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Made available in DSpace on 2014-08-20T13:49:44Z (GMT). No. of bitstreams: 1 LILIAN MOURA DE LIMA.pdf: 1272342 bytes, checksum: e6c136314886322d6aa38853685abd38 (MD5) Previous issue date: 2011-10-07 / Household contacts of index cases tuberculosis have an increased risk of developing the disease due to the closeness and the time duration of exposure to the bacillus. For this reason the evaluation of these individuals is decisive to controlling the disease, since the early diagnosis and timely treatment stop the transmission chain of the disease reflecting on the reduction of incidence rates. To this purpose there are protocols and targets proposed by the World Health Organization in which the health services should be based in the proper evaluation of the contacts. The study aimed investigate the health services that diagnosticate tuberculosis in Pelotas in relation to the service offered to household contacts of the index case. It consists of a descriptive, quantitative and transversal cut study linked to the multicentric project entitled "Delay in the diagnosis of tuberculosis: analysis of causes in different regions of Brazil". The study sample was composed of 85 index cases of tuberculosis interviewed in the origin study in Pelotas and their 163 household contacts. The collection of these data took place between July and December 2009 in the control of tuberculosis program in Pelotas and the collection of medical records has occurred in January 2011 in this same service. It was used the database research of the multicentric study and it was built a database in Excel software with the data from medical records. The analysis of data was performed using descriptive statistics. The results show that attention to tuberculosis in Pelotas need to be rethought with the of involving primary care in the evaluation of household contacts in order to facilitate early diagnosis, appropriate clinical evaluation of contacts and interruption of transmission chain of TB in appropriate time. / Os contatos intradomiciliares dos casos índices de tuberculose têm risco aumentado de desenvolver a doença em virtude da proximidade e do tempo de exposição ao bacilo. Por este motivo a avaliação destes indivíduos é determinante para o controle da doença, já que o diagnóstico precoce e o tratamento oportuno interrompem a cadeia de transmissão da doença repercutindo na redução das taxas de incidência. Para tanto existem protocolos e metas propostos pela Organização Mundial da Saúde, nos quais, os serviços de saúde devem basear-se na avaliação adequada dos contatos. O estudo objetivou investigar os serviços de saúde que fazem o diagnóstico da tuberculose em Pelotas quanto ao atendimento oferecido aos contatos intradomiciliares do caso índice. Constitui-se de um estudo descritivo, quantitativo de corte transversal, vinculado ao projeto multicêntrico intitulado Retardo no diagnóstico da tuberculose: análise das causas nas diferentes regiões do Brasil . A amostra do estudo foi composta por 85 casos índices de tuberculose entrevistados no estudo de origem em Pelotas e seus 163 contatos intradomiciliares. A coleta destes dados deu-se entre julho e dezembro de 2009 no programa de controle da tuberculose de Pelotas e a etapa de coleta do prontuário em janeiro de 2011, neste mesmo serviço. Utilizou-se o banco de dados da pesquisa do estudo multicêntrico e com os dados do prontuário construiu-se um banco no software Excel. A análise dos dados foi realizada por meio da estatística descritiva. Os resultados evidenciam que a atenção a tuberculose em Pelotas necessita ser repensada no intuito de envolver a atenção primária na avaliação dos contatos intradomiciliares, visando facilitar o diagnóstico precoce, a avaliação clínica adequada dos contatos e a interrupção da cadeia de transmissão da TB em tempo oportuno.

