Orientador: Taís Maria Bauab / Coorientadora: Margarete Teresa Gottardo de Almeida / Banca: Carlos Henrique Gomes Martins / Banca: Flávia Aparecida Resende Nogueira / Banca: Elfriede Marianne Bacchi / Banca: Mara Correa Lelles Nogueira / Resumo: A elevada incidência de casos infecciosos causada por C. albicans, tal como a candidíase vulvovaginal (CVV) expõe o ser humano a terapias agressivas, bem como implica no desenvolvimento da resistência aos antifúngicos disponíveis na terapêutica clínica. Neste sentido, diversos pesquisadores encontram na natureza, bem como em plataformas nanotecnológicas de liberação de fármacos, um novo horizonte para disponibilizar novos recursos que possibilitem compor o arsenal terapêutico das doenças fúngicas. Em vista disso, este trabalho visou avaliar o potencial antifúngico in vitro e in vivo de frações do extrato metanólico de escapos de Syngonanthus nitens, o qual vem se mostrando promissor no tratamento da CVV, não incorporado e incorporado em um sistema nanoestruturado de liberação de fármacos (nanoemulsão lipídica - NE) buscando aprimorar os parâmetros referentes à biodisponibilidade das mesmas. Os ensaios investigativos foram iniciados com o fracionamento do extrato bruto (extração em fase sólida) e caracterização química das frações (ensaios cromatográficos por CCD e CLAE-DAD), seguido para o desenvolvimento da NE, a qual foi composta por colesterol (fase oleosa), Brij 58 (tensoativo) e tampão fosfato pH 7,4 + 0,25% de dispersão de quitosana (fase aquosa). 12 frações foram obtidas e apresentaram perfis químicos e antimicrobianos distintos, dentre elas, a fração Fr3 foi a mais promissora e constatou-se que o flavonóide luteolina é o composto majoritário e o responsável pela ativi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The incidence incidence of infectious caused by C. albicans, such as vulvovaginal candidiasis (CVV) exposes humans to aggressive therapies, and to the development of resistance to antifungal agents available in clinical therapy, as well. In this sense, several researchers find in the nature, and in the nanotechnology platforms for drug delivery, a new horizon to make available new resources that allow to compose the therapeutic arsenal of fungal diseases. The aim of this study was to evaluate the in vitro and in vivo antifungal potential of fractions from the methanolic extract of Syngonanthus nitens, which has been shown to be promising in the treatment of CVV, not incorporated and incorporated in a nanostructured drug delivery system (lipid nanoemulsion - NE) aiming to improve the parameters related to the bioavailability. The investigations were initiated with the fractionation of the crude extract (solid phase extraction) and chemical characterization of the fractions (TLC and HPLC-DAD chromatographic analyzes), followed for the development of the NE, which was composed by cholesterol (oil phase), Brij 58 (surfactant) and phosphate buffer pH 7.4 + 0.25% chitosan dispersion (aqueous phase). 12 fractions were obtained and presented distinct chemical and antimicrobial profiles, among them, the Fr3 fraction was the most promising and it was verified that the flavonoid luteolin is the majoritarian compound and responsible for the antimicrobial activity. Pharmacotechnical experiments (phase diagram design, polarized light microscopy, dynamic light scattering, zeta potential, stability evaluations, continuous and oscillatory rheological... (Complete abstract click electronic access below) / Doutor

Magister Scientiae (Nutrition Management) - MSc(NM) / In South Africa, healthcare professionals (HCPs) are at an increased risk of developing non-communicable diseases due to their unhealthy lifestyle behaviours, which mainly consist of excessive alcohol drinking and smoking, physical inactivity, and unhealthy diets. Attitudes towards healthy eating, a healthy lifestyle, and physical activity (PA) of individuals contribute towards individuals engaging in these health behaviours.

Background: Non-communicable diseases (NCDs) account for over two-thirds of deaths worldwide, and global efforts to address NCDs have accelerated. Current prevention and control efforts rely primarily on individual behavior/lifestyle approaches that place the onus of responsibility for health on the individual. These approaches, however, have not stopped the increasing trend of NCDs worldwide. Thus, there is urgent need for exploring alternative approaches in order to attain the aim of reducing global premature NCDs mortality by 25% by 2025, and meeting the NCD reduction objective in the Sustainable Development Goals. Discussion: We suggest the need for a structural approach to addressing the NCDs epidemic that integrates social science and public health theories. We evaluate two overarching principles (empowerment and human rights) and three social determinants of health (labor and employment, trade and industry, and macroeconomics) addressed in the 2013 Global Action Plan for the Prevention and Control of NCDs to demonstrate how a structural approach to NCDs can be incorporated into existing NCD interventions. For each area considered, theoretical considerations for structural thinking are provided and conclude with recommended actions. Conclusion: Achieving the global health agenda goals of reducing NCDs mortality will require a shift to a paradigm that embraces concerted efforts to address both behavioral/lifestyle factors and structural dimensions of NCDs.

