Aim: The aim of this study was to describe the total energy expenditure (TEE) and physical activity levels (PAL) within a group of children with cystic fibrosis (CF) and to compare the results with a control group with healthy children. The aim also was to compare the rated activity levels between the groups as well comparing the difference between boys and girls within the groups. Method: The study included 30 participating children, divided into two groups with 15 participants in each group. One of the groups was a CF-group and the other a group of controls, matched for gender and age. Activity diaries were studied and data were presented decrepitly and analyzed with Wilcoxon rank sum test. Result: The result showed no difference between the groups while comparing TEE and PAL. Half of the participants in both groups (53,34 % and 46,67 %) reached a moderate or high physical activity level during the registration. No significance was proved between the groups as they rated their activity level, numbered 6-9, in their activity diaries. Neither could any differences be proved significant in rated activity between the boys and girls within the groups. Conclusion: The conclusion was that no significant differences appeared regarding TEE or PAL between the CF-group and the control group participating in this study. Neither were there any differences in activity level between boys and girls within the groups. / Syfte: Syftet med studien var att beskriva energiomsättning och fysisk aktivitetsnivå hos en grupp barn med cystisk fibros (CF) och jämföra resultatet med friska barn i en kontrollgrupp. Syftet var också att jämföra skattade aktivitetsnivåer mellan grupperna samt mellan flickor och pojkar inom de båda grupperna. Metod: I studien deltog 30 barn, indelade i två grupper om 15 deltagare. Grupperna var en CF-grupp och en kontrollgrupp matchad efter kön och ålder. Aktivitetsdagböcker granskades och data sammanställdes och data presenterades deskriptivt och analyserades med Wilcoxsons rangsummetest. Resultat: Resultatet visade att det inte fanns skillnad mellan de båda grupperna vid jämförelse av TEE och PAL. Ungefär hälften av alla deltagare (53,34 % resp. 46,67 %) nådde moderat eller hög aktivitetsnivå under de registrerade dagarna. Det förekom ingen signifikant skillnad mellan grupperna med avseende antal skattade 6-9:or i aktivitetsdagboken. Inte heller någon skillnad mellan könen inom de båda grupperna kunde påvisas. Slutsats: Slutsatsen var att det inte fanns någon signifikant skillnad beträffande energiomsättning eller fysisk aktivitet mellan barn med CF och friska barn som deltog i denna studie. Inte heller kunde någon skillnad i aktivitetsnivå mellan könen inom grupperna påvisas.

Image analysis techniques have been broadly used in computer aided diagnosis tasks in recent years. Computer-aided image analysis is a popular tool in medical imaging research and practice, especially due to the development of different imag- ing modalities and due to the increased volume of image data. Image segmenta- tion, a process that aims at identifying and separating regions of an image, is crucial in many medical applications, such as in identification (delineation) of anatomical structures and pathological regions, providing objective quantitative assessment and monitoring of the onset and progression of the disease. Multidetector CT (MDCT) allows acquisition of volumetric datasets with almost isotropic voxels, enabling visualization, characterization and quantification of the entire extent of lung anatomy, thus lending itself to characterization of Interstitial Lung Diseases (ILDs), often characterized by non uniform (diffuse) distribution in the lung volume. Interpretation of ILDs is characterized by high inter and intra- observer variability, due to lack of standardized criteria in assessing its complex and variable morphological appearance, further complicated by the increased vol- ume of image data being reviewed. Computer-Aided Diagnosis (CAD) schemes that automatically identify and char- acterize radiologic patterns of ILDs in CT images have been proposed to improve diagnosis and follow-up management decisions. These systems typically consist of two stages. The first stage is the segmentation of left and right Lung Parenchyma (LP) region, resulting from lung field segmentation and vessel tree removal, while the second stage performs classification of LP into normal and abnormal tissue types. The segmentation of Lung Field (LF) and vessel tree structures are crucial preprocessing steps for the subsequent characterization and quantification of ILD patterns. Systems proposed for identification and quantification of ILDpatterns havemainly exploited 2D texture extraction techniques, while only a few have investigated 3D texture features. Specifically, texture feature extraction methods that have been exploited towards lung parenchyma analysis are: first order statistics, grey level co-occurrence matrices, gray level run length matrices, histogram signatures and fractals. The identification and quantification of lung parenchyma into normal and abnormal tissue type has been achieved by means of supervised classification tech- niques (e.g. Artificial Neural Networks, ANN, Bayesian classifier, linear discrimi- nant analysis (LDA) and k-Nearest Neighboor (k-NN). However, the previously proposed identification and quantification schemes in- corporate preprocessing