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Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / "May 2002." Typescript. Vita. Includes bibliographical references (leaves 104-114).

A thesis presented to the Faculty of Medicine, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Medicine / Since changes occur in size, shape and haemoglobin content of red cells in disease a classification of the anaemias based on the morphology of the red cell has been widely used ( Wintrobe, 1956 ) . While such classification has a limited usefulness from the diagnostic and therapeutic approach it has two serious defects.. / IT2018

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 104-114).

The use of aminoglycosides in the treatment of the febrile neutropaenic patient with haematological disease is difficult and often suboptimal. This study reviews the available literature to establish therapeutic guidelines in this population and then reports the use of a Bayesian statistics based predictive model to implement and manage therapy in 10 patients. A review of the literature on aminoglycoside Pharmacology and clinical use is essential to determine therapeutic guidelines for this population. Aminoglycosides are amino sugars in glycosidic linkage and are polycations at physiological PH. The antibiotic effect is mediated through inhibition of protein synthesis and disruption of cell membrane integrity. Principal use is in treatment of Gram negative infection although aminoglycosides have activity against some Gram positive organisms including staphylococci. Aminoglycosides are inactive against anaerobes. Acquired resistance is mediated by bacterial enzymatic drug metabolism. Aminoglycosides are nephro- and ototoxic, this is the major constraint in clinical use.

A pessoa com distúrbios hematológicos demonstra desarranjos físicos, emocionais e sociais. Assim, atuar nesta área é estar disposta a cuidar do indivíduo, percebendo e intervindo precocemente nas alterações manifestadas. Os tratamentos para as patologias hematológicas podem ser feitos pela radioterapia, quimioterapia e o transplante de células tronco hematopoéticas (TCTH). Na maioria dos casos, a combinação destas modalidades terapêuticas faz-se necessária para o alcance do controle da doença. Após ser submetido à quimioterapia e/ou radioterapia o paciente é encaminhado para o TCTH almejando-se a cura. Estes tratamentos são altamente agressivos, acarretando prejuízos em todas as dimensões da vida do doente. A compreensão da trajetória da pessoa acometida por uma doença, desde o início dos sinais e sintomas até as perspectivas para o futuro, identificando suas idéias e condutas na luta pela sobrevivência, parte do entendimento do contexto sociocultural em que está inserida. Nessa perspectiva, o objetivo deste estudo foi identificar os modelos explicativos (MEs) para o TCTH alogênico aparentado, na visão de um grupo de pacientes. Para o seu alcance, estabelecemos como base teórica a antropologia médica, o método do estudo de caso qualitativo e a técnica de análise de conteúdo indutivo. Participaram deste estudo 11 pacientes, sendo três com leucemia mielóide aguda, quatro com leucemia mielóide crônica, dois com leucemia linfóide aguda e dois com anemia aplástica grave. As seis mulheres e os cinco homens formam um grupo de adultos em idade produtiva e suas características sociais mostram que são pessoas oriundas da classe social popular. Realizamos entrevistas semi-estruturadas, norteada por questões que integram a construção dos modelos explicativos. Posteriormente compilamos cada uma das entrevistas e seguimos para a análise de dados que se realizou em duas etapas. Reunimos as entrevistas e após várias leituras elencamos as categorias temáticas: da trajetória da doença ao tratamento especializado, os sentidos dados à doença e aos tratamentos, o lidar com a doença e os tratamentos e a vida após os tratamentos. Por estas categorias apreendemos os diversos elementos constitutivos dos modelos explicativos do adoecer e do submeter-se ao TCTH alogênico, onde evidenciamos a influência da cultura em que estão inseridos os participantes. Os entrevistados retrataram os sinais e sintomas da doença, a percepção do estar doente e suas causas, a difícil busca pela assistência à saúde, os tratamentos caseiros, a necessidade das terapêuticas, a existência de um doador compatível, as complicações e suas consequências, as dificuldades financeiras, os cuidados e as mudanças no modo de vida após os tratamentos e as perspectivas de futuro. Concluímos que a cultura é um sistema de referência para as pessoas de um grupo social, que fornece formas de pensar e agir sobre uma determinada situação ou evento. Evidenciamos exemplos da trajetória percorrida pelos participantes em busca da cura, almejando instigar os profissionais da saúde, em especial à equipe de enfermagem, que cuidam destes pacientes a olhá-los em todas as suas dimensões da vida, desejando um cuidado integral e diferenciado, integrando conhecimentos culturais ao modelo biomédico. / People with hematologic disorders face physical, emotional and social alterations. Thus, acting in this area means to be willing to care for the individual, precociously perceiving and intervening in the revealed changes. Hematologic pathologies can be treated by radiotherapy, chemotherapy and hematopoietic stem cell transplantation (HSCT). In most cases, the combination of these types of therapy is needed to control the disease. After undergoing chemotherapy and/or radiotherapy the patient is subject to HSCT, aiming the cure. These treatments are highly aggressive, causing damages in all dimensions of patients lives. Understanding patients sociocultural context is necessary to comprehend the trajectory of someone affected by a disease, since the beginning of the signs and symptoms up to the perspectives for the future, identifying their ideas and behaviors in the fight for survival. In this way, this study aimed to identify the explanatory models (EMs) for allogeneic HSCT of related donors, in the view of a group of patients. In order to achieve this, the medical anthropology, the qualitative case study method and the inductive content analysis technique were established as theoretical bases. Eleven patients participated in the study, three with acute myeloid leukemia, four with chronic myeloid leukemia, two with acute lymphoid leukemia and two with severe aplastic anemia. The six women and five men are adults at reproductive age and their social characteristics show they are from the lower social class. Semi-structured interviews guided by questions that are part of the construction of the explanatory models were carried. Afterwards the interviews were compiled and analyzed in a two-phase data analysis. Interviews were gathered and after several readings, the following thematic categories were listed: from the trajectory of the disease to specialized treatment, the meanings given to the disease and treatments, dealing with the disease and treatments, and life after treatments. Different elements of the explanatory models of becoming ill and undergoing allogeneic HSCT emerged from these categories. The influence of participants cultural context was evidenced. Interviewed subjects reported the signs and symptoms of the disease, the perception of being ill and its causes, the difficult search for health care, home treatments, the need of medications, the existence of a compatible donor, complications and their consequences, the financial difficulties, care and changes in the lifestyle after treatments and the perspectives of future. It is concluded culture is a reference system to people from a social group, which provides ways of thinking and acting about a certain situation or event. Examples of the trajectory followed by the participants in the search for care is evidenced, aiming to motivate health professionals, specially from the nursing team, who delivery care to these patients, to look them in all dimensions of their lives, to provide a comprehensive and differentiated care, integrating cultural knowledge to the biomedical model.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 6 uppsatser.

