<p>The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use <i>per se</i> and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID.</p><p>The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID.</p><p>There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD.</p><p>IUD use <i>per se</i> was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID.</p><p>An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.</p>

The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use per se and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID. The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID. There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD. IUD use per se was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID. An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.

<p align="justify">The production of reactive oxygen species is strictly kept under control in the Human body. However, several conditions are characterized by the over-production or the uncontrolled production of these species, promoting damage to the host tissue. Among oxygen species producer, the myeloperoxidase/hydrogen peroxide/chloride system is a key element. This the consequence of the large quantity of myeloperoxidase found in neutrophils and that can be released rapidly during an inflammatory process. Moreover, hypochlorous acid, synthesized by this system, is a powerful oxidant.</p> <p align="justify">We have studied the impact of non-steroidal anti-inflammatory drugs (oxicams, nimesulid and flufenamic acid) on three reactive oxygen species, namely, hydroxyl radical, hydrogen peroxide and hypochlorous acid. The first results showed the weak antioxidant properties of these molecules and the necessity to focus on the myeloperoxidase/hydrogen peroxide/chloride system. During the study of the myeloperoxidase inhibition, it appeared that flufenamic acid was an efficient inhibitor that modulated the hypochlorous acid production and was directly oxidized by the enzyme.</p> <p align="justify">Due to the efficacy of flufenamic acid, this molecule was tested in a model of myeloperoxidase-dependent low-density lipoprotein (LDL) oxidation and compared to thiol-containing molecules like N-AcetylCystein and its lysinate salt, glutathione and captopril. The results showed that flufenamic acid lost part of its inhibiting effect while thiol-containing molecules demonstrated an interesting inhibiting activity in this model. A potential explanation could be the ability of myeloperoxidase to bind lipoproteins, masking the entry of its catalytic pocket. In these conditions, the inhibitor size becomes a key parameter in the inhibition of the MPO-dependent low-density lipoprotein oxidation and N-AcetylCystein appears as a powerful inhibitor in this context. These results render N-AcetylCystein an excellent candidate for studies that focus on the reduction of cardiovascular pathology risk.</p> <br> <p align="justify">Le corps humain est le siège constant de la synthèse d’espèces oxygénées réactives dont la production contrôlée est indispensable au bon fonctionnement de l’organisme. Cependant dans de nombreuses pathologies, il arrive qu’une production exagérée et/ou incontrôlée de ces espèces aboutisse à des dégâts oxydatifs. Parmi les mécanismes de production d’espèces oxydantes, le système myéloperoxydase / peroxyde d’hydrogène / chlorure détient une place importante. Ceci est notamment la conséquence de la grande quantité de MPO présente dans les neutrophiles, pouvant être libérée très rapidement lors de l’inflammation. De plus l’acide l’hypochloreux synthétisé par ce système est un très bon oxydant.</p> <p align="justify">Nous avons étudié l’impact des anti-inflammatoires non-stéroïdiens (oxicams, nimésulide et acide flufénamique) sur trois espèces oxygénées réactives : le radical hydroxyle, le peroxyde d’hydrogène et l’acide hypochloreux. Les premiers résultats montrent le faible pouvoir anti-oxydant des molécules testées et la nécessité de concentrer notre recherche sur le système myéloperoxydase / peroxyde d’hydrogène / chlorure, responsable de la synthèse de l’acide hypochloreux. Lors de l’étude de l’inhibition de ce système, il est ressorti que l’acide flufénamique est un bon inhibiteur de la myéloperoxydase car il inhibe la synthèse de l’acide hypochloreux en étant directement oxydé par l’enzyme.</p> <p align="justify">En raison de l’efficacité de l’acide flufénamique, cette molécule a été testée dans un modèle d’oxydation des lipoprotéines de basse densité (LDL) par le système myéloperoxydase / peroxyde d’hydrogène / chlorure en comparaison avec des thiols tels que la N-acétylcystéine et son sel de lysine, le glutathion et le captopril. Les résultats montrent une perte importante du pouvoir d’inhibition de l’acide flufénamique dans ce modèle alors que les thiols et la N-acétylcystéine en particulier, présentent une efficacité non négligeable. Ce phénomène pourrait être attribué à la capacité de la myéloperoxydase de se fixer sur les lipoprotéines, ce qui pourrait masquer l’entrée du site catalytique. Dans ces conditions, la taille de la molécule devient un facteur crucial dans l’inhibition de l’oxydation des lipoprotéines de basse densité et la N-acétylcystéine apparaît dès lors comme un inhibiteur puissant dont les résultats en font un excellent candidat dans des études d’intervention visant la diminution du risque de pathologies cardiovasculaires chez certains patients.</p>