segmentation algorithms, effective on normal patient data. In addition the effect of the preprocessing stages (i.e. segmentation of LF and ves- sel tree structures) on the performance of ILD characterization and quantification schemes has not been investigated. Finally, the complex interaction of such automated schemes with the radiologists remains an open issue. The current thesis deals with identification and quantification of ILD in lung CT. The thesis aims at optimizing all major steps encountered in a computer aided ILD quantification scheme, by exploiting 3D texture feature extraction techniques and supervised and unsupervised pattern classification schemes to derive 3D disease segments. The specific objectives of the current thesis are focused on: • Development of LF segmentation algorithms adapted to pathology. • Development of vessel tree segmentation adapted to presence of pathology. • Development of ILD identification and quantification algorithms. • Investigation of the interaction of an ILD identification and quantification scheme with the radiologist, by an interactive image editing tool. / Η Διάμεση Νόσος (ΔΝ) του πνεύμονα αποτελεί το 15% των παθήσεων του πνεύμονα που εμφανίζονται στην κλινική πρακτική. Η ΔΝ επηρεάζει κυρίως το πνευμονικό παρέγχυμα και εμφανίζεται στις εικόνες Υπολογιστικής Τομογραφίας (ΥΤ) του πνεύμονα με την μορφή διάχυτων περιοχών χαρακτηριστικών προτύπων υφής που παρεκκλίνουν από αυτό του φυσιολογικού παρεγχύματος. Η Πολυτομική Υπολογιστική Τομογραφία (ΠΥΤ) επιτρέπει την απόκτηση τρισδιάστατων απεικονίσεων με σημαντική μείωση του χρόνου λήψης και αποτελεί την απεικονιστική τεχνική επιλογής για την ποσοτικοποίηση και τη διάγνωση της ΔΝ. Η διάγνωση της ΔΝ χαρακτηρίζεται από μειωμένη διαγνωστική ακρίβεια χαρακτηρισμού και ακρίβεια ποσοτικοποίησης έκτασης ακόμα και για τον έμπειρο ακτινολόγο, αλλά και από χαμηλή επαναληψιμότητα. Η δυσκολία διάγνωσης οφείλεται στη μειωμένη ικανότητα του ανθρώπινου παράγοντα ως προς το καθορισμό έκτασης των προτύπων υφής λόγω ομοιότητας ακτινολογικής εμφάνισης τους σε συνδυασμό με το φόρτο εργασίας του ακτινολόγου και τον αυξημένο όγκο δεδομένων της ΠΥΤ. Αυτοματοποιημένα συστήματα ανάλυσης εικόνας μπορούν να αντιμετωπίσουν τα παραπάνω προβλήματα παρέχοντας σημαντική υποβοήθηση στο έργο της διάγνωσης και παρακολούθησης της νόσου. Η ανάπτυξη αυτοματοποιημένων συστημάτων ανάλυσης εικόνας για υποβοήθηση διάγνωσης στην ΥΤ του πνεύμονα έχει αποτελέσει θέμα εκτεταμένης έρευνας την τελευταία δεκαετία με ένα μικρό τμήμα της να επικεντρώνεται στο χαρακτηρισμό και ποσοτικοποίηση της έκτασης της ΔΝ. Σημαντικά στάδια προεπεξεργασίας των συστημάτων αυτών αποτελούν οι τμηματοποίησεις των Πνευμονικών Πεδίων (ΠΠ) και του αγγειακού δένδρου για τον καθορισμό του προς ανάλυση όγκου του πνευμονικού παρεγχύματος. Τα έως σήμερα προταθέντα συστήματα αυτόματης ανίχνευσης και ποσοτικοποίησης της έκτασης της ΔΝ αξιοποιούν κυρίως μεθόδους ανάλυσης δισδιάστατης (2Δ) υφής εικόνας, ενώ μόνο δύο μελέτες έως σήμερα έχουν αξιοποιήσει ανάλυση 3Δ υφής. Συγκεκριμένα, μέθοδοι ανάλυσης υφής εικόνας που έχουν αξιοποιηθεί είναι: στατιστική 1ης τάξης (ιστόγραμμα), μήτρες συνεμφάνισης αποχρώσεων του γκρι (Grey level Co-occurrence Matrices), μήτρες μήκους διαδρομής απόχρωσης του γκρι (Gray Level Run Length Matrices), υπογραφές ιστογράμματος και Fractals. Ο χαρακτηρισμός και η ποσοτικοποίηση περιοχών του πνευμονικού παρεγχύματος που αντιστοιχούν σε φυσιολογικό παρέγχυμα και υποκατηγορίες παθολογίας υλοποιείται με μεθόδους επιβλεπόμενης ταξινόμησης προτύπων όπως: τεχνητά νευρωνικά δίκτυα (Artificial Neural Networks, ΑΝΝ), Bayesian ταξινομητής, ανάλυση γραμμικού διαχωρισμού ( Linear Discriminant Analysis, LDΑ) και ταξινομητής πλησιέστερου γείτονα (k-Nearest Neighboor, k-NN). Στα έως σήμερα προταθέντα συστήματα, η τμηματοποίηση των ΠΠ υλοποιείται με συμβατικές μεθόδους τμηματοποίησης με βάση τις αποχρώσεις του γκρί (τιμές έντασης) εικονοστοιχείων. Ανοικτό ζήτημα παραμένει και η αξιολόγηση της επίδρασης των σταδίων προ-επεξεργασίας (τμηματοποίηση ΠΠ και αγγειακού δένδρου) στην ακρίβεια συστημάτων χαρακτηρισμού και ποσοτικοποίησης της έκτασης της ΔΝ. Τέλος, η αξιολόγηση της αλληλεπίδρασης αυτόματων συστημάτων ποσοτικοποίησης και ακτινολόγου στη λήψη αποφάσεων χαρακτηρισμού και ποσοτικοποίησης της έκτασης που αφορούν την ΔΝ δεν έχει διερευνηθεί. Η παρούσα διδακτορική διατριβή επικεντρώνεται στην ανάπτυξη ολοκληρωμένου συστήματος ανάλυσης εικόνας το οποίο χαρακτηρίζει και ποσοτικοποιεί την έκταση περιοχών με ΔΝ σε απεικονίσεις ΠΥΤ θώρακος, στοχεύοντας στη βελτιστοποίηση όλων των σταδίων του, καθώς και στην αξιολόγηση της συμβολής του συστήματος στην λήψη διαγνωστικών αποφάσεων. Για το σκοπό αυτό διερευνώνται τεχνικές 3Δ ενίσχυσης εικόνας, 3Δ τμηματοποίησης εικόνας καθώς και 3Δ χαρακτηριστικά υφής εικόνας σε συνδυασμό με επιβλεπόμενα και μη επιβλεπόμενα συστήματα ταξινόμησης. Συγκεκριμένα η συμβολή της παρούσας διατριβής επικεντρώνεται στα ακόλουθα: • Ανάπτυξη μεθόδων τμηματοποίησης των ΠΠ και του αγγειακού δένδρου παρουσία παθολογίας. • Διερεύνηση της συμβολής αλγορίθμων εξαγωγής 3Δ υφής εικόνας στην ακρίβεια μεθόδων ταξινόμησης προτύπων ΔΝ. • Βελτιστοποίηση μεθόδων χαρακτηρισμού και ποσοτικοποίησης έκτασης με χρήση τεχνικών επιβλεπόμενης και μη επιβλεπόμενης ταξινόμησης. • Αξιολόγηση της επίδρασης των σταδίων προεπεξεργασίας στην ακρίβεια συστημάτων ποσοτικοποίησης. • Αξιολόγηση της συμβολής συστημάτων ποσοτικοποίησης στη διάγνωση της ΔΝ.