Thematic Paper ((M.C.T.M. Clinical Tropical Medicine))--Mahidol University, 2006. / LICL has E-Thesis 0012 ; please contact computer services. LIRV has E-Thesis 0012 ; please contact circulation services.

Objectives. Evaluate the three blood cell series and identify the presence of hypochromia, macrocytosis, leucopenia, lymphopenia, and thrombocytopenia in a group of workers exposed to the mixture of benzene-toluene-xylene (BTX). Materials and methods. A cross-sectional study which included 97 workers from a paint factory in Mexico. The participants underwent conventional blood count and tests for potential cumulative daily dose of BTX fumes, to estimate exposure. Results. From the total of workers, 19.6% showed macrocytosis, 18.6%, lymphopenia, hypochromia 10.3%, 7.2% and 5.2% thrombocytopenia leukopenia. The crude association of macrocytosis with exposure to high doses of BTX mixture was the only with statistical significance (OR: 3.6, 95% CI 1.08 to 13.9, P = 0.02), and the base for a logistic regression model (OR: 6.7, 95% CI 1.33 to 13.55, P = 0.02) adjusted for age, alcohol consumption, and smoking. Conclusions. All blood cytological components analyzed demonstrated mild changes, potentially associated with exposure to the mixture of BTX. Macrocytosis could constitute an early manifestation worthy for surveillance. / Revisión por pares.

