Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-08-31T21:07:12Z No. of bitstreams: 1 AmaliaDias.pdf: 1513567 bytes, checksum: 691f9dced43ab3ba893647b2686c7c43 (MD5) / Made available in DSpace on 2017-08-31T21:07:12Z (GMT). No. of bitstreams: 1 AmaliaDias.pdf: 1513567 bytes, checksum: 691f9dced43ab3ba893647b2686c7c43 (MD5) Previous issue date: 2014-12-28 / Leprosy is an infectious disease, a chronic disease that usually causes changes in the psyche and physical changes that affect significantly the life of the carrier of this disease. In this study, it was sought to understand the experiences and feelings of women with leprosy. A qualitative study conducted with 15 women aged over 18 years in the Health Centre of Bairro de Fatima, Sao Luis - MA. Data collection was conducted through a questionnaire with open and closed questions to characterize the respondents and a roadmap guiding questions related to experiences and feelings about the disease. The analysis was performed using the analysis technique content. Emerging categories as a result of the research were Living with leprosy; Life change as a result of leprosy; Leprosy and social relationships; The search support as coping; Feelings and future prospects. The results showed that leprosy is experienced differently by every woman that significant changes occurred in the lives of these women, the impact suffered, is seen as a bad experience, and that causes physical and psychological changes. Some lines resembled while listening to speeches, however, the disease is unique for each of them. It was found as the life of the woman who has leprosy is changed in the face of illness, treatment and living with others. Women in this study reported the importance of humane care by health care professionals with guidelines to assist them in the acceptance of the diagnosis, as well as in understanding the treatment that will be established and the possible changes arising from the disease. / A hanseníase é uma doença infectocontagiosa, de evolução crônica, que em geral, causa alterações no psiquismo e alterações físicas que comprometem de maneira significativa a vida do portador desta doença. Neste estudo, buscou-se conhecer a vivência e os sentimentos das mulheres portadoras de hanseníase. Estudo descritivo com abordagem qualitativa, realizado com 15 mulheres, maiores de 18 anos no Centro de Saúde Bairro de Fátima, São Luís – MA. A coleta de dados foi realizada por meio de um formulário com perguntas abertas e fechadas para caracterizar as entrevistadas e um roteiro com questões norteadoras relacionadas à vivência e aos sentimentos em relação a doença. A análise foi realizada utilizandose a técnica de análise de conteúdo. As Categorias emergentes, como resultado da pesquisa foram: Convivendo com a hanseníase; Mudança de vida em decorrência da hanseníase; A hanseníase e as relações sociais; O apoio como busca de enfrentamento; Os sentimentos e as perspectivas futuras. Os resultados mostraram que a hanseníase é vivida de maneira diferenciada por cada mulher, que ocorreram mudanças significativas na vida dessas mulheres e que o impacto sofrido, é tido como uma experiência ruim e que acarreta transformações físicas e psicológicas. Algumas falas se assemelharam durante a audição dos discursos, no entanto, a doença é singular para cada uma delas. Verificou-se como a vida da mulher portadora de hanseníase é alterada diante da doença, do tratamento e do convívio com as demais pessoas. As mulheres desse estudo, relataram a importância de uma assistência humanizada por parte dos profissionais de saúde, com orientações que auxilie as mesmas na aceitação do diagnóstico, bem como na compreensão do tratamento que será estabelecido e as possíveis alterações oriundas da doença.