Chlamydia trachomatis infections are associated with a spectrum of clinical diseases including urethritis, prostatitis and epididymitis among men and cervicitis and pelvic inflammatory disease (PID), with an increased risk of infertility and ectopic pregnancy (EP), among women. In the search for other pathogens causing urethritis, Mycoplasma genitalium was isolated from urethral specimens from two men with acute urethritis (1980). Mycoplasma bacteria are extremely difficult to isolate by culture, and clinical studies have been possible only after the advent of the first PCR-based detection method. M. genitalium has been found to be associated with lower genital tract infections in both men and women. Finding evidence for a connection between M. genitalium and upper genital tract infections in women is still of major importance. The aim in papers I and II was to develop a PCR method for genetic characterization of clinical C. trachomatis isolates by sequence analysis of the omp1 gene, and to study the distribution of genotypes within sexual networks and determine if genotyping would improve partner notification. The method was used to determine the genotypes of C. trachomatis in 237 positive urogenital and/or urine specimens from men and women attending the STDClinic in Örebro during one year. Sequence analysis of the omp1 gene revealed that the most prevalent genotypes corresponded to C. trachomatis serovar E (47%), followed by F (17%), and K (9%). There were 161 networks found and specimens were sequenced from at least two patients in 47 networks. In seven of these 47 networks there were discrepant genotypes. In the largest network comprising 26 individuals two different C. trachomatis genotypes were found, and one partner had urethritis due to a Mycoplasma genitalium infection but was C. trachomatis negative. The need for a new method for M. genitalium DNA detection was one reason for study III. An existing conventional PCR protocol for detection of M. genitalium DNA was further developed into a real-time PCR (RT-PCR) with hybridisation probes. In order to evaluate the RT-PCR assay with clinical material, specimens from 398 men and 301 women attending the STD Clinic in Örebro were analysed, using the RT-PCR assay, and also by the well established conventional PCR in Copenhagen. Using the conventional PCR method as “gold standard”, the sensitivity for the RT-PCR assay was 72.2% and 68.2% and the specificity was 99.7% and 98.6%, respectively, in urogenital specimens from men and women. The aim in paper IV was to adapt a Triton X-114 extracted Lipid-Associated Membrane Protein (LAMP) Enzyme Immuno Assays (EIA) method to detect antibodies against M. genitalium and to evaluate the association between M. genitalium and PID and EP, using sera sampled in Örebro during the 1980s, and also to compare the number of sera having M. genitalium antibodies against those having C. trachomatis antibodies, using a commercial anti- Chlamydia trachomatis EIA assay. No statistical significant association could be demonstrated between M. genitalium antibodies and PID or EP in our serum material. However, a slight trend toward association was found when focusing on younger individuals. Antibodies against C. trachomatis were found to be significantly associated with PID and EP.

The main aim of this thesis is to develop a library for integrating fully homomorphic encryption-based computations on a standard database. The fully homomorphic encryption is an encryption scheme that allows functions to be performed directly on encrypted data without the requirement of decrypting the data and yields the same results as if the functions were run on the plaintext. This implementation is a promising solution for preserving the privacy of the health care system, where millions of patients’ data are stored. The personal health care tools gather medical data and store it in a database. Upon importing this library into the database, the data that is being entered into the database is encrypted and the computations can be performed on the encrypted data without decrypting.

Abstract Background Data about the effectiveness of digital contact tracing are based on studies conducted in countries with predominantly high- or middle-income settings. Up to now, little research is done to identify specific problems for the implementation of such technique in low-income countries. Methods A Bluetooth-assisted GPS location-based digital contact tracing (DCT) app was tested by 141 participants during 14 days in a hospital in Monrovia, Liberia in February 2020. The DCT app was compared to a paper-based reference system. Hits between participants and 10 designated infected participants were recorded simultaneously by both methods. Additional data about GPS and Bluetooth adherence were gathered and surveys to estimate battery consumption and app adherence were conducted. DCT apps accuracy was evaluated in different settings. Results GPS coordinates from 101/141 (71.6%) participants were received. The number of hours recorded by the participants during the study period, true Hours Recorded (tHR), was 496.3 h (1.1% of maximum Hours recordable) during the study period. With the paper-based method 1075 hits and with the DCT app five hits of designated infected participants with other participants have been listed. Differences between true and maximum recording times were due to failed permission settings (45%), data transmission issues (11.3%), of the participants 10.1% switched off GPS and 32.5% experienced other technical or compliance problems. In buildings, use of Bluetooth increased the accuracy of the DCT app (GPS + BT 22.9 m ± 21.6 SD vs. GPS 60.9 m ± 34.7 SD; p = 0.004). GPS accuracy in public transportation was 10.3 m ± 10.05 SD with a significant (p = 0.007) correlation between precision and phone brand. GPS resolution outdoors was 10.4 m ± 4.2 SD. Conclusion In our study several limitations of the DCT together with the impairment of GPS accuracy in urban settings impede the solely use of a DCT app. It could be feasible as a supplement to traditional manual contact tracing. DKRS, DRKS0 00293 27. Registered 20 June 2020 - Retrospectively registered.