Les maladies cardiovasculaires (MCV), résultant de complications de l'athérosclérose, restent la principale cause de morbidité et de mortalité dans le monde. L'athérosclérose, considérée comme une maladie inflammatoire chronique, implique à la fois les systèmes immunitaires inné et adaptatif. Les macrophages jouent un rôle majeur dans l'initiation de la lésion, sa progression et les complications thrombotiques potentiellement dévastatrices. Un grand nombre de données rapporte l'implication du stress oxydatif, conséquence d'un déséquilibre entre antioxydants et espèces réactives de l'oxygène, dans les maladies cardiovasculaires. En outre, ces pathologies sont fréquemment associées à des changements dynamiques de l'activation des macrophages, soit vers le phénotype pro-inflammatoire M1 (activation classique), soit vers le phénotype anti-inflammatoire M2 (activation alternative). Parmi les antioxydants endogènes, la thiorédoxine-1 (Trx1) est une protéine ubiquitaire qui exerce différents effets physiologiques. Outre son rôle dans l'homéostasie redox cellulaire et comme puissant antioxydant, cette protéine est également impliquée dans le métabolisme énergétique, les réponses inflammatoires, la croissance cellulaire et la survie. En revanche, sa forme tronquée (Trx80) exerce des effets opposés. Il est à noter que plusieurs études ont rapporté le rôle bénéfique du système de la Trx1 dans les MCV mais les mécanismes moléculaires n'ont toujours pas été décrits. Par conséquent, notre étude porte sur le rôle des Trx1 et Trx80 dans le développement et/ou la régression de l'athérosclérose, en particulier dans la modulation de la polarisation des macrophages et dans les différentes voies de signalisation impliquées dans ces processus. Nos principaux résultats obtenus in vitro sur des cultures primaires de macrophages humains ou de macrophages péritonéaux murins, ont révélé d'une part que la Trx1 induit la polarisation des macrophages vers le phénotype anti-inflammatoire M2 suite à la régulation négative de p16INK4a et l’inhibition de la translocation nucléaire de la protéine activatrice-1(AP-1) et de Ref-1; d'autre part, que la Trx1 inhibe la polarisation des macrophages vers le phénotype pro-inflammatoire M1 induit par le lipopolysaccharide (LPS). Par contre, la Trx80 inhibe la polarisation anti-inflammatoire M2 induite par IL-4 ou IL-4/IL-13 mais potentialise le phénotype M1 induit par le LPS. Pour valider in vivo les résultats obtenus in vitro, nous avons utilisé comme modèles expérimentaux, des souris C57Bl/6.ApoE2.ki hyperlipoprotéinémiques et des vaisseaux athérosclérotiques de patients ayant subi une chirurgie vasculaire. Injectées en intraveineuse, la Trx1 et la Trx80 affectent le phénotype des macrophages dans le thymus, le foie et les lésions athérosclérotiques. Chez la souris, la Trx1 réduit la surface des lésions aortiques alors que la Trx80 l’augmente. Enfin le traitement aussi bien par la Trx1 que par la Trx80 n’affecte pas les niveaux de cholestérol et de triglycérides plasmatiques. Pour explorer davantage nos résultats, nous avons étudié les voies de signalisation impliquées dans ces processus. Nos résultats montrent que la Trx1 et la Trx80 activent toutes les deux Akt. La Trx80 utilise la voie de signalisation mTOR pour exercer ses effets dans la polarisation M1 des macrophages puisqu'elle active mTOR de manière dose-dépendante comme l’indique l'augmentation de la phosphorylation de p70S6K. De plus, la Trx1 antagonise l'athérosclérose alors que la Trx80 la potentialise par suite des changements des phénotypes M1/M2, ce qui fait de la Trx1 une cible thérapeutique prometteuse. / The cardiovascular diseases (CVDs), resulting from complications of atherosclerosis, remain the leading cause of morbidity and death worldwide. Atherosclerosis as a chronic inflammatory disease, involves both innate and adaptive arms of immunity in which macrophages play the orchestral role in modulating lesion initiation, progression, and potentially devastating thrombotic complications. Available evidences support the notion of a central role of oxidative stress, due mainly to the imbalance between antioxidants and reactive oxygen species (ROS) in CVDs. Furthermore, the pathology is frequently associated with dynamic changes in macrophage activation, with classically activated M1 cells implicated in initiating and sustaining inflammation and M2 or M2-like cells associated with resolution or smoldering chronic inflammation. Among endogenous