INTRODUÇÃO: A pneumonite de hipersensibilidade (PH) é uma doença intersticial causada pela inalação de antígenos orgânicos específicos ou substâncias de baixo peso molecular em indivíduos geneticamente suscetíveis. A PH crônica representa seu estágio final, na qual a exposição antigênica prolongada leva à fibrose. Na PH crônica, o envolvimento das pequenas vias aéreas (PVA) é proeminente; entretanto, uma avaliação detalhada através de métodos funcionais e de avaliação quantitativa e automatizada pela tomografia computadorizada (TC) não foi realizada previamente. MÉTODOS: estudo transversal de 28 pacientes com PH crônica, com avaliação através de provas de função pulmonar (PFPs); oscilometria forçada (FOT); análise automatizada do volume pulmonar através da TC, incluindo quantificação de aprisionamento aéreo; e teste cardiopulmonar de exercício (TCPE) incremental em cicloergômetro para avaliar performance ao exercício, incluindo medidas seriadas da capacidade inspiratória e hiperinsuflação dinâmica (HD). Foram incluídos pacientes entre 18 a 75 anos, com diagnóstico confirmado pela combinação de achados tomográficos, exposição antigênica e biópsia compatível e/ou LBA com linfocitose. Foram excluídos pacientes com CVF e/ou VEF1 < 30% predito, tabagismo > 20 anos-maço, uso de oxigênio suplementar; diagnóstico prévio de asma ou DPOC, diagnóstico de hipertensão arterial pulmonar ou impossibilidade de realizar TCPE. Os dados foram comparados com controles saudáveis. RESULTADOS: 28 pacientes (16 mulheres; idade média 56 +- 11 anos; CVF 57 +- 17% predito) foram avaliados, e todos apresentavam padrão ventilatório restritivo sem resposta broncodilatadora. Na FOT, 4 pacientes apresentaram resistência aumentada a 5 Hz (R5), enquanto todos apresentaram baixa reactância (X5), sendo que nenhum apresentou resposta broncodilatadora significativa. Pacientes com PH crônica tiveram menor capacidade de exercício com menor O2 de pico, diminuição da reserva ventilatória, hiperventilação, dessaturação de oxigênio e escores de dispneia (Borg) aumentados quando comparado aos controles. A prevalência de HD foi encontrada em apenas 18% da coorte. Ao comparar pacientes com PH crônica com O2 normal e baixo (< 84% predito, LIN), o último grupo apresentou maior hiperventilação (slope E/CO2), um menor volume corrente e menores escores de capacidade física na avaliação do questionário de qualidade de vida (SF-36). A análise da curva ROC mostrou que volumes pulmonares reduzidos (CVF%, CPT% e DLCO%) foram preditores de baixa capacidade ao exercício. Na TC, a PH crônica teve aumento de áreas com alta densidade em unidades Hounsfield, inferindo maior extensão de opacidades em vidro fosco e fibrose em relação aos controles saudáveis. A extensão das áreas de atenuação reduzida (AAR) e aprisionamento aéreo em relação ao volume pulmonar total é pequena, e não se correlaciona com índices funcionais obstrutivos; entretanto, pacientes com maior percentual dessas áreas apresentam menos fibrose e função pulmonar mais preservada. CONCLUSÃO: a PH crônica se caracterizou por um acometimento eminentemente restritivo, e não de obstrução de vias aéreas, nos diferentes métodos diagnósticos aplicados. A redução da capacidade de exercício foi prevalente devido à limitação ventilatória e de troca gasosa, a exemplo de outras doenças intersticiais pulmonares, e não pela HD. Redução dos volumes pulmonares foram bons preditores das respostas ventilatórias durante o exercício / INTRODUCTION: Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of specific organic antigens or low molecular weight substances in genetically susceptible individuals. Chronic HP represents its final stage, in which prolonged antigenic exposure causes fibrosis. In chronic HP, small airway involvement is prominent; however, a detailed characterization through functional evaluation and through automatic quantitative evaluation of computed tomography (CT) has not been previously assessed. METHODS: Cross-sectional study with 28 chronic HP patients, with evaluation by pulmonary function tests (PFTs), forced oscillometry (FOT), automated lung volume analysis through CT, including quantification of air trapping (AT); and incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer to evaluate exercise performance, including serial measurements of inspiratory capacity to establish dynamic hyperinflation (DH). Inclusion criteria: patients aged 18 to 75 years, with a chronic HP diagnosis confirmed by the combination of CT findings, known antigenic exposure and compatible biopsy and / or BAL with lymphocytosis. Exclusion criteria: FVC and / or FEV1 < 30% predicted, smoking > 20 pack-years, supplemental oxygen use; previous diagnosis of asthma or COPD; pulmonary arterial hypertension, or medical conditions that could interfere with CPET. Data were compared with healthy controls. RESULTS: All patients (16 women; mean age 56 +- 11 years; FVC 57 +- 17% predicted) had restrictive ventilatory pattern without bronchodilator response. In FOT, 4 patients had increased resistance at 5 Hz (R5), all patients presented low reactance (X5) values, and none presented a significant bronchodilator response. Chronic HP patients had reduced exercise performance with lower peak V?O2, diminished breathing reserve, hyperventilation, oxygen desaturation and augmented Borg dyspnea scores when compared with controls. The prevalence of DH was only found in 18% of patients. When comparing chronic HP patients with normal and low peak VO2 (< 84%predicted, LLN), the later exhibited higher hyperventilation (VE/VCO2 slope), lower tidal volumes, and poorer physical functioning scores on Short-form-36 health survey. ROC curve analysis showed that reduced lung volumes (FVC%, TLC% and DLCO%) were high predictors of poor exercise capacity. On CT, chronic HP is characterized by increased pulmonary densities (Hounsfield Units) inferring the extension of ground glass opacities and fibrosis when compared with healthy subjects. The extension of low attenuation areas (LAA) and AT in relation to the hole lung volume is low and does not correlate with PFT indexes of obstruction; however, patients with greater extension of these areas had less fibrosis and more preserved PFTs. CONCLUSIONS: Chronic HP was characterized by an imminently restrictive lung disorder, and not by airway obstruction, according to the different diagnostic methods applied in this study. Reduction of exercise capacity was prevalent due to ventilatory and gas exchange limitation, similarly to other fibrotic interstitial lung diseases, rather than due to DH. Reduced lung volumes were good predictors of ventilatory responses during exercise