Orientador: Marli Terezinha Cassamassimo Duarte / Resumo: As úlceras cutâneas crônicas de origem neuropática secundárias à hanseníase são de difícil resolução e onerosas ao sistema público de saúde e aos pacientes acometidos. Há coberturas de alta tecnologia para o tratamento das úlceras, entretanto, são de custo elevado. Desta forma, faz-se necessário identificar tratamento que possa ser usado nessa população, buscando minimizar ou regredir completamente a úlcera e que seja de baixo custo. Objetivo: Avaliar a viabilidade de um protocolo para uso da pomada de óxido de zinco nas concentrações a 20% e 25% comparada ao hidrogel, no tratamento de úlcera crônica de perna de pessoas com sequelas de hanseníase e propor instrumento de acompanhamento de pacientes em tratamento de úlceras crônicas. Método: Estudo clínico pragmático, do tipo piloto, randomizado com três braços paralelos, aberto em relação ao controle (hidrogel) e cego entre os dois grupos de intervenção, a saber: óxido de zinco a 20% e 25%. A população do estudo foi constituída por pacientes atendidos nos ambulatórios do Instituto Lauro de Souza Lima, portadores de úlceras de perna, que já concluíram o tratamento para a hanseníase e a amostra constituída por 12 pacientes com 36 úlceras. Como desfechos primários foram avaliadas as taxas de adesão, recrutamento e de eventos adversos. O desfecho secundário foi a avaliação da eficácia das intervenções por meio da avaliação inicial e evolução da úlcera, empregando-se a Pressure Ulcer Scale for Healing (PUSH) e a mediana da área em ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The chronic skin ulcers of neuropathic origin, secondary to leprosy, are difficult to heal and costly to the public health system and patients. There are high technology dressings for wound treatment, however, they are expensive. In this way, it is necessary to identify the treatment which can be applied to this population, seeking to minimize or completely reduce the ulcer at lower costs. Objective: To evaluate the viability of a protocol for the use of zinc oxide ointment at 20% and 25% concentrations compared to hydrogel, in the treatment of chronic leg ulcers of people with leprosy sequelae, and to suggest a follow-up instrument for patients under treatment of chronic ulcers. Method: This is a pragmatic, pilottype, randomized trial with three parallel segments, open to the control (hydrogel) and blind between the two intervention groups, namely: zinc oxide at 20 and 25%. The study population consisted of patients with leg ulcers, attended at the outpatient clinics of Lauro de Souza Lima Institute, who had already completed the treatment for leprosy, and the sample comprised 12 patients with 36 ulcers. Adherence, recruitment, and adverse event rates were assessed as primary outcomes. Evaluation of the efficacy of the interventions through the initial evaluation and evolution of the ulcer, using Pressure Ulcer Scale for Healing (PUSH), and median of the area in cm2, were assessed as secondary outcomes. Results: Four participants with 11 ulcers were included in the hydrogel ... (Complete abstract click electronic access below) / Mestre

Between 1860 and 1900 the British Government in India – along with many other areas of the world – enacted numerous legal acts which superficially sought to prevent or control the transmission of disease. The implementation of legislative efforts attempted to identify and control subcultures that were marked as transmitters of infection. Thus legislation combined medical, legal and cultural concepts which formed the framework for the construction of societal control of infections. The Madras Presidency offers two tangible examples of this association of medicine, law and society. The Cantonment Regulations (1864), which were the origin of the Contagious Diseases Act (1868), were introduced to control venereal disease, while the Lepers Act (1898) was directed at leprosy sufferers. These laws embodied the official response to two diseases which attracted significant attention in Victorian culture. Evidenced within these statutes are the cultural markers of the society which engendered them. This thesis compares these two acts and explores how these acts were the product of similar cultural mores. A thematic approach has been adopted to examine how these acts are consequently coloured by characterisations of gender, race, class, colonialism, politics and morality. Leprosy and syphilis are biologically unrelated diseases. Prior to the twentieth century however, difficulties in diagnosis saw these two diseases often confused with one another. Additionally, these diseases were deeply stigmatizing and carried an imagined significance out of proportion to their biological impact. This thesis analyses the way in which this legislation reified the corporeal form of sufferers. A visibly diseased body was constructed, which then allowed authorities to focus their efforts on the control of specifically identified groups, segregate them and render the visible invisible. As a consequence of these pieces of legislation, marginalised groups were stigmatised as the visible carriers of disease and subjected to governmental restrictions by statutes that were embedded with the culture mores of the British in India, providing an illustration not so much of sanitary control but social control.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Univ., 2004. / Härtill 7 uppsatser.

