Les propriétés du papier - pompe capillaire, prix et disponibilité - lui permettent de répondre à tout type de contraintes logistiques et économiques d'un diagnostic médical de terrain. En amont de l'application, nous avons étudié les écoulements dans des géométries confinées par des barrières de cire. Une focalisation hydrodynamique associée à l'évaporation, crée un effet de concentrateur atteignant un facteur d'amplification de 1000. La continuité du diagnostic depuis le terrain jusqu'au laboratoire est assurée par des dispositifs hybrides papier-microsystèmes. Dans cette thèse, l'élution d'échantillons séchés dans le papier est quantifiée et sa compatibilité avec différentes fonctions microfluidiques démontrée. Nous nous sommes intéressés à deux applications de diagnostic : la détection d'un biomarqueur cardiaque par immunoessai et celle du virus Ebola par amplification d'acides nucléiques (RT-RPA). Avec un dispositif papier simple et une révélation colorimétrique, la troponine a été détectée jusqu'à une concentration de 1 ng/mL. Le diagnostic précoce de maladies infectieuses est rendu possible par la biologie moléculaire sur papier. Après des développements en laboratoires sur ARN synthétiques, des expériences réalisées en Guinée, sur des échantillons cliniques, à partir de papiers prêts à l'emploi, avec une instrumentation transportable ont atteint une sensibilité à 85.3%. Le multiplexage du diagnostic est obtenu dans des géométries multicouches par la réalisation simultanée de tests et contrôles. Enfin, l'application à d'autres pathogènes comme HIV et la Dengue, a montré les limites du papier et de son environnement biochimique non contrôlé. / Paper properties – such as capillary pump, affordability and availability – made it suitable for medical diagnostics in logistic and economic field constraints. Upstream of application, we studied liquid flows in wax-confined geometries. Hydrodynamic focus coupled to evaporation creates a concentrator effect reaching an amplification factor of 1000. Diagnosis continuity from the point of care to testing laboratory is insured thanks to hybrid paper-microsystem devices. In this thesis, the elution of dried samples in paper is quantified and its compatibility with various microfluidic functions demonstrated. We were interested in two diagnostics application: detection of a cardiac biomarker by immunoassay and of Ebola virus by nucleic acids amplification (RT-RPA). With simple paper devices and a colorimetric signal, Troponin has been detected until a concentration of 1 ng/mL. Early diagnostics of infectious diseases is made possible with molecular biology on paper. After laboratory preliminary developments on synthetic RNA strains, experiments performed in Guinea with clinical samples, from ready to use papers, with carry-on equipments achieved a sensitivity of 85.3%. Multiplexed diagnostics is obtained in multilayered geometries enabling simultaneous tests and controls. Finally, application to other pathogens, like HIV and Dengue, showed paper limits from its uncontrolled bio-chemical environment.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-10-02T19:41:10Z No. of bitstreams: 2 Dissertação - Liliam Borges Fernades - 2013.pdf: 1021436 bytes, checksum: ed17067b456cf27093e83d9cf999cd72 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-02T20:11:13Z (GMT) No. of bitstreams: 2 Dissertação - Liliam Borges Fernades - 2013.pdf: 1021436 bytes, checksum: ed17067b456cf27093e83d9cf999cd72 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-02T20:11:13Z (GMT). No. of bitstreams: 2 Dissertação - Liliam Borges Fernades - 2013.pdf: 1021436 bytes, checksum: ed17067b456cf27093e83d9cf999cd72 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-06-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / It is estimated that between 60 and 80 million people worldwide enfretem difficulties to reproduce at some point in their lives and it is estimated that this ratio reaches approximately 20% of couples of reproductive age. Gonorrhea is a common bacterial infection caused by Neisseria gonorrhoeae (NG), transmitted almost exclusively by sexual or perianal contact. In women genital infection can be asymptomatic and when it discovers there may be serious complications such as pelvic inflammatory disease, and ectopic pregnancy, a leading cause of female infertility. The molecular diagnostic techniques are powerful allies in the tracking of NG and other sexually transmitted diseases (STD). Therefore, an investigation was conducted in the scientific literature in the form of a Systematic Literature Review (SLR) on the prevalence of NG, molecular diagnostic techniques and the samples used in the detection of this bacterium. Simultaneously, we developed a chart review in the last 4 years to detect the prevalence of gonococcal infection among other diagnoses as the cause of infertility in women seen at the Laboratory of Human Reproduction - Clinical Hospital, Goiânia, Goiás. SLR was found in 720 articles of which 694 were excluded due to previously established criteria and 26 were included in this review. The population was predominantly young 7 (27%) and female sex workers 6 (23%). The age ranged from 12 to 59 years. The more frequent biological material was endocervical swab 10 (38.46%), vaginal swabs 8 (30.76%), urine 4 (15.38%) and the association of these 3 (11.53%). The in-house PCR was the choice of 12 trials for the diagnosis of NG. In the other 14 studies different commercial diagnostic kits were used. Gradually more it is observed the use of biological samples collected from a less invasive diagnosis of STD. Molecular techniques found in this study are the most used in asymptomatic patients, since they have greater efficiency in the detection of NG, whose gold standard applies only in symptomatic patients. In reviewing the records among the 340 women studied, the prevalence of NG 0.6% and co-infection with Chlamydia trachomatis (CT) was 0.6%. DIP was present in 2.1% of cases and 2 cases of coinfection of NG and CT and the mean age was 33 years. The CT and NG infections had low prevalence in the studied sample and studies are needed in other breeding centers in the country to confirm the prevalence of infections in this particular group of women with infertility problems. / Estima-se que entre 60 e 80 milhões de pessoas em todo o mundo em algum momento de suas vidas enfrentem dificuldades para se reproduzirem e calcula-se que este índice atinja aproximadamente 20% dos casais em idade reprodutiva. A gonorréia é uma infecção bacteriana frequente, causada por Neisseria gonorrhoeae (NG), transmitida quase que exclusivamente por contato sexual ou perianal. Nas mulheres a infecção genital pode ser assintomática e quando se descobre pode haver complicações sérias como a doença inflamatória pélvica (DIP), uma das principais causas da infertilidade feminina e da gravidez ectópica. As técnicas diagnósticas moleculares são grandes aliadas no rastreamento de NG e outras doenças sexualmente transmissíveis (DST). Objetivos: realizar uma investigação na literatura científica no formato de uma Revisão Sistemática de Literatura (RSL) sobre a prevalência de NG em mulheres assintomáticas, observando a faixa etária, as técnicas moleculares diagnósticas e as amostras utilizadas na detecção dessa bactéria; e, uma revisão de prontuários dos últimos 4 anos para detectar a prevalência da infecção gonocócica entre outros diagnósticos como fator causal da infertilidade em mulheres atendidas no Laboratório de Reprodução Humana – Hospital das Clínicas/UFG, Goiânia, Goiás. Na RSL foram encontrados 720 artigos dentre os quais 694 foram excluídos por critérios previamente estabelecidos e 26 incluídos nesta revisão. A população predominante foi de jovens 7 (27%) e mulheres profissionais do sexo 6 (23%). A idade variou de 12 a 59 anos. O material biológico mais frequente foi esfregaço endocervical 10 (38,46%), esfregaço vaginal 8 (30,76%), urina 4(15,38%) e a associação dos mesmos 3(11,53%). A técnica PCR convencional foi a técnica de escolha em 12 estudos para diagnóstico de NG. Nos outros 14 estudos foram utilizados distintos kits diagnósticos comerciais. Cada vez mais se observa o uso de amostras biológicas coletadas de forma menos invasiva para o diagnóstico de DST. As técnicas moleculares encontradas no presente estudo são as mais empregadas em pacientes assintomáticos, pois apresentam maior eficiência na detecção de NG, cujo padrão ouro só se aplica em pacientes sintomáticos. Na revisão de prontuários entre as 340 mulheres estudadas, a prevalência de NG de 0,6% e coinfecção com Chlamydia trachomatis (CT) foi 0,6%. DIP foi presente em 2,1% dos casos estudados sendo 2 casos por coinfecção de NG e CT e a média de idade foi 33 anos. As infecções por CT e NG tiveram baixa prevalência na amostra estudada e são necessários estudos em outros centros de reprodução do país para confirmar a prevalência de infecções nesse grupo particular de mulheres com problemas de infertilidade.

SUMMARY Aim of the study. To evaluate the information on admissions due to injuries, accidents and poisonings to health care institutions in the major health databases. Methods. The information about injuries, accidents and poisonings has been evaluated in the certified registration forms and reports, which are filled in at the health care institutions, emergency services, medico-social expertise commission. Comparison of the records on admissions due to injuries in 2003 of the adults (16 years old and over) in the database of Lithuanian Health Information Centre and in the database of State Sickness Fund „SVEIDRA” was performed. The continuity of the data from inpatient to outpatient health care institutions was analyzed. The more detailed analysis was carried out analyzing two largest groups of traumas: head injuries (S00-S09) and arm and shoulder injuries (S40-S69) in the database of State Sickness Fund „SVEIDRA“. Morbidity rates per 1000 population were calculated. Statistical analysis was carried out using SPSS 11.00 for Windows. The associations between the variables were measured using the Chi-squared and the Student test. The results were considered statistically significant, when p<0.05. Results. Injuries, accidents and poisonings in most forms of the registration were coded according to the medical consequences, and only in few medical registration forms were coded according to external causes. Some forms used different codes for coding external causes, and some... [to full text]

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