Orientador: Marcelo de Carvalho Ramos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-26T14:19:04Z (GMT). No. of bitstreams: 1 Aoki_FranciscoHideo_D.pdf: 3906599 bytes, checksum: 6e221a82a1ec683a22642639f401776d (MD5) Previous issue date: 2000 / Resumo: A Criptococose, doença cosmopolita, causada pelo Cryptococcus neoformans, é conhecida há cerca de um século. A imunossupressão que decorre, tanto de tratamentos com esteróides e outros tipos de drogas, quanto de doenças degenerativas e infecciosas, facilita a multiplicação e o desenvolvimento desse agente tornando a doença importante, particularmente, nesses casos. o aparecimento da Síndrome da Imunodeficiência Adquirida (AIOS) ao final da década de 70 fez proliferar a criptococose, já que um dos efeitos daquela síndrome é '0 comprometimento acentuado das defesas dos pacientes. Neste trabalho foram estudadas trinta e três cepas de Cryptococcus neoforrnans isoladas de vinte e quatro pacientes atendidos no Hospital das Clínicas da Universidade Estadual de Campinas. Esses isolamentos foram obtidos de líquor, sangue e biópsia de pele. As trinta e três cepas de Cryptococcus neoformans foram inicialmente sorotipadas, utilizando-se o "kit" comercial "Cryptocheck" (Iatron, Japan). Vinte e quatro dessas cepas, provenientes de dezenove pacientes portadores de Aids foram caracterizadas como do sorotipo A. Das nove cepas recuperadas de pacientes sem Aids, sete revelaram-se como sendo do sorotipo A e duas do sorotipo B. Cepas de C. n eoformans sorotipos A e B foram testadas pelo método da Reação em Cadeia da Polimerase (PC R) com iniciadores comerciais aleatórios denominados R 1, R2 e R3 para determinação do seu perfil genômico (RAPD). A partir desse perfil, foi selecionada uma banda de 695 pares de bases (pb) presente apenas no perfis do sorotipo A e uma de 448 pb do sorotipo B. Esses "amplicons" foram sequenciados e, a seguir, desenvolvidos dois pares de iniciadores a serem testados para caracterização dos sorotipos A e B. Esses dois pares de iniciadores foram testados nas 33 amostras de C. neoformans previamente determinadas como sorotipos A ou B pela técnica de aglutinação. No caso do sorotipo A, de todas as amostras de referência testadas, bem como as isoladas de casos clínicos foi amplificada a sequência típica desse sorotipo (banda de 695 pb). Do mesmo modo, no sorotipo B a banda de 448 pb pode ser amplificada. A amplificação dessas seqüências especificas, utilizando os iniciadores estudados para amb'es os sorotipos foi sensível e específica, quando comparados com o teste de aglutinação. Para o estudo da Concentração Inibitória Mínima (CIM) as 33 cepas de C. neoformans foram testadas contra a Anfotericina B, o Itraconazol, o Fluconazol, a 5 - Fluorocitosina e a Anfotericina B comercial (Fungison@), de acordo com as normas do "National Commitee for Clinical and Laboratorial Standards" (NCCLS). As Concentrações Inibitórias Mínimas das várias drogas estudadas empregando-se o meio de RPM I 1640 para trinta e três cepas de C. neoformans foram: Anfotericina B: 0,25 a 2 J.lg/ml, Fungison: 0,03- 2J.lg/ml, FCZ: 0,5-32J.lg/ml; Itraconazol: 0,06-2 e 5-Fluorocitosina: 1-16 J.lg/ml. Os resultados deste estudo trouxeram uma nova abordagem para a caracterização dos sorotipos A e B de C. neoformans com base na técnica da Reação em Cadeia de Polimerase (PCR), para o conhecimento dos padrões de sensibilidade de cepas colhidas entre nós aos principais agentes antifúngicos e, ainda, para a preocupante presença de cepas dose dependentes ao Fluconazol em pacientes com e sem infecção pelo Vírus da Imunodeficiência Humana (HIV) / Abstract: 1. The cryptococcosis, a cosmopolitan disease, caused by Cryptococcus neoformans , a fungus, has been known about one century. The immunossupression that occurs by the consequence with steroids treatments and other kinds of drugs, degeneratives and infectious diseases, facilitates the proliferation and the development of these infectious agents, that permit to this disease be transformed itself in an important disease, particularly, on these cases. 2. The appearance of AIOS at the 70's end has facilitated the proliferation of cryptococcosis, since one of the effects of this syndrome is the great immunocompromise of the patients immunological defenses. 3. In this work 33 strains of Cryptococcus neoformans were isolated from 24 patients treated at the Hospital of Clinics from The State University of Campinas - State of São Paulo, Brazil. The isolation of these strains were obtained from skin, blood and specially from Central Nervous System Fluid(CNSF). 4. The 33 strains of Cryptococcus neoformans were, innitially, submitted to an identification by serotyping technique using the comercial kit named Cryptocheck(latron, Japan). Twenty four strains, from nineteen AIOS patients, were characterized like serotype A. Considering the rest of the samples, nine were from patients without AIDS, and from these nine, seven were characterized as serotype A and 2 as serotype B. 5. C. neoformans strains serotype A and B were tested by PCR method with ramdomized commercial primers denominated R 1, R2 and R3 to the determination of the genomic profile (RAPO). Using that profile, a exclusive 695 bp band were ~elected from the serotype A strains and other with 448 bp, beeing exclusive toe in the serotype B strains. These amplicons were sequenced and, after that, there was a developing of two primer pairs to be tested to the characterization of serotype A and B. 6. These two primer pairs were tested in the 33 strains of C. neoformans, previously determined like serotype A and B by the aglutination test. In the serotype A case, from ali reference strains tested, as well strains isolated from clinical cases, there was amplification of typical sequence of this serotype(695 bp band). Similarly, in the serotype B strains, a 448 bp band were amplified. The amplification of these specific sequencies, using primers studied for both serotypes was specific and sensitive, compared with the aglutination test. 7. For minimal inhibitory concentraion(MIC) study, 33 strains of C. neofonnans were tested with amphotericin B, Itraconazole, Fluconazole, 5- Fluorcytosin and commercial Amphotericin B(Fungison@), according the "National Comittee for Clinical and Laboratorial Standards"(NCCLS) proceedings. . 8. The MIC of the various studied drugs, using RPMI 1640 medium for 33 strains of C. neoformans were: Amphotericin B: 0,25 to 2 J,1g/ml; Fungison@: 0,03 to 2 J.1g/ml; Fluconazole:O,5 to 32 J.1g/ml; Itracon~zole: 0,06 to 2 J.1g/ml; 5 - Fluorcytosin: 1 to 16 J.1g/ml. 9. The results of this study showed a new approach to the characterization of C. neoformans serotype A and B based in the Protein Chain Reaction(PCR) technic, to the knowledge of C. neoformans strains sensibility collected from patients against antifungal agents and to the worried presence of strains SDD(Sensibility Dose Dependent) to the Fluconazol in patients with and without HIV infection / Doutorado / Clinica Medica / Doutor em Clínica Médica