Made available in DSpace on 2014-06-11T19:23:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-12-10Bitstream added on 2014-06-13T18:50:49Z : No. of bitstreams: 1 oliveira_fm_me_arafcf.pdf: 691249 bytes, checksum: 670e6f0d696ee9078564c0f8a9fb067b (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Universidade Estadual Paulista (UNESP) / A hanseníase é uma doença infectocontagiosa causada pelo bacilo Mycobacterium leprae e endêmica em muitos países subdesenvolvidos e em desenvolvimento, inclusive o Brasil. O diagnóstico ainda é complexo e muitas vezes dificultado por vários aspectos, como por exemplo, a ampla variedade de manifestações clínicas e aos diferentes tipos e graus de resposta imune do hospedeiro. O estresse oxidativo, depleção antioxidante e alteração de micronutrientes são importantes condições metabólicas observada nos pacientes com hanseníase. A investigação e elucidação desses mecanismos são importantes, uma vez que podem levar a descoberta de fatores associados à suscetibilidade/resistência a doença e à caracterização das alterações bioquímicas e nutricionais observadas nos pacientes. Nesse sentido, foi realizado um estudo observacional do tipo transversal no qual participaram 62 pacientes com hanseníase antes do tratamento poliquimioterápico e 30 indivíduos saudáveis, todos adultos e de ambos os gêneros. Foram quantificados sorologicamente o marcador de peroxidação lipídica malondialdeído, os antioxidantes glutationa reduzida e vitamina E, além do anticorpo glicolipídio fenólico 1 que foram comparados entre o grupo controle versus grupos com hanseníase, multibacilar e paucibacilar, além dos minerais selênio, zinco, cobre e magnésio, quantificados no grupo com hanseníase, que foram avaliados segundo valores de referência da literatura. Foi avaliada também a associação do anticorpo (prediz a carga bacilar) com as demais variáveis quantificadas no estudo. Foram observados aumento do marcador de peroxidação lipídica e redução de antioxidantes nos pacientes com hanseníase, ressaltando que os paucibacilares apresentaram maior nível de glutationa reduzida em relação aos multibacilares e semelhante ao grupo controle. Foi observado também baixo nível... / Leprosy is an infectious-contagious disease caused by the bacillus Mycobacterium leprae and is endemic in many underdeveloped countries, including Brazil. The diagnosis is still complex and is often impaired by several factors such as the wide variety of clinical manifestations and the different types and degrees of the host immune response. Oxidative stress, antioxidant depletion and changes in micronutrients are important metabolic conditions observed in leprosy patients. The investigation and elucidation of these mechanisms are important since they can lead to the discovery of factors associated with susceptibility/resistance to the disease and to the characterization of the biochemical and nutritional changes observed in these patients. On this basis, a cross-sectional observational study was conducted on 62 leprosy patients before polychemotherapeutic treatment and on 30 healthy individuals of both genders. The lipid peroxidation marker malondialdehyde, the antioxidants reduced glutathione and vitamin E, as well as the phenolic glycolipid-1 antibody were determined in serum and compared between the control group and the groups with multibacillary and paucibacillary leprosy. In addition, the minerals selenium, zinc, copper and magnesium were quantitated in the leprosy group and evaluated according to literature reference values. The association of the antibody (which predicts the bacillary load) with the remaining variables quantitated in this study was also evaluated. Increased levels of the lipid peroxidation marker and reduced antioxidant levels were observe in the leprosy patients, with emphasis on the fact that paucibacillary patients had higher reduced glutathione levels than multibacillary patients which were similar to those of control subjects. A low magnesium level was also observed in all leprosy patients, indicating a possible... (Complete abstract click electronic access below)

Orientador: Elenice Deffune / Banca: Marcos Andrey Cipriani Frade / Banca: Luciana Patrícia Abbade / Resumo: O hemocomponente gerador da cola de fibrina home made é a fração do plasma fresco congelado. Neste os fatores I (fibrinogênio), VIII, XIII, von Wilebrand e fibronectina estão presentes em elevada concentração. O fibrinogênio, fator I da coagulação sangüínea, sofre ativação nos processos de injúria tecidual onde são desencadeados os fenômenos hemostáticos que culminam com a formação de uma rede resistente de fibrina na qual existem leucócitos, hemácias e plaquetas. O gel de plaquetas é um hemocomponente obtido a partir de concentrado de plaquetas ou de plaquetaféres com adição de gluconato de cálcio e trombina e tem sido alvo de muitos estudos na última década sua participação no processo de cicatrização, especialmente porque libera fatores de crescimento no leito de feridas promovendo a reparação fisiológica tecidual. Neste estudo avaliou a ação de curativos bioativos home made: células tronco mesenquimais incorporadas ao gel de plaquetas laminares com laserterapia, no processo de cicatrização de feridas crônicas. Foram avaliados feridas crônicas em membros inferiores, de 5 pacientes, sendo predominantemente feridas decorrentes de seqüelas de hanseníase. O gel laminar de plaquetas mostrou-se ser um promissor meio de microencapsulação de células tronco mesenquimais, fibroblastos e queratinócitos. Nas feridas tratadas com células tronco mesenquimais, incorporadas ao gel laminar de plaquetas, foi