Twenty publications are submitted. All deal with the issues of control of two ends of the spectrum of immune-mediated respiratory disorders in children, namely atopic (asthma and allergic rhinitis) and HIV-related lung disease. This submission summarises the research by the author into this spectrum of lung diseases of children in South Africa, highlighting the diversity of conditions that are not only clinically important, but also common. Understanding of all conditions is required to improve the health of children in this region. Management of chronic conditions requires two major end points - adequate and timely diagnosis and - management to control the condition. The author has a passion for improving the quality of life of children and firmly believes that the research findings will, and have, led to transformation in management of both these common disorders. This document follows the progression of the authors research work and highlights how interesting and important is the scope of two disorders which could be thought to have a central origin, namely in the T-cell. T-cells form the basis of cellular immunity and an excess of T-helper 2 cell activity promotes atopy, whilst the human immunodeficiency (HI) virus infects T-helper cells and promotes cellular immune deficiency and its attendant clinical disorders. The author’s research work is not based on the immunological basis of these conditions but does deal with the clinical implications and especially aspects relating to control of these two extremes of a clinical spectrum of disorders. To take the clarity of two diseases at the end of a spectrum to its natural conclusion these extremes are defined in aetiology or pathophysiological differences (excess versus suppression of the immune system), occurring in the affluent and poor alike versus just the poor, control being required to improve quality of life versus to save lives and finally that management requires anti-inflammatory therapy versus antibiotic and anti-infective therapy. For the eight publications based on atopic respiratory disease in children the themes are firstly that children with asthma and chronic rhinitis are diagnosed late, that most individuals with these conditions are not well controlled and finally that the reasons for lack of control are becoming obvious. For the first time, the significant lack of asthma and allergic rhinitis control in South Africa is documented. These studies suggest that, like surveys from the rest of the world, asthma control is seriously under-estimated and neglected in all asthmatics in South Africa, in both the privileged and the under-privileged. The research also defines reasons for poor asthma and allergic rhinitis control in this region. As in many studies published from around the world it is now evident that poor asthma and allergic rhinitis control cannot be blamed on any one source. A multitude of reasons underlie this phenomenon and each of the subsequent papers in this section illustrates attempts at defining these principles. The three most important reasons for poor control are probably that most asthmatics are managed in the wrong hands (by doctors who don’t understand adequate control and who aren’t empowered to use the correct therapy), that control may actually be a pipe dream and practically difficult to do or even impossible to achieve and lastly that the allergic basis of asthma is over emphasised and may not in fact determine all asthma. The subsequent papers summarise research work in the field of HV infection in children and exposes the opposite end of a spectrum of Paediatric respiratory disease and highlight research into the conditions common in HIV-infected children. Eleven papers are presented. For the diseases associated with the HI virus the major complications of inadequate diagnosis and prevention in children are acute pneumonia (especially severe pneumonia) and bronchiectasis. Bronchiolitis is not common in HIV infected children, despite epidemics of this condition in non-infected children. Passive smoking does not aggrevate or worsen disease progression in children. The complications of HIV related diseases in children require the same principles of adequate diagnosis and control as would apply to the chronic atopic conditions. Once the author delved into the disorders at the other end of the clinical spectrum, namely those associated with immune deficiency secondary to HIVinfection he faced the question of a possible relationship between the conditions. One submission explores that relationship. This research has a unique perspective, conferred by the fact that these two conditions do not occur to the same extent anywhere else in the world. Atopic respiratory conditions and HIV-related lung diseases occur side by side in abundance in this region. This perspective has created a clarity for research to address the two most important aims in clinical medicine, namely to diagnose correctly and then to manage the condition so that control is achieved. These must be universal principles of the successful practice of medicine. / Thesis (DSc)--University of Pretoria, 2013. / gm2013 / Paediatrics and Child Health / unrestricted