Chlamydia trachomatis (CT) can cause infertility and is the most common sexually transmitted infection (STI) of bacterial origin in Europe. Surveys in seven countries estimated a population prevalence of 1.4-3.0 % in people 18 to 44 years. Approximately 87% of those diagnosed in Sweden are 15-29 years. Since 1997, with the exception of 2009-2010, despite all efforts, CT has increased steadily in many European countries including Sweden. That made us investigate risk factors associated with catching STIs, especially CT. In Sweden partner notification is mandatory by law when a patient is diagnosed with CT. Centralised partner notification, performed by a few experienced counsellors, and evaluation of the sexual history for at least 12 months back in time, shows superior results compared to other studies. Phone-interviews are a good option in remote areas. “The Västerbotten model” for partner notification fulfils these criteria and our evaluation has functioned as a model for changing recommendations of partner notification in Sweden. Preventing CT by primary prevention such as information and counselling is, however, still of great importance. We investigated whether it was necessary to test for CT in the throat. We found that patients testing positive for pharyngeal CT neither had more symptoms or signs nor a sexual history that differed from others. We therefore believe that we will find most or all of these patients by conventional testing of urine and cervical/vaginal samples. We wanted to further identify risk factors among patients attending a clinic for sexually transmitted infections to enable individualized care depending on risk. None or inconsistent use of condoms with new/temporary partners in combination with having at least one new/temporary partner within the past 6 months could identify persons with risk behaviour and at increased risk of CT (re)infection. Additional information about whether the condom was used during the whole intercourse did not add any risk of infection. A drop-in reception is a good contribution to an opportunistic screening approach. The rate of CT infected is high and the clinic attracts men and individuals ≥25 years old at risk of infection, groups which usually have a reduced test rate. The mean age was 28 years and 58% of the patients were men. The figure of correct condom usage is very low indicating the need for risk reducing counselling also in this grown-population. Among adult STI patients anxiety was common and depression uncommon. Neither was linked to high risk sexual behaviour nor ongoing CT infection. Hazardous alcohol consumption, however, was common and linked to anxiety and high risk sex. We conclude that preventive work can not only focus on STI prevention, but must consider the high frequency of hazardous alcohol consumption, which probably is contributing to sexual risk behaviour.

Made available in DSpace on 2016-12-23T13:56:04Z (GMT). No. of bitstreams: 1 DISSERTACAO FINAL.pdf: 1304058 bytes, checksum: 22df93a24605e7e83e388686a27fb38f (MD5) Previous issue date: 2009-05-29 / The tuberculosis continues to represent a severe worldwide public health issue, particularly in developing countries. Besides early diagnosis and therapy, one of the great challenges for its control is the scarce knowledge available about the transmission mechanisms and the related risks. The retrospective cohort described in this study aims to evaluate the risk of Mycobacterium tuberculosis infection, measured by tuberculin skin testing, in contacts of patients with cavitary and noncavitary pulmonary tuberculosis. Identification and screening of index cases between july/2003 and december/2007 was performed based on analysis of two databases: National information system of disease notification and TB notes. Only index cases, with age above 18 years old, living at Cariacica, Serra, Vila Velha and Vitoria cities were screened. Demographic, clinical and laboratory informations of the index cases and contact informations were captured from the medical charts. Bacteriological confirmation based on mycobacterial cultures was captured from TB notes database. among the 1662 index cases identified, 320 met the