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Les infections rickettsiales et la fièvre aiguë indifférenciée (FAI) sont des problèmes de santé publique importants sous les tropiques. Ce projet a été réalisé dans le but d'explorer les agents de rickettsies et autres étiologies de la FAI au Vietnam.Dans la première cohorte de 67 participants se concentrant sur les patients cliniquement suspectés de typhus des broussailles, le diagnostic de typhus des broussailles a été confirmé pour 32 patients (47,8%) par qPCR ou IFA. Parmi les 20 patients pour lesquels des escarres et du sang total ont été obtenus, 17 (85%) des échantillons d'escarre et 5 (25%) des échantillons de sang total étaient positifs pour O. tsutsugamushi par qPCR. L'analyse génétique des séquences du gène TSA 56-kDa a démontré que les 14 séquences étaient apparentées à 4 génotypes: Karp, Kawasaki, Gilliam (JG-v et TG-v) et TA716. Ensuite, une analyse prospective des étiologies de la FAI au Vietnam a été réalisée avec 378 patients adultes fébriles (FAIs) et 384 patients adultes fébriles (Contrôles). L'étiologie la plus courante était le virus de la grippe (20,9% dans les FAIs versus 0% dans les Contrôles), suivi des rickettsies (11,11% vs 0,26%), virus de la dengue (7,67% vs 0,52%), Leptospira (4,76% vs 0,78%), adénovirus (4,76% vs 1,04%) et entérovirus (2,12% vs 0%) (p<0,05).Par conséquent, de telles données sur les rickettsies et autres étiologies obtenues au Vietnam pourraient être très utiles pour l’établissement d’une méthode d’approche pour les patients atteints de FAI dans les aspects de diagnostic, de gestion et de prévention au Vietnam et dans les régions tropicales dans l'avenir. / Rickettsial infections and acute undifferentiated fever (AUF) are the important public health issues in the tropics. This project was performed with the aim to explore the rickettsial agents and other etiologies of AUF in Vietnam. In the first 67-participant cohort of patients who were clinically suspected of having scrub typhus, 32 (47.8%) patients were confirmed as scrub typhus by either qPCR or IFA. Among the 20 patients for whom both eschar and whole blood were obtained, 17 (85%) of the eschar specimens and 5 (25%) of the whole blood specimens tested positive for O. tsutsugamushi by qPCR. Genetic analysis of the 56-kDa TSA gene sequences demonstrated that the 14 sequences were related to 4 groups: Karp, Kawasaki, Gilliam (JG-v and TG-v) and TA716.Subsequently, a prospective case-control analysis of the etiologies of AUF in Vietnam was performed. A total of 378 febrile adult patients (AUFs) and 384 afebrile adult patients (Controls) were enrolled. The most common etiology was influenza virus (20.9% in AUFs versus 0% in Controls), followed by rickettsial agents (11.11% in AUFs versus 0.26% in Controls), dengue virus (7.67% vs 0.52%), Leptospira (4.76% vs 0.78%), adenovirus (4.76% vs 1.04%), and enterovirus (2.12% vs 0%) (p<0.05). Consequently, such data of rickettsial agents and other etiologies in Vietnam obtained from this project are extremely useful in guiding the diagnosis, management and preventive-health methods for patients with AUF in the future in Vietnam as well as in the tropics worldwide.

Diabetes mellitus (DM) is a syndrome of multiple etiologies resulting from lack of insulin and / or the inability of insulin properly exercise its effects. It is considered the world, a public health problem by the position it occupies with high epidemiological incidence and prevalence, besides causing macrovascular and microvascular complications. The DM has two main forms, type 1 (DM1), which appears mostly in childhood or adolescence and type 2 (DM2), the most frequent, accounting for 85% to 90% of cases, usually of insidious onset, especially after 40 years of age, affecting obese individuals in 90% of the time. Cardiovascular diseases (CVD) are responsible for approximately 52% of deaths of patients with DM. The strategy of prevention of these chronic complications essentially depend on the adequate control of blood glucose and other comorbidities, including dyslipidemia and hypertension (SAH). This ivestigação was conducted to evaluate the effect of pharmaceutical intervention on glycemic control in outpatients suffering from DM2.Trata is a longitudinal study with intervention, using 100 subjects during query consecutively diagnosed with DM2 in private clinic endocrinology from May 2011 to February 2012. All patients answered a questionnaire and underwent pharmaceutical intervention, conducted by the researcher. After this intervention, there was a significant reduction of 45% CI 95% in A1C levels. Thus, there was still improvement in outcomes among women (69%) (p = 0.01) and the following parameters: fasting glucose (p = 0.000), frequency of exercise (p = 0.0001), adoption of low-calorie diet (p = 0.0001), adherence to drug therapy (p = 0.024) and BMI (p = 0.012). / O diabetes mellitus (DM) é uma síndrome de etiologia múltipla decorrente da falta de insulina e/ou da incapacidade da insulina exercer adequadamente seus efeitos. É considerado, mundialmente, um problema de saúde pública pela posição epidemiológica que ocupa com altas taxas de incidência e prevalência, além de acarretar complicações macrovasculares e microvasculares. O DM apresenta duas formas principais, o tipo 1 (DM1), que aparece principalmente na infância ou na adolescência e o tipo 2 (DM2), a mais freqüente, responsável por 85% a 90% dos casos, geralmente de instalação insidiosa, principalmente após os 40 anos de idade, acometendo indivíduos obesos em 90% das vezes. As doenças cardiovasculares (DCV) são responsáveis por aproximadamente 52% das mortes dos portadores de DM. A estratégia de prevenção destas complicações crônicas dependem, fundamentalmente, do adequado controle da glicemia e de outras comorbidades, entre elas a dislipidemia e a hipertensão arterial sistêmica (HAS). A presente ivestigação foi conduzida visando avaliar o efeito da intervenção farmacêutica no controle da glicemia de pacientes ambulatoriais portadores de DM2.Trata-se de um estudo longitudinal com intervenção, utilizando-se 100 sujeitos durante consulta, consecutivamente, com diagnóstico de DM2 em ambulatório privado de endocrinologia no período de maio de 2011 a fevereiro de 2012. Todos os voluntários responderam a um questionário e sofreram intervenção farmacêutica, realizada pelo pesquisador. Após esta intervenção, ocorreu uma redução significativa de 45% IC 95% nos níveis de A1C. Diante disso, observou-se ainda melhora nos resultados entre as mulheres (69%) (p=0,01) e nos seguintes parâmetros: glicemia de jejum (p=0,000), frequência de exercícios físicos (p=0,0001), adoção da dieta hipocalórica (p= 0,0001), adesão à terapia medicamentosa (p= 0,024) e IMC (p= 0,012).