Magister Scientiae (Physiotherapy) - MSc(Physio) / The use of high active antiretroviral therapy in people living with HIV/AIDS is increasing worldwide. In Rwanda, above 70 % of people in need of antiretroviral therapies is getting them. This drug therapy is associated with abnormal fat redistribution and metabolic complications which increase the risks of cardiovascular and diabetes diseases among these patients. The best recommended preventive and treating modality for these complications is physical activity participation. Despite this recommendation, there is lack of information about physical activity in HIV individuals under high active antiretroviral therapy. The current study aims to determine physical activity levels among people living with HIV treated with high active antiretroviral therapy in Kigali, Rwanda. A cross-sectional design using quantitative method was used. The participant's levels of physical activity participation and their association with anthropometric profiles were measured, using a structured self-administered questionnaire adapted from the Sub-Saharan Africa Activity Questionnaire. Based on a scientific calculation, 407 clients passing through the clinics were included in the study. A convenient sample of people attending the clinics approached to participate voluntarily in the study. The statistical package for social sciences version 19.0 and descriptive statistics were used to analyze the data. Inferential statistics like Chi-square test was used to determine the associations between physical activity levels and anthropometric profiles (p<0.05). Of the participants, 77% were female with a mean age of 38.82 years (SD=8.9. According to body mass index and weight hip ration, approximately 40% and 43% were obese and overweight respectively. Obesity was more common amongst the females (45%). The study found a high prevalence of inactivity in the following activities, of leisure-time (82.6%), household (71%), walking to/from work (61.7%) and work related physical activities (75%). Obesity was found to be strongly associated with inactivity in all types of activity. The findings of the current study highlighted the lack of motivation, lack of time and fear of worsening the disease amongst the strong barriers to physical activity participation. The current study recommends education about the benefits of physical activity participation and encouragement of patient treated with high active antiretroviral therapy in Rwanda to be emphasized on to improve their lives. / South Africa

Includes bibliography. / This dissertation comprises an application of social marketing principles and techniques to AIDS prevention in the workplace. The overall research objective of this dissertation is to investigate the provisions which have been made for AIDS in companies in South Africa, and to gain an understanding of the "preventative AIDS provisions" which the respondents consider practical to implement in their workplace, in order to generate conclusions and recommendations. The research findings, discussions and conclusions highlight areas for future research.