inclusion criteria: 154 (48,1%) with cavitary disease (C group) and 166 (51,9%) with non-cavitary disease (NC group) based on chest xray. among these 320 index cases, 1257 contacts were identified. most cases of C and NC groups denied previous contact with tuberculosis: 70,2% and 60,1%, respectively. index cases reported cough ranging between 0 and 980 days; mean of 93,5 and median of 60 days; 25 and 75 percentis were 30 and 90 days, respectively. period of cough, which represent time of disease, was higher in the c group (p=0,01, OR 1,82, IC 95%:2,8-13,5) when the threshold was 60 days. higher number of positive sputum smear patients was observed in the C group (p <0,00, OR=5,86, IC 95%: 2,8-13,5). among the 1257 enrolled contacts, 555 (44%) were contacts of the C group and 702 (56%) of the NC group patients. both groups were similar regarding gender, age and chest xray images. however, more reactors to tuberculin skin testing (PPD &#8805; 10 mm) were found among contacts of C group: 48% versus 40,6% (p= 0,009, OR1,35, IC 95% 1,07-1,7 ). Taking into account images observed in chest xray, M tuberculosis infection rate was 1,7 higher among contacts of cavitary in comparison with non-cavitary patients. After logistic regression analysis this association was statistically significant for two variables: period of cough &#8805; 30 days (p=0, 0007OR=3, 20, IC 95%: 1, 5-8.6,) and positivity of sputum smears (p=0, 0039 OR=2, 47, IC 95: 1, 24-4, 81). Positivity of sputum smears was also related to the presence of cavitary disease. Index cases included in C group had 5, 86 more chance of having positive sputum smear (IC 95%: 2, 8-13, 5). Using infection prevalence rate of 30% or more as the threshold for transmission analysis, the three following variables were related to infection transmission to contacts: period of cough, cavitary disease and positive sputum smear. It was concluded that: a period of cough &#8805;30 days was associated with TB infection; smear positivity was associated with a higher chance of infection among contacts. The association between cavitary disease and TB infection transmission to contacts was marginally statistically significant. / Um dos principais desafios para o controle da tuberculose (TB) é ainda o pouco conhecimento disponível sobre os mecanismos intrínsecos de sua transmissão e os graus de risco associados a eles. Este estudo, uma coorte retrospectiva, teve por objetivo avaliar o risco de infecção por Mycobacterium tuberculosis, medido pela prova tuberculínica, em contatos de pacientes com tuberculose pulmonar cavitária e não cavitária. A identificação e a seleção dos casos índices foram realizadas por meio da análise de dois bancos de dados: Sistema de Informação de Agravos de Notificação (SINAN) e TB notes. O período abrangido foi de julho de 2003 a dezembro de 2007. Foram selecionados indivíduos residentes em quatro municípios da Região Metropolitana de Vitória (Cariacica, Serra, Vila Velha e Vitória). De todos os casos índices com idade superior a 18 anos notificados no SINAN, obteve-se os prontuários médicos para análise dos dados demográficos, clínicos e laboratoriais e as informações dos respectivos contatos. A confirmação bacteriológica por cultura dos pacientes foi obtida no banco de dados TB-notes. Dos 1662 casos índices identificados, 320 preencheram os critérios de inclusão do estudo 154 (48,1%) com doença cavitária (grupo C) e 166 (51,9%) sem doença cavitária (grupo NC) à radiografia do tórax. Os 320 casos índices geraram 1.257 contatos. A maioria dos casos do grupo C e NC não tinha história epidemiológica de contato prévio com a doença 70,2% e 60,1%, respectivamente. O tempo de tosse variou de 0-980 dias, com média de 93,5 dias (± 130 dias), e mediana, de 60 dias. Os percentis 25 e 75 foram, respectivamente, de 30 e 90 dias. O tempo de tosse, que, na prática, retrata o tempo de doença, foi maior nos pacientes do grupo C (p=0,01, RC 1,82, IC 95%: 1,01-3,04), quando o ponto de corte foi de 60 dias. Houve uma maior concentração de pacientes com baciloscopia positiva no grupo C, o que representa uma diferença estatisticamente significativa (p <0,00, RC=5,86, IC 95%: 2,8-13,5). Dos 1.257 contatos