Diagnostics serve as the frontline defense for the containment and mitigation of infectious diseases. The emerging synthetic biology field established numerous useful applications of engineered biological systems and networks that led to the development of living biosensors. Significant effort has been made to develop G-coupled protein receptor (GPCR)-based yeast biosensors for applications in drug discovery, environmental monitoring, and clinical diagnostics of small molecules and fungal pathogens. Of the living biosensor chassis, yeast-based biosensors offer exceptional advantages over other in vitro diagnostics, such as long-term storage in a reagent-free and dried dormant state, an engineered colorimetric readout for yes/no result interpretation, and high scalability through industrial fermentation. These advantages could be the next innovation as a low-cost, low-tech, and reliable diagnostic alternative in point-of-care and at-home contexts. Chapter 1 provides background information related to synthetic biology, living biosensors, direction evolution, and point-of-care diagnostics. Chapter 2 covers the development of engineered living yeast as a diagnostic tool for viral infections by tailoring the biosensing recognition element to sense any amino acid-based biomarker of choice via directed evolution. Chapter 3 describes the development of living yeast biosensor for the detection of the pathogenic fungus, Aspergillus fumigatus, in clinical supernatants and patient samples. Chapter 4 describes the progression of a living yeast biosensor for the multi-drug resistant pathogenic fungus, Candida auris, and its detection in clinical culture supernatants and samples.

This study demonstrates the first case report in which an NK Cell deficiency initially presented as an asymptomatic disseminated herpes simplex viremia (HSV). A pre-term 13- day- old patient presented with disseminated HSV after investigation because his twin brother was found to have HSV vesicular lesions. The patient remained asymptomatic throughout the entire hospital course. While 40% of neonates never exhibit vesicular lesions, most of the infants will be symptomatic with DIC and/or respiratory and/or hepatic failure. The HSV development in his twin brother prompted immediate multiple HSV PCR testing even though he was asymptomatic. The results were positive for HSV in both plasma & nasopharynx. He received intravenous acyclovir treatment for 21 days. Both CSF & brain MRI studies demonstrated no CNS involvement. He was discharged home with oral acyclovir for one year. Two months after being off acyclovir he developed herpetic vesicles which resolved with acyclovir treatment. Currently, he is on chronic acyclovir treatment. Lymphocyte enumeration tests demonstrated NK cell deficiency. Typically, HSV is a virulent symptomatic infection especially when it presents with viremia. Here we have a case of asymptomatic HSV viremia. Likewise, HSV infection does not usually recur after 1 year of acyclovir treatment. Here, we have a child presenting with what seems to be recurrent congenital HSV infection even with adequate treatment. These atypical HSV presentations may have been due to NK cell deficiency. We, therefore, propose that clinicians should consider NK cell deficiency as possible etiology when HSV presents in an atypical manner as described in our case.

Adherence to masking recommendations and requirements continues to have a wide variety of impacts in terms of viral spread during the ongoing pandemic. As governments, schools, and private sector businesses formulate decisions around mask requirements, it is important to observe real-life adherence to policies and discern subsequent implications. The CDC MASCUP! observational study tracked mask-wearing habits of students on higher-education campuses across the country to collect stratified data about mask typologies, correct mask usage, and differences in behaviors at locations on a college campus and in the surrounding community. Our findings from a single institution include a significant adherence difference between on-campus (86%) and off-campus sites (72%) across the course of this study as well as a notable change in adherence at the on-campus sites with the expiration of a county-wide governmental mandate, despite continuance of a university-wide mandate. This study, completed on and around the campus of East Tennessee State University in Washington County TN, was able to pivotally extract information regarding increased adherence on campus versus the surrounding community. Changes were also seen when mask mandates were implemented and when they expired.

INTRODUCTION: Non-communicable diseases (NCDs) burden has increased significantly over the past decade in Saudi Arabia (SA). Disparities of NCDs disease prevalence have been documented; however, little is known regarding inequities in NCDs health services access and delivery especially at the primary health care (PHC) level. Moreover, equity considerations have not explicitly been part of allocative financial decision-making criteria. The goal of this study is to assess equity-related challenges in accessing NCDs services as well as the current NCDs priority setting and financial resources allocation process to support the ongoing health system transformation efforts. METHODS: This study used a mixed methods approach. The quantitative data was obtained from existing secondary data of 10,000 households’ surveys, The Kingdom of SA World Health Survey, 2019. The primary collected qualitative data consist of 33 in-depth interviews (IDIs) with public officials from national and regional level using an interview guide supported by documents review. A multiple logistic regression and thematic analysis were used for the analysis. RESULTS: More than 35% of people with diagnosed diabetes, hypertension or dyslipidemia have an unmet need of primary care services. Only 20% of surveyed women had a cervical cancer screening during their last pelvic exam while only 18% of eligible women ever had a mammogram. Significant factors affecting primary care services utilization were region of residence, population density, wealth, income and education. Findings from the interviews revealed that NCDs and PHC are top priorities of the Saudi health reform with strong political commitment and major investments. However, there is no clear strategic direction to improve NCDs services given the highly centralized financial system with suboptimal resources allocation towards PHC and where increasing efficiency focuses mainly on higher level care. Governance-related challenges include accountability and power struggle, partly due to financial and human resources variations across the region. DISCUSSION: Improving budget formulation for primary care and NCDs programs, and harmonizing NCDs programs funding across sectors apart from the health sector while defining what equity and allocative efficiency mean for the Saudi health system transformation are priorities to achieve the health system transformation goals. / 2025-12-11T00:00:00Z