Depuis 2006, une recrudescence de cas de protostrongylose, parasitose liée à la présence de nématodes au niveau pulmonaire, apparaît dans le Sud-est de la France au sein de la population de lièvres européens (Lepus europaeus). Le cycle de développement de ces parasites nécessite le passage obligatoire par un hôte intermédiaire connu pour être un mollusque gastéropode terrestre. Notre programme a pour objectif l'étude épidémiologique de la maladie et notamment l'identification des acteurs du cycle parasitaire.Basée sur une analyse morphologique et moléculaire, nous identifions : Protostrongylus pulmonalis (Frölich, 1802) fréquemment inventorié en Europe et P. oryctolagi Babos, 1955, décrit à une seule occasion en Hongrie en 1955, comme les agents responsables de la protostrongylose en France. Cette étude a permis de déposer de nouvelles séquences d'ADN de référence, utiles pour l'identification ultérieure de nos espèces parasites, en particulier les stades larvaires et sur lesquelles nous nous sommes basées pour la reconnaissance des hôtes intermédiaires intervenant dans le cycle naturel. Sur 3622 mollusques analysés, nous avons mis en évidence des larves de stade 3 (P. pulmonalis et P. oryctolagi) à partir de 18 individus, appartenant à la famille des Hygromiidae et dont l'identification spécifique repose sur différents marqueurs moléculaires (de loin préférables aux critères morphologiques). Au sein des populations de lièvres, nous identifions l'âge et l'environnement, en lien avec la répartition des hôtes intermédiaires comme les facteurs de risque de la maladie. Le parasitisme, concernant près de 55% des animaux, n'a pas eu d'effet mesurable sur l'état général de l'hôte, mais pourrait être impliquée dans une diminution de la fécondité des hases, suggérant un impact potentiel sur les dynamiques de populations de lièvres. / Since 2006, in the South-East of France, we observe an increase in the number of hares (Lepus europaeus) suffering from pulmonary protostrongyliasis, which is a parasitic disease caused by nematodes in the lungs. The development cycle of these parasites requires the obligatory pathway through an intermediate host, terrestrial gastropod mollusk. Our goal was the epidemiological study of the disease, particularly the identification of the parasite cycle.Based on morphological and molecular analysis, we identified two causative agents of pulmonary protostrongyliasis in France: Protostrongylus pulmonalis (Frölich, 1802) frequently inventoried in Europe and P. oryctolagi Babos, 1955 described only once in Hungary in 1955. Thus new reference sequences of DNA are available, which is useful for the subsequent identification of our parasite species and particularly for larvae-stage, allowing the recognition of intermediate hosts involved in their natural cycle. In total 3622 terrestrial mollusks were analyzed. We identified three-stage larvae of P. pulmonalis and P. oryctolagi from 18 individuals belonging to the family of Hygromiidae and belonging to several species identified with different molecular markers. In the hare populations, we identify the age and environment (in association with the distribution of intermediate hosts) as risk factors for the disease. The parasite, with approximately 55% of infected animals, had no measurable effect on the health status of the host, but could be involved in a decrease in the fecundity, suggesting a potential impact on population dynamics of hares.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-05-16T19:40:21Z No. of bitstreams: 1 Anderson Jose.pdf: 974286 bytes, checksum: 4ca01416343b27ba5d201fd52e0ce8cb (MD5) / Made available in DSpace on 2016-05-16T19:40:21Z (GMT). No. of bitstreams: 1 Anderson Jose.pdf: 974286 bytes, checksum: 4ca01416343b27ba5d201fd52e0ce8cb (MD5) Previous issue date: 2014-12-19 / Background: The effects of exercise training have not been evaluated in patients hospitalized with acquired pneumonia (CAP). Additionally, the field tests that assess functional capacity (FC) need to be more solidly studied in patients hospitalized for acute pulmonary diseases. Objectives: Article 1: To assess the reproducibility of the six-minute walk test (6MWT) and Glittre ADL-test (GT) in patients hospitalized for acute pulmonary diseases; Article 2: To evaluate FC and safety of the Chester step test (CST) and the modified incremental step test (MIST) in patients hospitalized for acute lung diseases and Article 3: Compare the effects of a physical training program with respiratory physiotherapy in patients hospitalized for CAP on peripheral muscle strength, functional capacity and quality of life. Methods: Article 1: 81 patients underwent two 6MWT and GT, in randomized order on two visits. Article 2: 77 patients underwent CST and MIST and were compared to a control group of 20 healthy volunteers. Article 3: 41 patients were randomized into two groups: For eight consecutive days, the control group (CG, 14 patients) performed respiratory physiotherapy program and the experimental group (EG, 27 patients) performed physical training program. Results: Article 1: 6MWT was reproducible [349 m (285-419) and 363 m (288-432); ICC: 0.97(0.95-0.98)], and time in GT [286s (220-378) and 244s (197-323); ICC: 0.91(0.95-0.96)], but with a huge variability in the results was observed by the large limits of agreement in the Bland-Altman analysis. Article. 2: patients in CST climbed 66±63 steps and 113±121 steps in MIST (P < 0.05). The tests correlated with the 6MWT (CST, r=0.54 and MIST, r= 0.61) and no adverse events were observed. Compared to the control group, patients had a lower number of steps in the two tests. Article 3: The FC tests initial and final of CG and EG, respectively, were: Shuttle Walk Teste Incremental (ISWT): from 327±93m and 367±88m (P=0.87) to 363±131m and 555±171m (P<0.0001); GT: from 219±47s and 205±38s (P=0.77) to 213±46s and 152±33s (P<0.0001). EG patients also showed significant improvement in the quality of life (QoL), increase in peripheral muscle strength (PMS) and decrease in dyspnea. The groups did not differ in terms of lung function, evolution, and time of hospitalization. Conclusion: The 6MWT and the GT were reproducible, however, due to the large variability of the results, two tests are needed to obtain reliable measurements. The CST and MIST showed to be safe and can be used to assess FC in hospitalized patients. The effects of exercise training program compared to physiotherapy treatment promoted an improvement in FC, increase in PMS, improve dyspnea and QoL. The treatment was not associated with the time of hospitalization. / Introdução: Os efeitos de um programa de treinamento físico ainda não foram avaliados em pacientes hospitalizados por pneumonia adquirida na comunidade (PAC). Adicionalmente, o uso de testes de campo que avaliam a capacidade funcional (CF) nos pacientes hospitalizados por doenças pulmonares agudas precisa ser solidamente estudado neste contexto. Objetivos: Artigo 1: avaliar a reprodutibilidade