Le but de cette thèse est d’étudier s’il existe une méthode de récolte d’informations, autre que celle couramment utilisée, permettant de mieux décrire l’histoire naturelle des lombalgies non spécifiques. Pour cela, une revue de la littérature a été effectuée et une étude prospective dans la population générale danoise a été analysée. Deux méthodes de récolte d’informations sont utilisées pour caractériser cette évolution : la méthode usuelle par questionnaires, permettant de classer les douleurs lombaires en fonction du nombre total de jours avec douleurs dans une année, et une nouvelle méthode par suivi SMS prenant en compte la durée et le rythme des épisodes douloureux dans une année. Les résultats de la revue de littérature et l’analyse de la population générale danoise vont dans le même sens. L’évolution des douleurs lombaires est relativement stable, notamment pour ceux qui n’ont pas de douleurs en début d’étude. Les deux systèmes de classification, issus respectivement des deux méthodes de récolte, répartissent les individus en groupes non similaires. De plus, les associations de ces groupes avec des variables biopsychosociales ne sont pas les mêmes, différenciant ainsi cliniquement les groupes de chaque classification. Le suivi SMS permet d’apporter des informations plus détaillées sur le rythme des douleurs lombaires dans le temps et semble plus appropriée pour caractériser l’évolution d’une affection récurrente comme la lombalgie non spécifique. Ces résultats permettent maintenant de prévoir l’évolution des douleurs lombaires et vont faciliter l’étude plus précise de profils d’évolutions des individus afin d’améliorer le diagnostic qui, pour l’instant, reste un diagnostic d’exclusion. / The aim of this thesis is to study if there is information gathering method, other than that commonly used to better describe the natural history of non-specific low back pain. For this, a literature review was performed and a prospective study in the Danish general population was analyzed. Two methods of gathering information are used to characterize this course: the usual method by questionnaires, classifying low back pain based on the total number of days with pain in one year, and a new SMS-Track method taking into account the duration and rhythm of painful episodes in a year. The results of the literature review and analysis of data on the Danish general population go in the same direction. The course of low back pain is fairly stable, especially for those who do not have pain at baseline. Both classification systems, respectively from the two methods of collection, divide individuals into different groups. In addition, associations of these groups with bio-psychosocial variables are not the same, differentiating clinically the groups of each classification. SMS-Track method provide more detailed information on the rhythm of low back pain over time and seems more appropriate to characterize the course of a recurring condition such as non-specific low back pain. These results now predict the natural history of low back pain and will facilitate the study of individual course patterns to improve the diagnosis, which remains, for now, a diagnosis of exclusion.

While significant progress has been made in the treatment and management of cancer, challenges remain because of the complexity and the heterogeneous nature of the disease. The improvement that has been seen in survival rates reflects advancements not only in treatment, but also in early stage detection and diagnostics for certain cancers. In particular, early stage detection and treatment of cancer before it has metastasized to other organs has resulted in a dramatic improvement in patient survival rates. One area of research that has shown considerable promise in further advancing diagnostics and early cancer detection is nanotechnology. Specifically, semiconductor and metal nanoparticles have great potential to provide advanced technology platforms for ultrasensitive and multiplexed detection of disease markers and probe disease on the molecular level. Because they are in the same size regime as biological molecules, these nanoparticles exhibit unique interactions with proteins, nucleic acids and other biomarkers of interest for detecting and