antioxidants, the thiordoxine-1 (Trx1) plays a central role in several diseases including CVD. Thus, the ubiquitous Trx1 has been reported to exert a myriad of beneficial roles. Indeed, it regulates not only cellular redox homeostasis and acts as a principal antioxidant defense system, but it also affects energy metabolism, modulates the immunological and inflammatory responses, and controls cell growth and survival. In contrast, its truncated form (Trx-80), exerts an opposite effects. However, several studies reported the beneficial role of Trx system in CVDs but the detailed molecular mechanism is not addressed yet. Therefore, the present study aims to investigate the role of both Trx1 and Trx80 in the biology of atherosclerosis through the modulation of macrophage polarization and the implicated signaling pathways as well. Our in vitro major findings, using human macrophages and murine peritoneal macrophages, revealed that Trx1 on one hand promoted the polarization of anti-inflammatory M2 macrophages through downregulation of p16INK4a and suppressing nuclear translocation of activator protein-1 (AP-1) and Ref-1 as evidenced by the expression of the CD206 and IL-10 markers. On the other hand Trx1 also reduced the lipopolysaccharide (LPS)-induced differentiation of inflammatory M1 macrophages, as indicated by the decreased expression of the M1 cytokines, tumor necrosis factor-α (TNF-) and monocyte chemoattractant protein-1 (MCP¨-1). By contrast, Trx80 treatment attenuated the polarization of anti-inflammatory M2 macrophages induced by IL-4 or IL-4/IL-13 even it potentiated LPS-induced M1 activation. To validate our obtained in vitro results, hyperlipoproteinemic C57Bl/6.ApoE2.ki mice and human atherosclerotic vessel specimens from patients undergoing vascular surgery were used. Consistently, Trx1 and Trx80 affected macrophage phenotype in thymus, liver and atherosclerotic lesions. As a consequence, Trx1 reduced whereas Trx80 increased the aortic lesion area in mice. Plasma levels of cholesterol and triglycerides did not changed by the treatment. To further explore our results, the implicated signaling pathways has been studied and it was found that both Trx1 and Trx80 activated Akt. Furthermore, Trx80 uses mTOR signaling pathway to exert its effect in polarizing macrophages toward M1 phenotype since it activated mTOR in a dose-dependent manner as demonstrated by the increased phosphorylation of P70S6K. Based on our results, Trx1 antagonizes whereas Trx80 potentiates atherosclerosis through changing M1/M2 phenotypes. Therefore, Trx1 represents a promising target for therapeutic interventions.

BACKGROUND: Female veterans are at risk for stress-related physical disorders given unique environmental stress factors, high rates of trauma exposure and a heightened physiologic stress response. There is a need to identify modifiable risk factors which may help minimize the emergence and impact of veteran illness. RESEARCH QUESTION: The present study investigated the contributions of posttraumatic stress symptoms, maladaptive repetitive thought (MRT), depression, childhood trauma and health behaviors (sleep, alcohol use and smoking) to physical disease as operationalized by immune-mediated inflammatory disease occurrence and related functional disability. METHOD: Female Reserve or National Guard veterans (N = 643) enrolled in a parent study conducted through the Iowa City Veteran's Affairs Hospital completed a one-time computer-assisted telephone interview. The current study examined self-report measures of posttraumatic stress symptoms, MRT, depression, childhood trauma, smoking, alcohol use, sleep, inflammatory disease incidence and physical functioning. RESULTS: Proposed models of primary hypotheses were tested using structural equation modeling. Results indicated that both physical disease and functional decline were greater in veterans reporting a history of trauma. Physical disease was associated with greater depression and childhood trauma but lower levels of alcohol use after accounting for covariates. Unexpectedly, greater MRT was associated with less physical disease, although it was only related to disease when depression was included as a covariate. Reduced sleep was linked with greater disease but only when depression was not included in the model, and depression was found to fully mediate the relationship between sleep and physical disease. Smoking and the interaction between posttraumatic stress symptoms and MRT were generally unrelated to physical disease in this sample. CONCLUSIONS: Results of this study are consistent with the hypothesis that physical disorders and related functional decline are greater in trauma-exposed individuals and that depression, childhood trauma, repetitive thought and alcohol use have independent associations with physical disease. This study offers support for further research and interventions which address these relationships to protect female veteran health.