do teste de caminhada dos seis minutos (TC6) e do Glittre ADL-test (GT) em pacientes hospitalizados por doenças pulmonares agudas; Artigo 2: avaliar a CF por meio do teste do degrau de Chester (TDC) e do teste do degrau incremental modificado (TDIM) e a sua segurança em pacientes hospitalizados por doenças pulmonares agudas e Artigo 3: Comparar os efeitos de um programa de treinamento físico na capacidade funcional, força muscular periférica e qualidade de vida com a fisioterapia respiratória em pacientes hospitalizados por PAC. Métodos: Artigo 1: 81 pacientes realizaram dois TC6 e GT, em ordem randomizada em duas visitas. Artigo 2: 77 pacientes realizaram o TDC e o TDIM e foram comparados a um grupo controle de 20 voluntários saudáveis. Artigo 3: 41 pacientes foram aleatorizados em dois grupos: O Grupo Controle (14 pacientes) realizou o programa de fisioterapia e o Grupo Experimental (27 pacientes) realizou o programa de treinamento físico durante oito dias consecutivos. Resultados: Artigo 1: As distâncias do TC6 [349m (285–419) e 363m (288–432); CCI: 0,97(0,95-0,98)] foram reprodutíveis, assim como o tempo do GT [286s (220–378) e 244s (197–323); CCI: 0,91(0,95-0,96)], mas com uma grande variabilidade observada pelos largos limites de concordância na análise de Bland-Altman. Artigo 2: os pacientes escalaram 66±63 degraus no TDC e 113 ± 121 no TDIM (P<0,05). Os testes se correlacionaram com o TC6 (TDC, r=0,54 e TDIM, r=0,61) e não ocorram complicações durante a execução dos testes. Em comparação ao grupo controle, os pacientes apresentaram um menor número de degraus nos dois testes. Artigo 3: Os testes de CF inicial e final dos Grupos Controle (GC) e Experimental (GE), respectivamente, foram: Shuttle Walk Teste Incrementale (ISWT): de 327±93 m e 367±88 m (P=0,87) para 363±131m e 555±171m (P<0,0001); de GT: 219±47s e 205±38s (P=0,77) para 213±46s e 152±33s (P<0,0001). Os pacientes do GE também apresentaram melhora significante na qualidade de vida (QV), aumento da força muscular periférica (FMP) e diminuição da dispneia. Os grupos não diferiram quanto à função pulmonar, evolução e tempo de hospitalização. Conclusão: O TC6 e o GT foram reprodutíveis, porém, devido à grande variabilidade dos resultados, dois testes são necessários para obter medidas confiáveis. O TDC e o TDIM mostraram-se seguros e podem ser usados para avaliar a CF de pacientes hospitalizados. Os efeitos do programa de treinamento físico comparado ao tratamento fisioterapêutico promoveu uma melhora da CF, aumento da FMP, melhora da dispneia e da QV. O tipo de tratamento não esteve associado ao tempo de hospitalização.

<p>Sindrom sagorevanja, eng. Burnout Syndrome (BOS) je oblik profesionalnog stresa koji se najče&scaron;će javlja u zanimanjima koja podrazumevaju direktan kontakt sa ljudima, a nastaje kao odgovor na hroničan stres. Ogleda se kroz aspekte: emocionalne iscrpljenosti eng. Emotional Exhaustion (EE), depersonalizacije eng. Depersonalisation (DP) i osećaja smanjenog ličnog postignića eng. Personal Accomplishment (PA). Sprovedena istraživanja ukazuju na visoku zastupljenost BOS-a kod zdravstvenih radnika i njegovu zavisnost ne samo od ličnih karakteristika nego i od mnogobrojnih faktora na poslu. Dokazano je da BOS dovodi do posledica kako na individualnom, tako i na organizacionom nivou. Usled o&scaron;tećenja fizičkog i psihičkog zdravlja lekara i medicinskih sestara/tehničara indirektno dolazi i do smanjenja nivoa zdravstvene usluge sa svim svojim posledicama po zdravstveni sistem i zdravlje pacijenata. Ovo istraživanje imalo je za cilj da ispita zastupljenost BOS-a kod zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti, utvrdi da li postoji razlika u zastupljenosti BOS-a u odnosu na nivo edukacije (lekari i medicinske sestre/tehničari) i u odnosu na radno mesto (zbrinjavanje bolesnika koji boluju od neizlečivih (terminalnih) u odnosu na zbrinjavanje bolesnika koji boluju od izlečivih (kurabilnih). plućnih bolesti. Istraživanje je sprovedeno među zaposlenim zdravstvenim radnicima u Institutu za plućne bolesti Vojvodine u Sremskoj Кamenici u periodu april-jun 2019. godine kao studija poprečnog preseka. Podaci istraživanja su prikupljeni pomoću sledećih upitnika: Upitnik o socio-demografskim karakteristikama ispitanika, Maslač inventar izgaranja (MBI), Skala izgaranja izvedene iz Kopenhagen inventara izgaranja &ndash; srpska verzija (SI), Upitnik op&scaron;teg zdravlja (UOZ-12) i Upitnik o stresorima na radnom mestu, zadovoljstvu na poslu i motivaciji i opu&scaron;tanju nakon posla. Istraživanjem je obuhvaćeno 165 zdravstvena radnika: 64 (38.8%) lekara i 101 (61.2%) medicinskih sestara/tehničara. BOS je utvrđen kod 47% ispitanika. Visoki stepen EE potvrđen je kod 43.0%, visok stepen DP kod 21.8%, a nizak stepen PA kod 32.1% ispitanih. Statistički značajna razlika u zastupljenosti nije dokazana u odnosu na stepen stručne spreme (40.6% vs. 51.5%) niti u odnosu na radno mesto (45.3% vs. 48.2%). Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na socio-demografske karakteristike ispitanika. Psihički distres prisutan je kod 30.8% zdravstvenih radnika sa potvrđenim BOS-om. Pokazana je statistički značajna razlika u povezanosti BOS-a i psihičkog distresa i u odnosu na stepen stručne spreme (p=0.000) i u odnosu na radno mesto (p=0.000), a ova povezanost je izraženija kod medicinskih sestara/tehničara (p=0.000). Značajna korelacija nije nađena samo između dva pretpostavljena stresora i BOS-a: prekovremenog rada i nedostatka odgovarajuće kontinuirane edukacije. Statistički značajna je i korelacija između svih domena BOS-a i ukupnog zadovoljstva radnim okruženjem. (EE p=0.000, DP p=0.000 i PA p=0.000). Trećina ispitanika sa potvrđenim BOS-om razmi&scaron;lja o promeni zanimanja, a njih 41% o promeni radnog mesta. Sindrom sagorevanja kod zdravstvenih zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti zastupljen je u visokom procentu. BOS značajno korelira sa psihičkim distresom, a ova povezanost je izraženija u populaciji medicinskih sestara. Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na nivo edukacije, niti u odnosu na radno mesto. Izražena je kompleksnost, varijabilnost i različitost u zastupljenosti pretpostavljenih stresora na poslu. Neophodnost otkrivanja stresogenih faktora i dono&scaron;enje mera sa ciljem njihovog sprečavanja i/ili ublažavanja je nesumnjiva. Unapređenje edukacije radi prepoznavanja BOS-a i prevazilaženju stresogenih faktora kao i iznalaženje novih organizacionih &scaron;ema u cilju eliminacije stresora na poslu trebalo bi da budu jedni od prioriteta svake zdravstvene institucije.</p> / <p>Sindrom sagorevanja, eng. Burnout Syndrome (BOS) je oblik profesionalnog stresa koji se najče&scaron;će javlja u zanimanjima koja podrazumevaju direktan kontakt sa ljudima, a nastaje kao odgovor na hroničan stres. Ogleda se kroz aspekte: emocionalne iscrpljenosti eng. Emotional Exhaustion (EE), depersonalizacije eng. Depersonalisation (DP) i osećaja smanjenog ličnog postignića eng. Personal Accomplishment (PA). Sprovedena istraživanja ukazuju na visoku zastupljenost BOS-a kod zdravstvenih radnika i njegovu zavisnost ne samo od ličnih karakteristika nego i od mnogobrojnih faktora na poslu. Dokazano je da BOS dovodi do posledica kako na individualnom, tako i na organizacionom nivou. Usled o&scaron;tećenja fizičkog i psihičkog zdravlja lekara i medicinskih sestara/tehničara indirektno dolazi i do smanjenja nivoa zdravstvene usluge sa svim svojim posledicama po zdravstveni sistem i zdravlje pacijenata. Ovo istraživanje imalo je za cilj da ispita zastupljenost BOS-a kod zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti, utvrdi da li postoji razlika u zastupljenosti BOS-a u odnosu na nivo edukacije (lekari i medicinske sestre/tehničari) i u odnosu na radno mesto (zbrinjavanje bolesnika koji boluju od neizlečivih (terminalnih) u odnosu na zbrinjavanje bolesnika koji boluju od izlečivih (kurabilnih). plućnih bolesti. Istraživanje je sprovedeno među zaposlenim zdravstvenim radnicima u Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici u periodu april-jun 2019. godine kao studija poprečnog preseka. Podaci istraživanja su prikupljeni pomoću sledećih upitnika: Upitnik o socio-demografskim karakteristikama ispitanika, Maslač inventar izgaranja (MBI), Skala izgaranja izvedene iz Kopenhagen inventara izgaranja &ndash; srpska verzija (SI), Upitnik op&scaron;teg zdravlja (UOZ-12) i Upitnik o stresorima na radnom mestu, zadovoljstvu na poslu i motivaciji i opu&scaron;tanju nakon posla. Istraživanjem je obuhvaćeno 165 zdravstvena radnika: 64 (38.8%) lekara i 101 (61.2%) medicinskih sestara/tehničara. BOS je utvrđen kod 47% ispitanika. Visoki stepen EE potvrđen je kod 43.0%, visok stepen DP kod 21.8%, a nizak stepen PA kod 32.1% ispitanih. Statistički značajna razlika u zastupljenosti nije dokazana u odnosu na stepen stručne spreme (40.6% vs. 51.5%) niti u odnosu na radno mesto (45.3% vs. 48.2%). Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na socio-demografske karakteristike ispitanika. Psihički distres prisutan je kod 30.8% zdravstvenih radnika sa potvrđenim BOS-om. Pokazana je statistički značajna razlika u povezanosti BOS-a i psihičkog distresa i u odnosu na stepen stručne spreme (p=0.000) i u odnosu na radno mesto (p=0.000), a ova povezanost je izraženija kod medicinskih sestara/tehničara (p=0.000). Značajna korelacija nije nađena samo između dva pretpostavljena stresora i BOS-a: prekovremenog rada i nedostatka odgovarajuće kontinuirane edukacije. Statistički značajna je i korelacija između svih domena BOS-a i ukupnog zadovoljstva radnim okruženjem. (EE p=0.000, DP p=0.000 i PA p=0.000). Trećina ispitanika sa potvrđenim BOS-om razmi&scaron;lja o promeni zanimanja, a njih 41% o promeni radnog mesta. Sindrom sagorevanja kod zdravstvenih zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti zastupljen je u visokom procentu. BOS značajno korelira sa psihičkim distresom, a ova povezanost je izraženija u populaciji medicinskih sestara. Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na nivo edukacije, niti u odnosu na radno mesto. Izražena je kompleksnost, varijabilnost i različitost u zastupljenosti pretpostavljenih stresora na poslu. Neophodnost otkrivanja stresogenih faktora i dono&scaron;enje mera sa ciljem njihovog sprečavanja i/ili ublažavanja je nesumnjiva. Unapređenje edukacije radi prepoznavanja BOS-a i prevazilaženju stresogenih faktora kao i iznalaženje novih organizacionih &scaron;ema u cilju eliminacije stresora na poslu trebalo bi da budu jedni od prioriteta svake zdravstvene institucije.</p> / <p>Burnout syndrome (BOS) is a form of occupational stress as a response to chronic stress. It occures most commonly in occupations that involve direct contact with people and manifests as: emotional exhaustion (EE), depersonalization (DP) and feelings of diminished personal achievement (PA). Large numbers of research indicates a high prevalence of BOS in healthcare professionals and its dependence on work related stressors. BOS has been proven to lead to consequences on individual and organizational levels. The level of health care can be reduced due to the decreased physical and mental health of helathcare providers caused by BOS. It is possible consequences on the patient health and healthcare system raises the need for further investigation. The aim of this research was to examine the prevalence of BOS among healthcare providers treating patients with respiratory diseases, to determine difference in the prevalnce of BOS regarding to education level (physicians vs. nurses), and regarding workplace (terminal vs. curable respiratory diseases). This exploratory study was conducted among healthcare providers at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica in the period April-June 2019 as a cross-sectional study Quantitative and qualitative data were collectedtrough survey using the following questionnaires: Questionnaire on sociodemographic characteristics, Maslach burnout inventory (MBI), Work burnout scale from the Copenhagen burnout inventory &ndash; serbian version (SI), General health questionnaire (GHQ-12) and Questionnaire on workplace stressors, job satisfaction, motivation and after work relaxation. Out of total 165 healthcare professionals 64 (38.8%) were physicians and 101 (61.2%) nurses. Prevalence of BOS was 47%. High level of EE was confirmed in 43.0%, of DP in 21.8%, and low level of PA in 32.1%. No statistically significant difference was observed in relation to the education (40.6% vs. 51.5%) nor the workplace (45.3% vs. 48.2%). There were no