increased the bacterial counts even more. For comparison, these experiments used control groups with clinically common ventilator settings. Summarily, these results support the use of protective ventilation as a means to reduce systemic inflammation and organ injury, and to optimize bacterial clearance in states of systemic inflammation and pneumonia.