The asymptomatic nature of chlamydial infection renders the differential diagnosis of acute and chronic infection difficult. An untreated Chlamydia trachomatis infection can become chronic, result in disease sequelae such as salpingitis and pelvic inflammatory disease (PID), and ultimately culminate in tubal occlusion and infertility. Diagnostic tests for C. trachomatis such as nucleic acid amplification testing (PCR), antigen detection and serological methods have variable performance capabilities with respect to sensitivity, specificity and stage of infection. The use of PCR as a diagnostic tool is somewhat limited, as specimen collection is routinely sampled from the lower genital tract; hence, infections in the fallopian tube where inflammatory damage is most significant, escape detection. Furthermore, PCR can only detect selected Chlamydia DNA sequences from readily accessible sites of the genital tract, and therefore cannot differentiate between acute and chronic infection. Other serological assays aim to discriminate the various stages of C. trachomatis infection through identification of key antigens. The efficacy of these assays however is impeded due to cross-reactivity between chlamydial species and the subsequent antibody response against the target antigen is not restricted to patients with a specific stage of infection. To identify antibody responses capable of differentiating various states of chlamydial infection, samples were collected from both men and women given the variability of immune responses between the two genders. Samples were assigned to a patient group according to infection status and then probed against protein extracts of HEp-2 cells infected with C. trachomatis serovar L2 and HEp-2 cells pre-treated with IFN-γ and infected with C. trachomatis serovar L2. (persistence cell culture) Serological analysis revealed the presence of five antigens (denoted bands A, B, C, D and M) which were shown to be differential between patient groups. Identification of bands B and C by N-terminal sequencing provided two possible candidates for each antigen, ie. CT727 and CT396 (band B) and CT157 and CT423 (band C). In contrast, band M which was unique to males was a PmpB (probable outer membrane protein B) fragment. The four target antigens (CT157, CT423, CT727 and CT396) were expressed as recombinant proteins using autoinduction media and were subsequently probed by both male and female sera to evaluate their diagnostic potential. Results showed that two chlamydial antigenic targets (CT157 and CT727) have the potential to discriminate between acute and chronic C. trachomatis infection. However, since only a small number of samples (n = 3) were used for this aspect of the study, the findings should simply be viewed as preliminary. In females, sensitivity and specificity values were derived using various combinations of the four target antigens into a panel format for the purpose of detecting chronic C. trachomatis infections. The preferred format was B + C with a sensitivity and specificity of 80% and 84% respectively. Using the IFN-γ-mediated persistence model, only two of the five antigenic targets were shown to be differentially expressed. PmpB in males and CT157 (the most likely band C candidate) in females were shown to be up-regulated to varying degrees in samples across the patient groups. We also demonstrated that no other chlamydial antigens are up-regulated during a persistent C. trachomatis infection. In conclusion, although combinations of bands A, B, C, D and M differentiate between male and female patient groups under normal chlamydial growth conditions, during IFN-γ-induced persistence, only bands C (CT157) and M (CT413 - PmpB) are up-regulated thus suggesting a potential role in chronic C. trachomatis infection.

Made available in DSpace on 2014-12-17T14:16:27Z (GMT). No. of bitstreams: 1 MarianaAOB_DISSERT.pdf: 3079508 bytes, checksum: 5d34c7cd249531ceb74afa12d1184e1f (MD5) Previous issue date: 2011-02-28 / The regulation of the inflammatory response is essential to maintain homeostasis. Several studies have been performed to search new drugs that can contribute to avoiding or minimizing an excessive inflammatory process. The aim of this study was to evaluate the effect of extracts of green algae Caulerpa mexican in models of inflammation. In mice, the model of peritonitis induced inflammatory zymosan pretreatment of mice with aqueous and methanol extracts of C. mexican was able to reduce cell migration to the peritoneal cavity. Treatment of mice with extracts of C. mexican also reduced the ear edema induced by xylene and exerted inhibitory action on the migration of leukocytes in inflammation-induced zymosan the air pouch, and timedependent for the extracts tested in the model of ulcerative colitis induced by DSS 3%, the extract methanol, but not the aqueous C. mexican, significantly reduced the clinical symptoms of colitis, as well as the production of proinflammatory cytokines in the culture of mouse colon, in the histological analysis there was a slight reduction of inflammation in the intestinal mucosa. We concluded that the administration of the extracts resulted in the reduction of cell migration to different sites as well as reducing the edema formation induced by