observada melhora clínica considerável, tanto na cicatrização, quanto na redução das manifestações inflamatórias e dolorosas, nos 5 pacientes / Abstract: The blood components of fibrin glue generator home made is the fraction of fresh frozen plasma. In the factors I (fibrinogen), VIII, XIII, von Wilebrand and fibronectin are present in high concentration. Fibrinogen, blood coagulation factor I, undergoes activation in the processes of tissue injury where the phenomena are triggered hemostatic culminating in the formation of a strong fibrin network in which there are leukocytes, red blood cells and platelets. The platelet gel is a blood components obtained from platelet concentrate with the addition of calcium gluconate and thrombin and has been the subject of many studies over the last decade due to their involvement in the healing process, especially because it releases factors growth in the wound bed to promote the physiological tissue repair. This study evaluated the action of bioactive dressings home made: mesenchymal stem cells embedded in the laminar platelet gel with laser therapy in the healing of chronic woundsChronic wounds were evaluated in the lower limbs of five patients, predominantly due to wounds sequelae of leprosy. The laminar platelet gel showed to be a promising be means of microencapsulation of mesenchymal stem cells, fibroblasts and keratinocytes. In wounds treated with mesenchymal stem cells embedded in the laminar platelet gel, significant clinical improvement was observed both in healing and in reducing inflammatory and painful manifestations in 5 patients / Mestre

Orientador: Zélia Lopes da Silva / Banca: Laurinda Rosa Maciel / Banca: Gilmar Arruda / Banca: Janete Leiko Tanno / Banca: Tânia Regina de Luca / Resumo: Esta pesquisa tem por objetivo investigar as experiências de pessoas que viveram e trabalharam em um antigo leprosário no interior do estado de São Paulo e que criaram, a partir de redes de sociabilidade e solidariedade, diversas táticas de sobrevivência e resistência. O Departamento de Profilaxia da Lepra, criado em 1935 e extinto em 1967, foi o responsável pela política de isolamento praticada na rede de cinco asilos-colônias paulistas (dentre eles, o de Aimorés, em Bauru), assim como as normas disciplinares adotadas nessas instituições. Para proteger o restante da população de uma endemia de lepra (hanseníase), os doentes foram excluídos da sociedade e passaram a viver na instituição sob regras e códigos disciplinares bastante severos, principalmente, em relação ao controle dos usos do tempo e de seus corpos. O antigo asilo-colônia Aimorés tinha características de uma instituição total, regida por diferentes políticas públicas para combate à doença (do isolamento compulsório até a internação para tratamento, possível desde o fim da década de 1940). Embora houvesse, a partir de 1962, um decreto que determinava o fim dessa prática para com os portadores do mal de Hansen, o estado de São Paulo a manteria até 1967, quando houve a reestruturação da Secretaria de Saúde paulista. Diante desse cenário, como esses homens e mulheres agiram para lidar com a vida em confinamento e quais as alternativas encontradas por eles para suportarem uma liberdade vigiada? Como essas modificações... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This research aims to investigate the experiences of people who lived and worked in a former Leprosy Home in the countryside of São Paulo state, and who developed, through sociability networks and solidarity, several tactics for survival and resistance. The Departamento de Profilaxia da Lepra (Leprosy Prophylaxis Department), created in 1935 and extinct in 1967, was responsible not only for the isolation policy deployed in five state leper colonies (including the one located in Bauru, called Aimorés) but also for all disciplinary laws and regulations implemented in the institutions. The patients were outcasted from society and started living in institutions under quite strict rules and regulations, to protect the population from an endemic situation of Leprosy, especially regarding their time and (free) use of their bodies. The "asilo - colônia Aimorés" (former Aimorés Home Colony) was recognized as a full function institution, ruled by different public policies for disease control (from mandatory isolation to treatment hospitalization, available since the end of the 1940s). Although a decree was signed in 1962 putting an end to this policy for all Leprosy patients, the state of São Paulo insisted on it until 1967, when the Health State Secretary went under a restructure. Considering this scenery, how did men and women deal with the confinement and what alternatives did they find to bear this probation? How these changes affected the way these people lived? Therefore, we are trying to identify how social networks formed in such strict environments allowed them to develop survival techniques and resistance to the isolation regime they were forced to, finding opportunities to subvert the disciplinary codes inflicted. Such tactics are presented after the analysis of interviews with former patients... (Complete abstract click electronic access below) / Doutor