diagnosing disease. However, high-quality nanoparticles are often unsuited for use in complex biological environments because of their coatings and surface chemistry. In this work, we describe the design and development of polymer-coated nanoparticle imaging agents for use in blood, cell and tissue diagnostic applications. Low-molecular weight, amphiphilic polymers capable of noncovalent interactions with nanoparticle surface ligands and the aqueous environment were synthesized and characterized for use in nanoparticle coating applications. We demonstrate that the hydrophobic and hydrophilic interactions between the nanoparticle surface, the amphiphilic polymer and the aqueous solvent were able to drive the coating and water solubilization of quantum dots. Novel nanoparticle synthetic techniques were also developed using the amphiphilic polymers in a one-pot method to make high quality semiconductor and gold nanoparticles and stabilize and encapsulate the particles for transfer into water. Using the polymer functional groups as multidentate ligands, nanoparticles were synthesized with a high degree of size control and increased stability. In addition, by performing the synthesis in a noncoordinating amphiphilic solvent such as polyethylene glycol, nanoparticles were immediately transferred to water with the excess polymer forming a water soluble coating. Next, nanoparticle surface charge and how it relates to the nonspecific binding of nanoparticles in cells, tissues and other complex biological samples was studied. We have found that highly charged (negative and positive) particles exhibit significant nonspecific binding to biomolecules and other cellular components in biological environments. By reducing the surface charge through the incorporation of hydroxyl functional groups, we have nearly eliminated the nonspecific binding of quantum dots in blood, cells and tissues. Moreover, through crosslinking and altering the surface chemistry of the polymer-coated quantum dots, we have increased the stability of the nanoparticles while maintaining a small hydrodynamic size. Finally, we have investigated the use of the low-binding, hydroxyl quantum dots in tissue staining applications, where nonspecific binding presents a considerable challenge to detection sensitivity and specificity. A number of biomolecule conjugation techniques were examined for the coupling of quantum dots to antibody targeting molecules and preliminary staining experiments were performed.

Submitted by LUANA CAMARGO SOUSA null (luanacamargo.bio@hotmail.com) on 2016-03-15T18:50:34Z No. of bitstreams: 1 005-2016 - Luana Camargo Sousa - DISSERTAÇÃO MESTRADO.pdf: 1321578 bytes, checksum: 0580f4bb0e26158d5c269f87473f2dad (MD5) / Approved for entry into archive by Sandra Manzano de Almeida (smanzano@marilia.unesp.br) on 2016-03-15T19:35:29Z (GMT) No. of bitstreams: 1 sousa_lc_me_ilha.pdf: 1321578 bytes, checksum: 0580f4bb0e26158d5c269f87473f2dad (MD5) / Made available in DSpace on 2016-03-15T19:35:29Z (GMT). No. of bitstreams: 1 sousa_lc_me_ilha.pdf: 1321578 bytes, checksum: 0580f4bb0e26158d5c269f87473f2dad (MD5) Previous issue date: 2016-01-20 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O presente trabalho tem como objetivo avaliar a influência de dietas com diferentes níveis de proteína (P) e carboidratos (CH) na resposta imunológica e nos índices zootécnicos de juvenis de surubim (Pseudoplatystomasp.). O experimento foi conduzido no Laboratório de Aquicultura da Unesp – Campus de Dracena, distribuído em um delineamento inteiramente casualizado com seis tratamentos e quatro repetições (38P/22CH; 38P/26CH; 38P/30CH; 42P/22CH; 42P/26CH; 42P/30CH). Os resultados obtidos foram submetidos à análise de variância (ANOVA) e as médias comparadas pelo Teste de Duncan (5%), através do programa estatístico SAS, versão 9.0. Não foram observadas diferenças significativas entre as dietas para os parâmetros de desempenho: ganho em biomassa, taxa de crescimento específico, conversão alimentar e taxa de eficiência protéica. Os grupos alimentados com a dieta 38P/22CH obtiveram melhor desempenho para comprimento padrão, peso final e ganho de peso. Não foram observadas diferenças significativas em albumina, atividade respiratória dos leucócitos