statistically significant difference in socio-demographic characteristics. Psychological distress was present in 30.8% of healthcare professionals with BOS. Statistically significant difference was observed between BOS and psychological distress in terms of educational level (p = 0.000) and workplace (p = 0.000) This correlation was more accentuated in nurses (p = 0.000). Significant correlation was not confirmed only between two perceived stressors and BOS: job overtime and lack of appropriate education. A statistically significant correlation was observed between all domains of BOS and overall job satisfaction. (EE p = 0.000, DP p = 0.000 and PA p = 0.000). One third of respondents with observed BOS are thinking about changing occupation, and 41% of them changing workplace. Prevalence of burnout syndrome among physicians and nurses caring for patients with respiratory diseases is high regardless of education level or workplace. It significantly correlates with level of psychological distress which is is more accentuated among nurses. There is no diference in BOS prevalence regarding neither educational level nor workplace. The complexity, variability and diversity of assumed work stressors is undoubtley related to BOS. The need for determination of job stressor and actions in order to prevent and/or mitigate them is beyond doubt. Improvement of recognition and overcoming stress factors and finding new organizational charts to eliminate potential stressors at work should be one of the priorities of any healthcare institution.</p>

The treatment of spontaneous pneumothorax in the civilian population can be influenced by the age of the patient and the presence of associated pulmonary disease. The medical records of 130 patients who presented with 168 occurrences of SP were reviewed during an 11-year period (1973 to 1984). Follow-up was from a minimum of 30 months to 13 years (mean 6.3 years). The therapeutic options included observation alone (40 occurrences), thoracentesis (6 occurrences), chest tube thoracostomy (102 occurrences), and thoracotomy (20 occurrences). Treatment of SP should be prompt with the objective of complete re-expansion of the lung and prevention of recurrent pneumothorax. This should be accomplished by the use of chest tube thoracostomy with early addition of thoracotomy as necessary. Selected use of thoracentesis can be effective. The use of observation alone can be dangerous and is associated with a higher recurrence rate.

O propósito da presente investigação foi avaliar o papel da atividade física no desenvolvimento de enfisema induzido por papaína em ratos. Para tanto, ratos Wistar foram randomicamente divididos em quatro grupos (n = 10 para cada grupo) que receberam, respectivamente, infusão intra-traqueal de papaína (6 mg em 1 mL de NaCl 0,9%) ou veículo e foram submetidos ou não ao protocolo de exercício em uma esteira ergométrica. Os ratos exercitaram-se a 13,3 m/min, 6 dias por semana, durante 9 semanas (o tempo de exercício foi aumentado gradualmente, de 10 a 35 min). Foram medidas a elastância e a resistência do sistema respiratório (Ers e Rrs, respectivamente), o peso e tamanho do coração, volume das câmaras cardíacas, diâmetro médio das fibras cardíacas e diâmetro alveolar médio. Após 9 semanas de atividade física não houve diferença para os valores de Ers e Rrs entre os quatro grupos experimentais. Houve um aumento estatisticamente significativo do peso do coração preenchido por solução de formaldeído nos grupos de animais submetidos à atividade física comparados aos grupos de animais sedentários (P = 0,007). Não houve diferenças significativas entre os dois grupos que fizeram exercício físico (tendo ou não recebido papaína) ou entre os dois grupos sedentários. O volume das câmaras cardíacas direita e esquerda não foram diferentes entre os diferentes grupos. O diâmetro médio das fibras do ventrículo esquerdo foi significativamente maior nos grupos submetidos à atividade física quando comparados aos grupos sedentários (P = 0,006). O diâmetro alveolar médio foi significativamente maior em ratos que receberam papaína quando comparados aos ratos que receberam salina intratraqueal (P = 0,025). Entretanto o diâmetro alveolar médio foi significativamente maior nos animais que receberam instilação intratraqueal de papaína e que foram submetidos à atividade física, quando comparados aos animais que foram instilados com papaína, mas não foram submetidos ao condicionamento físico. Concluímos que a atividade física pode aumentar à lesão alveolar induzida pela infusão de papaína / The purpose of the present study was to evaluate the role of exercise training on the development of papain-induced emphysema in rats. Wistar rats were randomly assigned to four groups (n = 10 for each group) that received, respectively, intratracheal infusion of papain (6 mg in 1 mL NaCl 0.9%) or vehicle and were submitted or not to a protocol of exercise on a treadmill. Rats exercised at 13.3 m/min, 6 days per week, for 9 weeks (increasing exercise time, from 10 to 35 min). We measured respiratory system elastance (Ers) and resistance (Rrs), the size and weight of the heart and mean alveolar diameter (Lm). After 9 weeks of exercise training, there were no differences in Rrs and Ers values among the four experimental groups. There was a significant increase in the heart weight filled with formaldehyde solute in animals submitted to exercise training compared to the sedentary groups (P = 0.007). There were no differences between the two groups submitted to exercise training (receiving or not papaine) or between the sedentary groups. There were no differences in cardiac chambers volume between all groups. The left ventricule fibers mean diameter was significantly greater in rats submitted to exercise training compared to sedentary rats (P = 0.006). Lm was significantly greater in rats that received papain compared to saline-infused rats (P = 0.025). However, Lm was significantly greater in papain + exercise rats compared to rats that received papain and were not submitted to exercise. We conclude that exercise training can increase alveolar damage induced by papain infusion

He, Qiqiang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 142-154). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.