A pessoa com distúrbios hematológicos demonstra desarranjos físicos, emocionais e sociais. Assim, atuar nesta área é estar disposta a cuidar do indivíduo, percebendo e intervindo precocemente nas alterações manifestadas. Os tratamentos para as patologias hematológicas podem ser feitos pela radioterapia, quimioterapia e o transplante de células tronco hematopoéticas (TCTH). Na maioria dos casos, a combinação destas modalidades terapêuticas faz-se necessária para o alcance do controle da doença. Após ser submetido à quimioterapia e/ou radioterapia o paciente é encaminhado para o TCTH almejando-se a cura. Estes tratamentos são altamente agressivos, acarretando prejuízos em todas as dimensões da vida do doente. A compreensão da trajetória da pessoa acometida por uma doença, desde o início dos sinais e sintomas até as perspectivas para o futuro, identificando suas idéias e condutas na luta pela sobrevivência, parte do entendimento do contexto sociocultural em que está inserida. Nessa perspectiva, o objetivo deste estudo foi identificar os modelos explicativos (MEs) para o TCTH alogênico aparentado, na visão de um grupo de pacientes. Para o seu alcance, estabelecemos como base teórica a antropologia médica, o método do estudo de caso qualitativo e a técnica de análise de conteúdo indutivo. Participaram deste estudo 11 pacientes, sendo três com leucemia mielóide aguda, quatro com leucemia mielóide crônica, dois com leucemia linfóide aguda e dois com anemia aplástica grave. As seis mulheres e os cinco homens formam um grupo de adultos em idade produtiva e suas características sociais mostram que são pessoas oriundas da classe social popular. Realizamos entrevistas semi-estruturadas, norteada por questões que integram a construção dos modelos explicativos. Posteriormente compilamos cada uma das entrevistas e seguimos para a análise de dados que se realizou em duas etapas. Reunimos as entrevistas e após várias leituras elencamos as categorias temáticas: da trajetória da doença ao tratamento especializado, os sentidos dados à doença e aos tratamentos, o lidar com a doença e os tratamentos e a vida após os tratamentos. Por estas categorias apreendemos os diversos elementos constitutivos dos modelos explicativos do adoecer e do submeter-se ao TCTH alogênico, onde evidenciamos a influência da cultura em que estão inseridos os participantes. Os entrevistados retrataram os sinais e sintomas da doença, a percepção do estar doente e suas causas, a difícil busca pela assistência à saúde, os tratamentos caseiros, a necessidade das terapêuticas, a existência de um doador compatível, as complicações e suas consequências, as dificuldades financeiras, os cuidados e as mudanças no modo de vida após os tratamentos e as perspectivas de futuro. Concluímos que a cultura é um sistema de referência para as pessoas de um grupo social, que fornece formas de pensar e agir sobre uma determinada situação ou evento. Evidenciamos exemplos da trajetória percorrida pelos participantes em busca da cura, almejando instigar os profissionais da saúde, em especial à equipe de enfermagem, que cuidam destes pacientes a olhá-los em todas as suas dimensões da vida, desejando um cuidado integral e diferenciado, integrando conhecimentos culturais ao modelo biomédico. / People with hematologic disorders face physical, emotional and social alterations. Thus, acting in this area means to be willing to care for the individual, precociously perceiving and intervening in the revealed changes. Hematologic pathologies can be treated by radiotherapy, chemotherapy and hematopoietic stem cell transplantation (HSCT). In most cases, the combination of these types of therapy is needed to control the disease. After undergoing chemotherapy and/or radiotherapy the patient is subject to HSCT, aiming the cure. These treatments are highly aggressive, causing damages in all dimensions of patients lives. Understanding patients sociocultural context is necessary to comprehend the trajectory of someone affected by a disease, since the beginning of the signs and symptoms up to the perspectives for the future, identifying their ideas and behaviors in the fight for survival. In this way, this study aimed to identify the explanatory models (EMs) for allogeneic HSCT of related donors, in the view of a group of patients. In order to achieve this, the medical anthropology, the qualitative case study method and the inductive content analysis technique were established as theoretical bases. Eleven patients participated in the study, three with acute myeloid leukemia, four with chronic myeloid leukemia, two with acute lymphoid leukemia and two with severe aplastic anemia. The six women and five men are adults at reproductive age and their social characteristics show they are from the lower social class. Semi-structured interviews guided by questions that are part of the construction of the explanatory models were carried. Afterwards the interviews were compiled and analyzed in a two-phase data analysis. Interviews were gathered and after several readings, the following thematic categories were listed: from the trajectory of the disease to specialized treatment, the meanings given to the disease and treatments, dealing with the disease and treatments, and life after treatments. Different elements of the explanatory models of becoming ill and undergoing allogeneic HSCT emerged from these categories. The influence of participants cultural context was evidenced. Interviewed subjects reported the signs and symptoms of the disease, the perception of being ill and its causes, the difficult search for health care, home treatments, the need of medications, the existence of a compatible donor, complications and their consequences, the financial difficulties, care and changes in the lifestyle after treatments and the perspectives of future. It is concluded culture is a reference system to people from a social group, which provides ways of thinking and acting about a certain situation or event. Examples of the trajectory followed by the participants in the search for care is evidenced, aiming to motivate health professionals, specially from the nursing team, who delivery care to these patients, to look them in all dimensions of their lives, to provide a comprehensive and differentiated care, integrating cultural knowledge to the biomedical model.