Includes bibliography. / This thesis is based on a series of interviews with key informants and a census of orphan households in Nguludi Mission Community, Southern Malawi, in 2000. The thesis argues that although HIV/AIDS is a relatively recent phenomenon, any contemporary understanding of the epidemic must be informed by an understanding of the past. The impact of the HIV/AIDS epidemic and the "orphan problem" at the local level, is, therefore, situated within the broader socio-economic context of the history of the region.

A dissertation submitted in partial fulfilment of the requirements for the degree of Masters of Arts in the Department of Psychology at the University of Zululand, South Africa, 1994. / AIDS is a major world wide problem with, the incidence and prevalence of the disease increasing at an alarming rate, affecting people regardless of their economic status, educational level, ethnicity, age, occupation or gender. Although initially perceived as affecting deviant subgroups in communities such as prostitutes, the fastest growing population in the AIDS epidemic especially in Africa consist of heterosexual men and women. In Africa the incidence represents over half the reported number of AIDS cases in the world.Almost all African countries are developing countries, which will make it very difficult for these countries to afford any future vaccine developed against AIDS. Thus AIDS education will continue to play a major role in the prevention of HIV-infection and AIDS. In South Africa the majority of people belong in poorer communities where violence, poverty, lack of education and unemployment are perceived as being relatively more problematic in etiology and prevention than AIDS. Most AIDS prevention programmes in South Africa have been relatively ineffective and simplistic in approach and methodology. The programmes that are needed are those that go beyond provision of knowledge, motivate and empower people to change risk behaviour and are designed to be self-supportive/ sustaining and effective. An educational psychological experiment was conducted to investigate the effect of learning through teaching about AIDS prevention. A pre-and post-test group method was used within a nested experimental design.Subjects were randomly divided into three groups. Group 1 experienced both passive and active learning, group 2 experienced only active learning and group 3 experienced only passive learning.. Scales which assessed subj ects' knowledge of AIDS, sexual attitudes and AIDS prevention practices were administered. The data- obtained on all variables were analyzed by means of simple one way and repeated measures analyses of variance ( ANOVA ) for nested experimental design followed by Tukey's HSD statistic for multiple comparisons. Pre-treatment base-line data indicated that the sample was relatively knowledgeable about AIDS. The results indicated that passive and active learning combined was better than either active or passive learning alone. This dissertation also revealed that it is practically feasible to implement this programme in any organization which includes educational systems. Ideally everyone should be equipped with enough information to educate others about HIV-infection and AIDS. It is neither possible nor desirable to leave all AIDS awareness and support initiatives to experts and professionals. Everyone needs to be actively involved in AIDS education.

A dissertation submitted to the Faculty of Arts in partial fulfilment of the requirements for the degree of Master of Arts in Community Work; in the Departmnet of Social Work, 2004. / In this study the researcher investigated care of children affected and infected by HIV/AIDS at Khayelihle Children's Home. The principal aim of the study was to offer a diagnostic, evaluative assessment of the care for children at Khayelihle Children's Home. Survey methodology was adopted for this research- Stratified sampling technique was used in selecting a sample of the respondents to participate in the study. Three strata of: children: aunts/grandmothers: and the international volunteers were selected from the total population at Khayelihle children's home. Sixty people drawn from the stratas participated in the study. Data was collected by use of structured interviews. Documentary sources and observations were utilised as complementary methods to data collection. Data collected was analysed using descriptive analysis. Tables and pie - charts were used to enter specific types of data and show-relationships between variables. The findings from the study indicated that the care of children at Khayelihle Children's Hume was not effective. Several reasons are advanced for this phenomenon. These include: inability to protect children from exploitation, abuse, and neglect: inability of fostering the development of a close and secure relationship with caregiver- as well as allowing a close relationship with the remaining family members. Other reasons include: little emphasis in helping children understand the imminent death of a parent: their identity; uniqueness and a sense of personal continuity especially in the maintenance of a close link with the cultural community: and failure in encouraging children expression of emotions a prerequisite for psychosocial development. It was concluded that the care for children at Khayelihle children's needed to promote psychosocial development and resilience in children for them to be able to deal with the imminent challenges of life as orphans in the face of HIWAIDS epidemic. The study recommends that, the care (or children at Khayelihle should put in perspective the underlying values advocated by the Convention on the Rights of the Child, which should serve as a constant reference for die implementing and monitoring all efforts to care, promote, fulfil and protect children's right-.