chemical irritant. This study demonstrates for the first time the antiinflammatory effect of aqueous and methanolic extracts from green marine algae Caulerpa mexican / A regula??o da resposta inflamat?ria ? essencial para manter a homeostase. Diversos estudos t?m sido realizados para a pesquisa de novas drogas que possam contribuir para evitar ou minimizar um processo inflamat?rio excessivo. O objetivo deste estudo foi avaliar o efeito de extratos de algas verde Caulerpa mexicana em modelos de inflama??o. Em camundongos, o modelo de peritonite inflamat?ria induzida por zimosam o tratamento pr?vio de camundongos com extrato aquoso e metan?lico de C. mexicana foi capaz de reduzir a migra??o celular para a cavidade peritoneal. O tratamento dos camundongos com os extratos da C. mexicana tamb?m diminuiu o edema de orelha induzido por xilol e exerceu a??o inibit?ria da migra??o de leuc?citos em inflama??o induzido pelo zimosam na bolsa de ar, sendo tempo-dependente para os extratos testados, no modelo de colite ulcerativa induzida por DSS 3%, o extrato metan?lico, mas n?o o aquoso da C. mexicana, reduziu de forma significativa o quadro cl?nico da colite, como tamb?m a produ??o de citocinas pr?-inflamat?rias na cultura do c?lon do camundongo, na an?lise histol?gica houve uma leve redu??o da inflama??o na mucosa intestinal. Conclu?mos que a administra??o dos extratos resultou na redu??o da migra??o de c?lulas para diferentes modelos experimentais, bem como reduzir a forma??o de edema induzida por irritante qu?mico. Este estudo demonstra pela primeira vez o efeito anti-inflamat?rio do extrato aquoso e metan?lico da alga verde marinha Caulerpa mexicana

Submitted by (edna.saturno@ufrpe.br) on 2016-10-11T12:34:04Z No. of bitstreams: 1 Jose Bezerra de Almeida Neto.pdf: 940567 bytes, checksum: 9da7476511aa98743d8fdba6588ef5b7 (MD5) / Made available in DSpace on 2016-10-11T12:34:04Z (GMT). No. of bitstreams: 1 Jose Bezerra de Almeida Neto.pdf: 940567 bytes, checksum: 9da7476511aa98743d8fdba6588ef5b7 (MD5) Previous issue date: 2009-02-10 / Brazil has currently the third largest herd of horses in the world with 5.9 million animals, stimulating economic activity of billions of U. S. dollars per year. In the Northeast of Brazil, the most important socio-economic equestrian activity is known as Vaquejada, where two riders gallop alongside a cow, one of them keeping the cow in a straight line, the other grabbing its tail and flipping it over onto its back before reaching the finish line. Highperformance athlete horses require heathy organic function to reach expected performance. Due to the importance of the respiratory system as the main entrance of many diseases and it´s direct influence in athletic performance and because of inexistent scientific literature in this subject, the aim of this study was to identify upper and lower respiratory tract alterations through endoscopy technique in vaquejada resting horses. 103 animals were evaluated within 30 and 45 minutes after exercise with no physical alterations or history of respiratory changes. Affections present in the upper respiratory tract were Follicular Hyperplasia (14/103) Recurrent Laryngeal Neuropathy (21/103), Epiglottic Entrapment (1/103). In the lower respiratory tract we observed the presence of Exercise-Induced Pulmonary Hemorrhage (25/103) and Inflammatory Airway Disease (36/103). Endoscopic airway examination, as a safe, low cost and of easy implementation exame, should become routine in these horse populations, expanding diagnosis ability and providing a better approach to correct treatment. / O Brasil possui atualmente o terceiro maior rebanho de eqüinos do mundo com 5,9 milhões de animais, movimentando cerca de R$ 7,3 bilhões ao ano. No Nordeste, a atividade eqüestre de maior importância socioeconômica é a vaquejada, onde uma dupla de competidores a cavalo tem puxar um boi pela cauda durante a corrida, derrubando-o dentro de uma faixa delimitada. Um funcionamento orgânico adequado é requisito necessário para que os cavalos atinjam o desempenho esperado em atletas de alto rendimento. Devido à importância do aparelho respiratório como sede de doenças que influenciam diretamente no rendimento atlético, este estudo teve por objetivo identificar as alterações do Trato Respiratório Cranial e Caudal Proximal em cavalos de vaquejada, pela técnica da endoscopia em repouso, uma vez que estes relatos são inexistentes na literatura científica. Para tal, avaliou-se 103 animais sem alterações físicas ou histórico de alterações respiratórias, entre 30 e 45 minutos após o exercício, em competições de vaquejada. As afecções presentes no trato respiratório superior foram Hiperplasia Folicular Linfóide (14/103), Neuropatia Laringeana Recorrente (21/103) e Encarceramento Epiglótico (1/103). No trato respiratório inferior, observou-se a presença de Hemorragia Pulmonar Induzida por Exercício (25/103) e Doença Inflamatória das Vias Aéreas (36/103). Além de observar, pela primeira vez em animais de vaquejada, diversas doenças respiratórias, constatou-se que é necessário que o exame endoscópico das vias aéreas, por ser seguro, de fácil realização e baixo custo, torne-se rotineiro nesta população, ampliando o diagnóstico das afecções e proporcionando melhores condutas de tratamento.