The severity of flood events is predicted to increase as a consequence of climate change and may lead to a higher burden of waterborne infectious diseases in the United States. Contaminated floodwater transports bacterial, protozoal, and viral pathogens that typically cause moderate intestinal or respiratory disease, but can also lead to more serious disseminated infections among immunocompromised, young, and older people. Hydroclimatology and drinking water infrastructure influence the transmission of disease, but their roles are not well-understood and may vary by pathogen-type or geographic region. Specific outbreaks of waterborne disease have been attributed to major floods and cases have been positively associated with some meteorological variables, but the association between infections and flooding has not been systematically examined. In this dissertation, we examine the association between seasonal and extreme floods and parasitic and bacterial infections using multiple flood-indicator variables and exposure definitions. In Chapter 2, we use multimodel inference and generalized linear mixed models to determine the effect of seasonal meteorology on hospitalizations across the US. We found that hospitalization rates were generally higher in rural areas and in places that relied on groundwater for drinking water sources. Soil moisture, precipitation, and runoff were associated with significant increases in hospitalizations for Legionnaires' disease, Cryptosporidiosis, and Campylobacteriosis, respectively. In Chapter 3, we use 23 years of weekly case data to examine the effect of cyclonic storms on six waterborne infections in a conditional quasi-Poisson statistical model. Storm exposure was defined separately for distinct storm hazards, namely wind speed and cumulative rainfall, and effects were examined over 3 weeks post-storm. We found that exposure to storm-related rainfall was associated with immediate and lagged increases in cases. In Chapter 4, we use a nonparametric bootstrap to examine the effect of anomalous meteorological conditions, i.e. extremes unrelated to cyclonic storms, on Legionnaires' disease hospitalizations. We also assess the effect of exposure to specific cyclonic storms in a GLMM framework and compare these approaches. Extreme precipitation and months with cyclonic storms were positively associated with Legionnaires' disease hospitalizations. Determining the effect of flooding on Legionnaires' disease is particularly important as it causes severe illness and has steadily increased in incidence for 20 years. An objective of this dissertation was to develop a framework for examining flood-disease dynamics in the context of hydrometeorological and infrastructure-related factors that may influence transmission. We demonstrated that drinking water source, rurality, and geography may play an important role in these dynamics; the analyses also underscored, however, the urgent need for more extensive epidemiological surveillance and water quality data. Climate change will likely place a considerable strain on aging water infrastructure in the US. A nuanced understanding of flood-disease dynamics is central to mitigating these effects.

The purpose of this study has been to examine and analyze the salient medical and legal aspects related to the educational placement of children in public schools with the human immunodeficiency virus (HIV) infection. The study attempts to provide information that will serve as a resource to public school personnel who are among the professionals that must make informed decisions on public school attendance policies for children with a lethal, complex, and controversial disease. New developments in medicine and in the courts have crucial implications for existing policies and for the development of new policies related to the issue. By examining precedents and patterns in the emerging area of AIDS litigation and legislation, the study serves as a resource for school officials enabling them to make informed proactive decisions. The methodology used in the study was legal research. Primary and secondary sources of law were utilized. Nonlegal research materials included medical research and data that might serve as evidence in legal disputes concerning the educational placement of children with the HIV infection. In addition to medical evidence related to educational placement issues, the information gathered for the study included an examination of the state antidiscrimination disease laws, state special education laws, state communicable disease laws, and state and selected local policy statements for sixteen states; an analysis of the relevant legal issues of the Education of the Handicapped Act (EHA) and Section 504 of the Rehabilitation Act of 1973; and an examination of the constitutional issues pertinent to educational placement of children with AIDS. Case law “in point” or “analogous” to the issue was presented. The concluding chapter summarizes the findings from Chapters Two, Three, Four and includes recommendations for decision-making and policy based on the medical and legal information presented. There is no medical evidence to support the exclusion of children from regular school attendance based on the suspicion of or identification of HIV infection. Awareness of sound medical evidence to support educational decision-making provides a means of projecting a solidly grounded policy to the school population and community at large. Health care precautions should be taken and routine procedures established for the removal of blood and/or body fluids in cases of accident or injury. Routine precautions should be followed by all school personnel regardless of whether an HIV-infected individual is present. / Ed. D.

M.S.