arrolados, 555 (44%) eram contatos do grupo C, e 702 (56%) do grupo NC. Os dois grupos de contatos foram semelhantes em relação ao gênero, idade e resultado da radiografia do tórax. Houve, entretanto, diferença na prevalência de positividade da prova tuberculínica (&#8805;10mm), que foi maior nos contatos do grupo C: 48% versus 40,6% do grupo NC (p= 0,009, RC 1,35, IC95% 1,07-1,7). Os casos índices com doença cavitária infectaram 1,7 vezes mais seus contatos do que os casos índices sem cavidade à radiografia do tórax (IC 95%: 0.94-3.08, p=0, 061). Após análise de regressão logística essa associação mostrou-se estatisticamente significativa para as variáveis: tempo de tosse superior a 30 dias (RC=3,20, IC 95%: 1,5-8.6, p=0, 0007) e positividade da baciloscopia do escarro (RC=2,47, IC 95: 1,24-4,81 p=0, 0039). A positividade da baciloscopia do escarro também esteve associada à presença de doença cavitária. Os casos índices incluídos nessa categoria possuíam 5,86 mais chance de apresentarem exame direto do escarro positivo (IC95%: 2,8-13,5). Essas três variáveis (tempo de tosse, doença cavitária e baciloscopia positiva do escarro) estiveram relacionadas à transmissão da infecção aos contatos, quando se utilizou, como ponto de corte para análise da transmissão, a presença de infecção igual ou superior a 30% nos contatos dos respectivos casos índices. Concluímos que o tempo de tosse superior a 30 dias e a baciloscopia positiva estão fortemente associados à transmissão por M.tuberculosis. Esta associação teve significância limítrofe para doença cavitária.

No description available.

INTRODUÇÃO: A poliquimioterapia (PQT-OMS) para tratamento da hanseníase resultou em drástica redução da sua prevalência, mas em limitado impacto na detecção de casos novos (CN), que se manteve estável em Santa Catarina, estado na fase de pós-eliminação. Casos com altos índices baciloscópicos apresentam risco de recidiva tardia e podem consistir em focos persistentes de transmissão da doença. OBJETIVOS: Avaliar a recidiva da doença em amostra de pacientes virchowianos regularmente tratados com PQT-OMS 24 doses; ensaios de resistência terapêutica em camundongos para os casos suspeitos; resposta imune específica (celular e humoral) e detecção do DNA do M. leprae nos casos-índices (CI) e seus contatos indradomiciliares (CID); e os achados frente aos indicadores epidemiológicos e operacionais de Santa Catarina. CASUÍSTICA E MÉTODOS: A partir da busca no Sistema de Informação de Agravos de Notificação (SINAN), foram selecionados 46 CI, tratados entre 1990-2000, e 187 CID, dos municípios de Itajaí e Joinville. A avaliação constituiu de: exames dermatoneurológico e anatomopatológico da pele; baciloscopia do esfregaço cutâneo; reação de Mitsuda; sorologia para glicolipídeo fenólico-I (IgM-anti-PGL-I); ensaios de resistência terapêutica em camundongos e de detecção do DNA bacilar no muco nasal por reação em cadeia da polimerase (PCR) para as seqüências repetitivas específicas RLEP-130 e RLEP-372. RESULTADOS: Entre os CI após alta por cura (m=11,2 ± 3 anos), a idade média (57,3±14,5 anos) foi superior (p<0,05) comparada aos CID, com predomínio de homens (p=0,001) e Mitsuda-negativos (78,6%). Em quatro casos (8,7%) considerados recidivados, o valor sérico médio (0,365) e as freqüências da positividade do anti-PGL-I e a da RLEP-130 (75%; p=0,03) foram consistentemente elevados, e os testes em camundongos, negativos. Dentre os 187 CID, 22 (11,8%) adoeceram (CIDd), a maioria (10 casos; 45,4%) foi diagnosticada entre 2 a 19 anos; 6 casos (27,3%), no mesmo período do seu respectivo CI; e 6 CN (3 dimorfo-tuberculóides e 3 tuberculóides) foram detectados durante a intervenção. Os CN evidenciaram elevada freqüência da positividade da RLEP-130 (50%) contrastante com a do anti-PGL-I (20%) e seu valor sérico médio (0,075) inferior. Entre os CI após a alta PQT-MB (>10 anos), houve inferioridade da freqüência da positividade (14,3%) e do valor sérico médio do anti-PGL-I (0,072), estabelecendo uma correlação negativa (p=0,038,r=-0,32) com o tempo decorrido. Valores similares da freqüência de positividade para RLEP-130 foram encontrados em: CI com alta por cura (26,7%), em períodos superiores (25%) a 10 anos de conclusão do tratamento e CID saudáveis (20,5%). A positividade para a RLEP-130 foi mais freqüente (p<0,001) comparada à da RLEP-372. CONCLUSÕES: A taxa de recidiva após PQT-MB 24 doses é baixa e prevalece alta percentagem de cura (91,3%). É racional considerar que o anti-PGL-I e a detecção do DNA bacilar por RLEP-130 devam ser analisados em conjunto com os demais achados clínicos e laboratoriais, ainda que nossos resultados possam ter diferenciado os grupos nas distintas condições: recidiva e alta por cura, e identificado doentes, contatos e famílias em risco. O seguimento e o monitoramento clínico e laboratorial por períodos prolongados incrementariam a detecção precoce de novos casos entre os comunicantes, desde que o intervalo para o diagnóstico foi longo para a maioria daqueles que adoeceram. Estas estratégias seriam potencialmente facilitadas em áreas com reduzida prevalência, e particularmente valiosas para a manutenção do controle na fase de pós-eliminação / Introduction: Multidrugtherapy (MDT-WHO) resulted in marked reduction of leprosy prevalence in Brazil, without impact on detection of new cases in Santa Catarina (SC) state in the post-elimination phase. Lepromatous cases with high bacilloscopic index have late relapse risk and can consist in the disease transmission focus. Objectives: The aim of this study was to evaluate the disease recurrence and microbiological resistance in lepromatous leprosy patients regularly treated with MDT-WHO/24 doses; specific immune response (cellular and humoral) and M. leprae DNA detection in index cases (IC) and their household contacts (HHC); and the findings face to the epidemiological and operational indicators of Santa Catarina state. Casuistic and methods: After consulting the Brazilian Information System of Notification (SINAN) database, 46 IC successfully diagnosed and treated between 1990 and 2000, and their 187 HHC from Joinville and Itajaí (SC) municipalities were selected. A dermatoneurological examination was performed, as well as the skin biopsies for histopathology and therapy resistance assay in mouse pads, skin smears for bacilloscopy, anti-PGL-I IgM serology, Mitsuda reaction, polymerase chain reaction for M. leprae DNA detection in nasal secretion based on 130bp and 372bp specific repetitive sequences (RLEP). Results: Cured IC (m=11.2±3 years) had mean age higher ((57.3±14.5 years old; p<0.05) than HHC, most of them were males (p=0.001) and Mitsuda negative (78.6%). In 4 relapsed cases (8.7%) the average anti-PGL-I serum levels (0.365), as well as frequency of positive antibody and RLEP-130 (75%; p=0.03) were consistently high and the mouse footpads assays resulted negative. Among 187 HHC, 22 (11.8%) became sick (sHHC), 10 cases (45.4%) were diagnosed between 2 and 19 years, being 6 cases (27.3%) in the same year of their IC; 6 new cases (3 borderline-tuberculoid and 3 tuberculoid) were detected during the study, with high RLEP-130 positive frequency (50%), as opposed to anti-PGL-I (20%) and low average serum levels (0.075). Among IC with more than 10 years of discharge, frequency of positive anti-PGL-I (14.3%) and average serum levels (0.072) were lower and had negative correlation (p=0.038, r= -0.32) with time after cure. Similar values of frequency of positivity for RLEP-130 were found: IC with discharge by cure (26.7%), when time interval was higher than 10 years (25%) and in healthy HHC (20.5%). RLEP-130 positivity was more frequent (p<0.001) than RLEP-372. Conclusions: Relapse rate after MDT-WHO 24 doses was low, with high cure rate (91.3%). Serology anti-PGL-I and M. leprae DNA detection by RLEP-130 must be analyzed together with other clinical and laboratory findings, though our results had differentiated groups in the following conditions: relapse and discharge by cure, patient identification, HHC and families at risk. Long term follow-up with laboratorial and clinical monitoring could lead to early detection of new cases among HHC, since the period between diagnoses was long for most sHHC. This strategy may be useful in areas with decreased prevalence, and of particular value for maintenance of disease control in the post-elimination phase