Philosophiae Doctor - PhD / Sexually transmitted infections (STIs) are a problem for both developed and developing countries. Sub-Saharan Africa has the highest rates in the 15-49 years old group. The discovery that these infections playa vital role in the transmission of HIV raised their profile and made their control one of the central strategies of stopping the HIV/AIDS epidemic. In response to the challenge of improving the quality of care for people infected with STIs in the public health sector, the South African Ministry of Health adopted the syndromic management approach, recommended by the World Health Organisation as suitable for resource-poor settings, for use in primary health care clinics. In addition to providing guidelines on clinical management of STIs, the syndromic approach requires health providers to counsel and educate patients about STIs, encourage patients to complete treatment even if symptoms abate, promote condom use and the treatment of all sexual partners. While the management guidelines are clear and detailed around the diagnostic and medication issues, the processes of education and counseling are not as clearly outlined. Furthermore, although the syndromic approach is a viable way of providing good quality care to larger sections of the population than could be serviced through dedicated STI clinics, it requires health providers working in primary health care clinics, most of whom are professional nurses, to perform some tasks for which they may not be adequately trained. This study evaluated the quality of care for persons infected with ST!s by examining the extent to which the syndromic approach was being implemented in primary health care clinics. Interviews, using semi-structured interview schedules, were conducted with ST! patients and health providers in twenty-four clinics located in four provinces. In depth qualitative interviews were also conducted with a sub-sample of the patients. For further triangulation the methods of participant observation, through the use of simulated patients, and focus group discussions with various community groups were used. The findings of the study indicate that although primary health care clinics in South Africa are well-resourced, the management of patients with ST!s is inadequate. Adherence to the various aspects of syndromic management was poor. Similar to other studies in South Africa, the attitudes of health providers towards patients with ST!s were found to be problematic, a finding that has implications for health-seeking behaviours. The thesis argues that a large part of the problem is related to the multiple roles that nurses have to play in primary health care settings, as well as the content and methodology of the training of nurses who manage ST! patients. It further argues for the constitution of the basic health team at primary health clinics to be multi-disciplinary, and for a multi-disciplinary input in the training of health providers.

Objective: The clinical significance of the potential for persistent human chlamydial infections in vivo is being actively reassessed because of the increased frequency of recurrent infection with the same serovar despite compliance with an effective antibiotic regimen. The ability to extend the length of time of in vitro cultivation of polarized human endometrial epithelial cells (HEC-1B) provided the opportunity to establish a model system to determine if a persistent form of Chlamydia trachomatis had the same susceptibility as the actively growing form to a cidal concentration of azithromycin. Methods: Polarized HEC-1B cells cultivated on extracellular matrix were infected with C. trachomatis serovar E and exposed to penicillin at 24 h post-infection (hpi) to induce a persistent infection characterized by slowly metabolizing but non-dividing, ultrastructurally aberrant reticulate bodies within the chlamydial inclusion; at 48hpi, infected cultures were exposed to a bactericidal concentration of azithromycin for 72 h. Results: Persistent chlamydiae were phenotypically resistant to azithromycin; the number of chlamydial inclusions on subpassage of progeny from persistent chlamydiae following removal of penicillin and recovery was essentially the same as from progeny from persistent chlamydiae following removal of penicillin and azithromycin and recovery. Neutrophils were attracted in vitro to persistently infected HEC-1B cells that had been exposed to penicillin and azithromycin. Conclusions: Thus, this study provides evidence at the cellular microbiology level in vitro for mechanisms that could exist in vivo to create sustained, but perhaps clinically inapparent inflammation, which might eventually lead to conditions such as silent pelvic inflammatory disease.