e atividade hemolítica complemento. A dieta 38P/30CH obteve valores médios significativamente maiores para as concentrações de proteína, globulina e lisozima. Para os parâmetros hematológicos, entre as dietas, não houve diferença significativa para as concentrações de eritroblasto, linfócito, eosinófilo, volume corpuscular médio e hemoglobina corpuscular média. Após serem desafiados, os peixes apresentaram uma resposta significativa na concentração de hemoglobina, e uma redução no hematócrito, em resposta ao estresse causado pelo desafio. A melhor resposta produtiva foi observada nos peixes que receberam a dieta 38P/22CH. As condições fisiológicas não foram comprometidas mostrando a capacidade dos peixes em responder ao desafio com LPS. / This study aimed to evaluate the influence of diets with different protein levels (P) and carbohydrates (CH) in the immune response and growth performance of juvenile surubim (Pseudoplatystoma sp.). The experiment was conducted in the Aquaculture Laboratory - Unesp Dracena, distributed in a completely randomized design with six treatments and four replications (38P/22CH; 38P/26CH; 38P/30CH; 42P/22CH; 42P/26CH; 42P/30CH). The results were submitted to analysis of variance (ANOVA) and the means were compared by Duncan test (5%), through the SAS statistical software, version 9.0. No significant differences were observed among diets regarding the growth performance parameters: weight gain, specific growth rate, feed conversion and protein efficiency ratio. Fish fed diets with 38P/22CH diet performed better for standard length, body weight and weight gain. There were no significant differences in albumin, respiratory activity of leukocytes and complement hemolytic activity. The 38P/30CH diet achieved significantly higher average values for the concentrations of protein, globulin and lysozyme. For hematological parameters, there were no significant difference in the concentrations of erythroblast, lymphocytes, eosinophils, mean corpuscular volume, mean corpuscular hemoglobin. After being challenged fish showed a significant response in hemoglobin concentration, and a decrease in hematocrit in response to stress caused by challenge. The best productive response was observed in fish fed diet 38P / 22CH. Physiological conditions were not compromised showing the ability of fish to respond to LPS challenge. / FAPESP: 2014/26723-1

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This thesis was composed of three scientific papers. The first paper was the more comprehensive one. All necropsy and biopsy cases of mycoses and oomycosis diagnosed in domestic animals between 1990 and 2012 were analyzed. In the studied period, 29,686 exams (9,487 necropsy reports and 20,199 biopsy reports) performed at the Laboratório de Patologia Veterinária (LPV) of the Universidade Federal de Santa Maria (UFSM) were studied. Two hundred and thirty cases of mycosis or pythiosis (oomycosis) were found, being 179 cases (78%) of mycoses and 51 cases (22%) of pythiosis. The main diseases observed, in descending order of prevalence, were: pythiosis, candidiasis, aspergillosis, zygomycosis, dermatophytosis, mallasseziosis, cryptococcosis, megabacteriosis, and sporothrichosis. Pythiosis affected mainly horses and the mycosis affected mainly dogs and cats. The second article focused on the histomorphological and histochemical characteristics determinant for the histopathological diagnosis of this condition in dogs and cats. By the hematoxylin-eosin (HE) stain, the yeasts were round, with a central cell containing a nucleus, surrounded by a clear halo (usually non-stained capsule). The techniques of periodic Schiff acid (PAS), Grocott, and Fontana-Masson (FM) were utilized and demonstrated the wall of the yeast cells. The FM stain showed the melanin present in these cells. The Alcian blue and Mayer s mucicarmin stains showed mainly the yeast polysaccharide capsule. The diameter of the cells ranged from 1.67 to 10.00μm and the full diameter of the encapsulated yeasts varied between 4.17 e 34.16μm. Yeast buddings were better observed through the PAS stain and were narrow based, simple or multiple, mainly in the opposite poles of the cells, or forming chains. The third article emphasized an