Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-04-26T19:16:12Z No. of bitstreams: 1 DiegoGomesTeixeira_DISSERT.pdf: 3901094 bytes, checksum: 8c230a0e1503d41ddbfe3f8758b2dbce (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-04-28T21:48:14Z (GMT) No. of bitstreams: 1 DiegoGomesTeixeira_DISSERT.pdf: 3901094 bytes, checksum: 8c230a0e1503d41ddbfe3f8758b2dbce (MD5) / Made available in DSpace on 2016-04-28T21:48:14Z (GMT). No. of bitstreams: 1 DiegoGomesTeixeira_DISSERT.pdf: 3901094 bytes, checksum: 8c230a0e1503d41ddbfe3f8758b2dbce (MD5) Previous issue date: 2015-07-02 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / A Leishmaniose ? uma doen?a infecciosa que at? o momento n?o possui uma vacina capaz de eliminar o parasita do hospedeiro, sendo tratada apenas por meio de drogas pouco eficientes e de alto custo. Essa doen?a normalmente se apresenta formando ulcera??es na pele, mucosas e v?sceras. Os pa?ses mais atingidos por esse parasita encontram-se nas regi?es tropicais do planeta, e afeta aproximadamente dois milh?es de pessoas a cada ano. Acredita-se que no continente americano a esp?cie Leishmania infantum tenha sido introduzida pelos imigrantes durante o processo de coloniza??o dos pa?ses da Am?rica Central e do Sul. Nas ?ltimas d?cadas, estudos v?m mostrando que a expans?o urbana associada com o fluxo de pessoas para regi?es muito povoadas est?o contribuindo para uma expans?o no n?mero de reservat?rios para o parasita, influenciando uma maior varia??o de suas caracter?sticas g?nicas. Tais varia??es gen?ticas v?m sendo associadas ao perfil sintomatol?gico dos parasitas em seus hospedeiros, principalmente humanos. No estado do Rio Grande do Norte, Brasil, foram isolados e sequenciados o genoma de 20 cepas de L. infantum as quais apresentaram diferentes padr?es sintomatol?gicos (sintom?tico e assintom?tico) e com diferentes per?odos de isolamento, 5 na d?cada de 1990 e 15 nos anos recentes. Apesar dos diferentes padr?es cl?nicos o genoma dos isolados apresentaram alto grau de identidade entre si, at? mesmo os isolados da d?cada de 90 quando comparados com os recentes. Entretanto, as poucas varia??es foram suficientes para a identifica??o de padr?es de agrupamentos dos isolados por meio de an?lises de componentes principais, mostrando que os isolados dos anos recentes se encontram mais homog?neos na popula??o. An?lises de reconstru??o filogen?tica utilizando m?todos Bayesianos foram realizadas e observou-se a manuten??o nos padr?es de agrupamento j? vistos nos resultados anteriores, al?m disso foi gerado um expanded bayesian skyline plot por onde foi poss?vel constatar o crescimento da popula??o gen?mica de L. infantum quando comparado com a d?cada de 1990. Foram observadas altera??es no n?mero de c?pias cromoss?micas em todos os isolados, entretanto apenas o cromossomo 31 se apresentou como exclusivamente triss?mico. O presente trabalho apresenta ind?cios de padr?es nos genomas de isolados de L. infantum relacionando-os ?s caracter?sticas cl?nicas dos hospedeiros. / Leishmaniasis is a complex of diseases with no preventable or therapeutic vaccine available. There is only a small set of drugs for treatment of these diseases, which evolve with distinct clinical outcomes from skin ulcers, to mucosal involvement or visceralization. The type of clinical presentation usually is associated with the infecting species of Leishmania. Leishmania infantum is the visceralizing species, causing visceral leishmaniasis, in Latin America, Europe and northern Africa and was introduced in the Americas by Europeans during colonization. Visceral leishmaniasis used to be a sporadic disease found in rural areas Northeast of Brazil, however with urbanization, outbreaks have been reported in periurban areas of major cities. L. infantum infection can evolve with control of the parasite without apparent clinical symptoms, with only a minority developing symptomatic disease. The reasons why one evolve with selfresolution and others develop full blown disease is not entirely understood, but seems to include host genetic susceptibility, comorbidity, sand fly exposure and potentially genetic variation in the infecting Leishmania species. Our ongoing study, have shown structural genome variations in several clinical Leishmania isolates obtained from people infected in the State of Rio Grande do Norte. Despite the different clinical patterns, the isolates? genomes showed a high identity degree to each other, even the ones isolated from the 90 compared with the latest. However, the few found changes were sufficient for the isolation of the distinct groups by a principal component analysis, showing that the isolates from more recent years are more homogeneous among the population. Phylogenetic analyzes using Bayesian reconstruction methods have been made and supported the grouping patterns already seen in the foregoing results. Moreover by an Expanded Bayesian Skyline Plot it was possible to observe the growth of the genomic population of L. infantum compared with the 1990s. Changes were observed in the number of chromosome copies in all strains, but only chromosome 31 is presented as exclusively trisomic. This work presents evidence on patterns of L. infantum isolated genomes relating them to clinical characteristics of their hosts.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T22:22:49Z No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-11T18:05:37Z (GMT) No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) / Made available in DSpace on 2017-04-11T18:05:37Z (GMT). No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) Previous issue date: 2016-12-15 / A s?filis ? uma doen?a infecciosa que permanece como um dos principais agravos de notifica??o a ser enfrentado em ?mbito global. No contexto materno-infantil relaciona-se a efeitos delet?rios a partir da transmiss?o vertical e exp?e o bin?mio m?e e filho a riscos como o aborto e a morte perinatal. Desse modo, a??es efetivas para o controle da doen?a devem ser realizadas no pr?