Thesis (MPH)--University of Limpopo, 2011. / INTRODUCTION: The human immune deficiency virus (HIV) leads to the acquired immune deficiency syndrome (AIDS). AIDS was first identified in the 1980’s and since then has spread globally causing one of the most dreaded pandemics of modern time. The issue of stigma is very important in the battle against HIV/AIDS as it affects attendance at health centres for obtaining ARV and regular medical check-ups, adherence of patients to ARV treatment. The fear of stigma further helps to fuel a culture of secrecy, silence, ignorance, blame, shame and fear of victimization. AIM: The aim of this study was to determine if there was any external stigmatization of HIV positive patients by health care workers (HCWs) at King Edward VIII Hospital. OBJECTIVES: To determine if the knowledge of HCWs regarding HIV/AIDS and its transmission affect the way they supply a service towards HIV positive patients at King Edward VIII Hospital and to determine the comfort level and the attitude of the HCWs in rendering care to a HIV positive patient. METHODOLOGY: This was a cross sectional survey where data was collected using an anonymous selfadministered structured questionnaire with closed ended questions on personal and professional characteristics, disease knowledge, and discriminatory practices such as attitudes and comfort levels towards people living with HIV/AIDS (PLWHA). A total of three hundred and thirty four HCWs from different units at the King Edward VIII hospital participated in this study. FINDINGS Overall the HCWs have an above average knowledge about HIV/AIDS and its transmission with only 1.8% scoring below average in the knowledge questions regarding HIV and its transmission, although some knowledge gaps were identified regarding occupational exposure risks. Evidently from the results is that HCW with higher levels of education are more knowledgeable on issues relating to HIV/AIDS. The implication is that a HCW with a better education is better equipped with the cognitive knowledge to deal with HIV/AIDS, highlighting iv the importance of education related to external stigmatization. Even though HCWs were knowledgeable about HIV/AIDS most still felt uncomfortable in performing some occupational duties on PLWHA like assisting a woman in labour and performing invasive surgical operations. Most of the HCWs showed a positive attitude towards PLWHA believing that they are not to be blamed for their condition but that individuals in the community who are perceived to be promiscuous men or women are the ones responsible for the spread of HIV/AIDS. Procedures like patients being tested without their consent and patients required to do a HIV/AIDS test before surgery that could be perceived as stigmatization have been observed in King Edward VII hospital. Patient confidentiality is also compromised in that gossiping by HCWs about the HIV/AIDS results of patients has been noted. Fortunately a significant number of HCWs are willing to report their colleagues to a higher authority if any form of stigmatization or discrimination towards PLWHA is seen at King Edward VIII Hospital. CONCLUSION Although the knowledge, attitude and comfort of the HCWs at King Edward VIII Hospital was above average continuing medical education and continuing professional development should be mandatory in the management of HIV/AIDS so that HCWs can have the needed knowledge to keep up with the changing world of HIV/AIDS medicine and also about universal precautions to take so as to reduce occupational exposures. Psychological support to the HCW is needed in dealing with PLWHA so that patients can be provided with quality and compassionate care irrespective of their HIV/AIDS status as this will eventually help in the reduction of stigma.

In Canada, queer men (or ‘men who have sex with men’) continue to be disproportionately affected by HIV/AIDS, representing at least 50% of all people living with HIV/AIDS (Public Health Agency of Canada, 2012). Every year, thousands of new infections significantly increase the toll that HIV/AIDS takes on queer men and their communities. With this epidemiological reality as context, I set out to explore how my subjectivity (as a gay, HIV-positive man) was and is shaped, specifically with respect to the following HIV/AIDS-related, socio-cultural phenomena: activism, community service, ‘safer’ sex, diagnosis and criminalization. These five phenomena provide focal points (or themes) for the presentation and analysis of my experience of living with HIV/AIDS, both before and after becoming infected. Through insider knowledge, my research examines three decades of personal stories, using critical reflexivity to increase my awareness (as well as my reader’s) of the myriad challenges and complexities of living one’s life in the midst of the ongoing pandemic. / Thesis / Master of Social Welfare (MSW)

No description available.

Univ., Diss.--Frankfurt M.