Diss. (sammanfattning) Linköping : Linköpings universitet, 2008. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 121-138).

Thesis (Ph. D.)--State University of New York at Binghamton, Decker School of Nursing, Rural Nursing, 2009. / Includes bibliographical references.

Thesis (M.S.)--Brigham Young University. Dept. of Exercise Sciences, 2007. / Includes bibliographical references.

Thesis (Ph.D.)--Memorial University of Newfoundland, 1999. / Bibliography: leaves 227-298.

Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 99-120).

A pneumonia nosocomial é uma infecção prevalente e associada com elevados custos e morbi-mortalidade. A maioria destes episódios ocorre em pacientes criticamente doentes em ventilação mecânica. Os biomarcadores, como a proteína C-reativa, tem se mostrado uteis na avaliação da evolução dos pacientes, podendo se descrever padrões de resposta associados ao sucesso da terapia antimicrobiana e ao prognostico de paciente com pneumonia associada a ventilação mecânica. Nesta tese, apresenta-se uma revisão da literatura abordando aspectos da fisiopatologia, diagnostico e manejo da pneumonia associada a ventilação mecânica. Além disso, é feita a análise do uso de biomarcadores em duas populações especificas de pacientes criticamente doentes (pacientes com doença critica cronica e pacientes idosos). Foram avaliados 405 pacientes com diagnostico clínico de pneumonia associada a ventilação mecânica. Descreve-se que pacientes com doença critica crônica apresentam episódios de pneumonia associada a ventilação mecânica com pior prognostico do que pacientes que não apresentam doença critica crônica. Entretanto, esses achados não parecem associados a um comprometimento da resposta inflamatória, uma vez que nao houve diferença significativa nem nos níveis basais, nem na evolução dos níveis de proteína C-reativa comparando episódios de pacientes com doença critica crônica com aqueles sem esta condição, sugerindo que seu uso é válido nessa população de pacientes. Ainda, descreve-se a evolução dos pacientes com pneumonia associada a ventilação mecânica de acordo com a idade. A partir dos 65 anos, parece haver um efeito da idade na mortalidade dos pacientes com PAV. No entanto, não houve alteração na resposta da PCR ou na sua cinética nas primeiras 96h quando comparamos pacientes com diferentes faixas etárias a partir de um ponto de corte de 65 anos, também sugerindo a validade do uso deste biomarcador nesta população de pacientes. Estes achados originais permitem que estudos futuros avaliem intervenções baseadas em biomarcadores em pacientes com pneumonia nosocomial levando em consideração estas populações especificas de pacientes não avaliadas previamente na literatura. / Nosocomial pneumonia is a prevalent infection associated with higher costs and worse outcomes. Most episodes occur in mechanically ventilated critically ill patients. Biomarkers, such as C-reactive protein, are useful to assess patients evolution, allowing identification of patterns associated with antimicrobial treatment success and prognosis in ventilator-associated pneumonia patients. In this thesis, a literature review is presented evaluating aspects of pathopsysiology, diagnosis and management of ventilator-associated pneumonia patients. In addition, biomarker use in two specific populations (chronic critical illness and elderly) was assessed. Four hundred and five patients with ventilator associated pneumonia clinical diagnosis were evaluated. Patients with chronic critical illness presented ventilator-associated pneumonia episodes associated with worse prognosis. However, these findings were not associated with a compromise of inflamatory response, assessed by comparison of C-reactive protein basal levels and kinetis evolution in patients with and wihtout chronic critical illness, suggesting its use remains valid in this specific population. Still, evolution of ventilator-associated pneumonia according to age is described. After 65 years old, our data suggest an effect of age on mortality in ventilator-associated pneumonia patients. However, no change in C-reactive protein basal levels, response or kinetics within 96h was found when comparing patients younger and older than 65 years old, also suggesting this biomarker usefulness in this specific population. These original findings allow that future studies assessing intervention based on biomarkers evolution in patients with nosocomial pneumonia consider these specific populations, never assessed before in literature.

The sex hormone testosterone supports male reproduction. However, testosterone is hypothesized to suppress immune activity, resulting in a tradeoff between energetic investment in reproductive effort and immune function. The Immunocompetence Handicap Hypothesis (ICHH) therefore argues that testosterone-linked masculine traits honestly signal health status to prospective mates, as only uninfected males should be able to maintain high testosterone levels. Still, this proposed tradeoff remains poorly tested among human men, especially among natural fertility populations experiencing high infectious disease burdens. This dissertation therefore tested the ICHH among indigenous Shuar men of Amazonian Ecuador. Specifically, this project examined testosterone variation patterns and assessed how male investment in reproductive effort is associated with reproductive success and immune function. The first study tested testosterone level variation among Shuar men in relation to body composition, age, and style of life factors. This study demonstrated that age and BMI interactions shape testosterone levels in complex ways, such that the relationship between body composition and testosterone profile varies throughout the life course. The second study investigated whether individual reproductive success was significantly influenced by masculine trait development and parasite load. These results failed to support the hypotheses that masculine traits increased reproductive success or honestly signaled lack of parasitic disease. Instead, a significant positive association was observed between a composite score of masculine traits and Ascaris lumbricoides infection load; suggesting that male investment in reproductive effort may increase parasitic infection risk. The final study assessed whether testosterone levels were negatively associated with four measures of immune function (parasite load, C-Reactive Protein [CRP], Immunoglobulin-G [IgG], and Immunoglobulin-E [IgE]). Testosterone levels were inversely associated with CRP levels and a positive relationship between testosterone levels and Trichuris trichiura infection load was documented, suggesting increased investment in reproductive effort may suppress some aspects of immune function and increase parasite burden. Overall, these studies fail to support the ICHH, but do indicate a context-dependent tradeoff between energetic investment in male reproductive effort and some aspects of immune function; thereby demonstrating complex interactions between physical characteristics, physiological processes, and immune activity in human men. This dissertation includes unpublished, co-authored material.