-natal, em momento oportuno, para garantir a preven??o da forma cong?nita da doen?a. Neste sentido, esta pesquisa objetiva analisar as notifica??es de s?filis gestacional e cong?nita e os fatores relacionados ? transmiss?o vertical. Trata-se de uma pesquisa de abordagem quantitativa epidemiol?gica, tipo seccional, de dados secund?rios, realizado no ano de 2016. A amostra foi composta a partir dos crit?rios de elegibilidade e totalizou 129 notifica??es de s?filis em gestantes e 132 notifica??es para s?filis cong?nita no per?odo entre junho de 2011 e dezembro de 2015, no Munic?pio de Natal/RN. A coleta de dados ocorreu entre os meses de maio a agosto por meio do banco do Sistema de Informa??o de Agravos de Notifica??o. Os dados foram analisados pela estat?stica descritiva e inferencial. Os testes Qui-Quadrado, T-Student e Fisher foram utilizados para verificar as associa??es entre as vari?veis de interesse. A pesquisa recebeu parecer favor?vel pelo Comit? de ?tica da Universidade Federal do Rio Grande do Norte, sob o n?mero 1.449.134 e Certificado de Apresenta??o para Aprecia??o ?tica 53305315.3.0000.5537. No per?odo investigado foi observado um incremento de casos notificados no ano de 2012. O perfil materno registrado aponta mulheres com idade m?dia de 24,78 anos, pardas (70,5%), residentes na zona urbana (95,3%) do Munic?pio de Natal. A an?lise do pr?-natal identificou predom?nio do diagn?stico materno no terceiro trimestre gestacional (69%) e presen?a de testes n?o trepon?micos reagentes em 94,6% das mulheres no momento do parto. No tocante ao tratamento materno, apenas 1,6% destas mulheres foram registradas com esquema de tratamento adequado e 16,3% dos parceiros foram tratados concomitantemente ?s gestantes. Nos desfechos relativos ?s crian?as, 78,8% foram registradas como assintom?ticas, contudo, essa vari?vel apresentou signific?ncia estat?stica quando relacionada ? titula??o do teste n?o trepon?mico materno e ? realiza??o de tratamento antes do parto. Na an?lise espacial por georreferenciamento, foi identificado o predom?nio de casos nos bairros Quintas e Felipe Camar?o, ambos assistidos pelo Distrito Sanit?rio Oeste do munic?pio. Os resultados apontam, al?m disso, para lacunas importantes nos processos de vigil?ncia epidemiol?gica quanto ao preenchimento das notifica??es no que versa a informa??es ignoradas e em branco. A an?lise da notifica??o da s?filis gestacional e cong?nita, possibilitou concluir que a transmiss?o vertical esteve relacionada a perdas de oportunidades diagn?sticas e terap?uticas. A elabora??o de estrat?gias para detec??o precoce e ades?o ao tratamento da doen?a devem ser adotadas, tendo em vista o fortalecimento da assist?ncia e a quebra na cadeia da transmiss?o vertical da s?filis. Ressalta-se a necessidade de qualifica??o profissional para notifica??o da doen?a e amplia??o no fornecimento de informa??es ? vigil?ncia epidemiol?gica, a fim de possibilitar a continuidade da an?lise ao agravo. / Syphilis is an infectious disease that remains as one of the major reporting aggravations to be addressed globally. In the maternal-infant context it is related to deleterious effects from the vertical transmission and exposes the mother-child binomial to risks such as abortion and perinatal death. Thus, effective actions to control the disease must be performed in prenatal care, in a timely manner, to ensure the prevention of the congenital form of the disease. In this sense, this research aims to analyze the reports of gestational and congenital syphilis and the factors related to vertical transmission. This is a cross-sectional, epidemiological, epidemiological approach to secondary data, conducted in 2016. The sample was composed of eligibility criteria and totaled 129 reports of syphilis in pregnant women and 132 reports for congenital syphilis in the period Between June 2011 and December 2015, in the Municipality of Natal / RN. Data collection occurred between May and August through the Database of the Notification of Injury Information System. Data were analyzed by descriptive and inferential statistics. The Chi-square, T-Student, and Fisher tests were used to verify the associations between the variables of interest. The research received a favorable opinion by the Ethics Committee of the Federal University of Rio Grande do Norte under number 1,449,134 and Certificate of Presentation for Ethical Appraisal 53305315.3.0000.5537. In the period under investigation, there was an increase in reported cases in the year 2012. The registered maternal profile indicates women with a mean age of 24.78 years, browns (70.5%), living in the urban area (95.3%) of the Municipality from Natal. The prenatal analysis identified a predominance of maternal diagnosis in the third gestational trimester (69%) and presence of non-treponemal reactive tests in 94.6% of the women at the time of delivery. Regarding maternal treatment, only 1.6% of these women were registered with an adequate treatment regimen and 16.3% of the partners were treated concomitantly with the pregnant women. In the outcomes related to the children, 78.8% were registered as asymptomatic, however, this variable presented statistical significance when related to the titration of the non-treponemal maternal test and to the pre-delivery treatment. In the spatial analysis by geo - referencing, the predominance of cases in Quintas and Felipe Camar?o neighborhoods, both assisted by the Sanitary District West of the municipality, was identified. The results point, moreover, to important gaps in the epidemiological surveillance processes regarding the filling of notifications regarding unknown and blank information. The analysis of the notification of gestational and congenital syphilis made it possible to conclude that vertical transmission was related to loss of diagnostic and therapeutic opportunities. The development of strategies for early detection and adherence to treatment of the disease should be adopted, with a view to strengthening care and breaking down the vertical syphilis transmission chain. The need for professional qualification for notification of the disease and extension in the provision of information to epidemiological surveillance is emphasized, in order to allow the continuity of the analysis to the disease.