Orientador: Ana Carla Pereira [UNESP[ Latini / Resumo: A hanseníase é causada pelo Mycobacterium leprae, que infecta macrófagos e células de Schwann, gerando lesões cutâneas e comprometendo nervos periféricos. A doença se apresenta sob diferentes formas clínicas, fortemente determinadas pela resposta imune do hospedeiro, podendo ser classificada como multibacilar (MB) e paucibacilar (PB). Trata-se de uma doença complexa e estudos voltados para a relação genótipo/fenótipo têm evidenciado a participação do componente genético humano nos desfechos da doença. O gene IL2RA está localizado na região cromossômica 10p15, próximo à região 10p13 que foi previamente associada à forma PB da doença, sendo um candidato posicional e funcional para estudos de associação genética com a forma clínica da hanseníase. Este receptor, também denominado CD25, tem papel fundamental na atividade imunorregulatória exercida pelas células Tregs. O TGF-β1 é uma das principais citocinas efetoras da atividade imunorreugulatória das Tregs e está presente em maior quantidade na forma MB. O objetivo do presente trabalho é investigar a associação dos genes IL2RA e TGFB1com as formas clínicas da hanseníase. Para tanto, conduzimos um estudo de associação baseado em duas amostras caso-controles incluindo 885 casos de hanseníase: 406 casos de Rondonópolis-MT como população primária; 479 casos provenientes do Estado de São Paulo como população de replicação. Os dados de frequências nos grupos de pacientes MB e PB foram comparados por modelo de regressão logística univar... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Leprosy is an infectious chronic disease compromising skin and peripheral nerves. There is a spectrum encompassing the clinical forms of leprosy, directed by host immune response. Leprosy has been classified as multibacillary (MB) and paucibacillary (PB), in accord to number of lesions and bacillary burden. Here we have conducted a genetic association study to clinical forms of leprosy based on two case-control samples from Brazil. We have investigated the association of the IL2RA and TGFB1 genes with clinical forms of leprosy. These genes codify important molecules to immunosuppressive activity of the Treg cells, and present differential expressions in accord to the clinical forms of leprosy. A total of 885 leprosy cases were included in the study: 406 cases from Rondonópolis municipality as start population, and 479 cases from the State of São Paulo as a replication population. The AA genotype of the rs2386841 polymorphism in the IL2RA gene was associated to PB form in the start population (OR: 4.29; p-value = 0.0043), but this was not confirmed for the replication population. The C allele of the rs1800470 marker at the TGFB1 gene was associated to MB form in the start population (OR: 2.36; p-value = 0.0238). This association was replicated for the replication population (OR: 2.10; p-value = 0.0300). In a combined analysis joining both populations the association of the rs1800470 was confirmed (OR: 1.81; p-value = 0.0475). We have demonstrated, for the first time, an associ... (Complete abstract click electronic access below) / Mestre

The Book of Leviticus has been described as the ‘first hygiene text’ based upon the observation that Leviticus contains a great deal of matter relating to two conditions. The first is צרעת translated in the Septuagint as λέπρα and confused in English translations with modern leprosy. The second, זוב was misused as a generic term for a whole spectrum of genital discharges. Apart from these, Leviticus contains nothing of a ‘medical’ nature. The question arises, as to whether these terms implied any sort of medical context or whether their only significance was as markers of ritual impurity to the priesthood. In Chapter 1 this question is developed and an hypothesis arrived at. A hermeneutic and methodology for the study are introduced and discussed. Chapter 2 is a review of the state of developing ‘medical practice’ in the Ancient Near East. Chapter 3 is concerned with the ideology of the levitical priesthood and their worldview in particular in respect of the establishment and operation of practice of ritual. Chapter 4 treats on the Levitical notion of impurity considered from both taxonomical and sociological standpoints and these approaches are discussed in the context of the present study. Chapters 5 and 6 each contain a detailed ‘medical exegesis’ of chapters 13 and 15 of Leviticus dealing with צרעת and .זוב Chapter 7 contains a similar treatment of the biblical notion of blemish and addresses the question of whether this was a mark of impurity like צרעת and .זוב In Chapter 8 embodies idea of contagion in the context of the ‘hygienic’ theme in Leviticus and the priests’ concern with what might imperil sacred objects. Chapter 9 employs context logometrical analysis in a detailed study of the word צרעת and whether there was, in Ancient Israel, any relationship, adverse or synergic between the activities of the priests in preserving purity, and early healthcare practice. Chapter 10 is a discussion of how צרעת has been seen from a theological perspective. While the exact nature of צרעת remains unknown, its biblical context — levitical and non levitical — is considered in relation to modern theories of the relationship of the impurity laws, sin and the wholeness↔ healthcare dynamic. Chapter 11 is a presentation of the conclusions that may be drawn from this study in respect of the wholeness↔ holiness paradigm posited in the hypothesis. It is concluded that there is no clear evidence to suggest that the priesthood saw צרעת and זוב in any terms commensurate with modern pathology and clinical medicine. Consequently it would be wrong to suppose, as many authors have, that in the levitical context, countermeasures to these conditions, though diagnostic, were hygienic in the modern, medical, — they were not, nor were they ever envisaged to be. That some of these measures subsequently found a significant place in preventive medicine appears to have been both fortuitous and fortunate.