immunohistochemical (IHC) study of cases of aspergillosis and zygomycosis aiming to optimize the use of the IHC technique in the detection of Aspergillus spp. and zygomycetes in animal tissues. Two fungal-specific monoclonal antibodies were utilized in tissue fragments (formalin-fixed paraffin-embedded) previously diagnosed as aspergillosis or zygomycosis. Tissues were submitted to three different detection systems (two biotinilated and one nonbiotinilated). Both antibodies showed high specificity and sensitivity in the examined tissues. No cross-reactions were observed between the antibodies utilized and the agents evaluated (including cases of aspergillosis, zygomycosis, candidiasis, and pythiosis). However, nonspecific reactions were observed in hyphae of some cases, but were eliminated by mean of one of the detection systems used. The IHC technique showed to be a useful tool detecting and confirming aspergillosis and zygomycosis in this retrospective study. / Esta tese foi constituída de três partes que resultaram em três artigos científicos. O primeiro artigo foi o mais abrangente, onde todos os casos de micoses e pitiose diagnosticados em animais domésticos, provenientes de necropsias e biópsias entre 1990 e 2012, foram analisados. No período estudado foram revisados 9.487 protocolos de necropsias e 20.199 exames histopatológicos, totalizando 29.686 casos examinados no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM). Do total de protocolos analisados, em 230 foram diagnosticadas micoses ou pitiose (oomicose), sendo 179 casos (78%) de micoses e 51 casos (22%) de pitiose. As principais doenças diagnosticadas, em ordem decrescente de prevalência, foram: pitiose, candidíase, aspergilose, zigomicose, dermatofitose, malasseziose, criptococose, megabacteriose e esporotricose. Os equinos foram os mais acometidos pela pitiose e os animais de companhia (cães e gatos) foram os mais acometidos pelas micoses. O segundo artigo enfocou as características histomorfológicas e histoquímicas determinantes no diagnóstico histopatológico da criptococose em cães e gatos. Pela técnica de hematoxilina-eosina (HE) as leveduras eram arredondadas, com célula central contendo um núcleo, circundada por um halo claro (cápsula geralmente não corada). As técnicas histoquímicas do ácido periódico de Schiff (PAS), Grocott e Fontana-Masson (FM) foram utilizadas e evidenciaram a parede das células das leveduras. Pelo FM observou-se a melanina presente nessas células. As técnicas do azul Alciano e da mucicarmina de Mayer evidenciaram principalmente a cápsula polissacarídica das leveduras. O diâmetro das células das leveduras variou de 1,67 a 10,00 μm e o diâmetro total das leveduras encapsuladas variou entre 4,17 e 34,16 μm. Os brotamentos foram melhor visualizados através do PAS e ocorreram em base estreita, de forma única ou múltipla, principalmente em polos opostos das células das leveduras ou formando uma cadeia. O terceiro artigo enfocou um estudo imuno-histoquímico (IHQ) em casos de aspergilose e zigomicose, visando a otimização do uso da técnica de IHQ na detecção de Aspergillus spp. e zigomicetos em tecidos de animais. Utilizaram-se dois anticorpos monoclonais fungo-específicos em fragmentos de tecidos (fixados em formol e embebidos em parafina) com diagnóstico histomorfológico prévio de aspergilose e zigomicose, os quais foram submetidos a três sistemas de detecção diferentes (dois biotinilados e um não biotinilado). Os dois anticorpos apresentaram alta especificidade e sensibilidade nos tecidos examinados. Não ocorreram reações cruzadas entre os anticorpos utilizados e os agentes etiológicos avaliados (incluindo casos de aspergilose, zigomicose, candidíase e pitiose). No entanto, reações inespecíficas foram observadas nas hifas em alguns casos, porém foram eliminadas através de um dos sistemas de detecção utilizados. A técnica de IHQ mostrou-se uma ferramenta muito útil na detecção e confirmação dos casos de aspergilose e zigomicose neste estudo retrospectivo.

Orientador: Leonardo Susumu Takahashi / Resumo: O presente trabalho tem como objetivo avaliar a influência de dietas com diferentes níveis de proteína (P) e carboidratos (CH) na resposta imunológica e nos índices zootécnicos de juvenis de surubim (Pseudoplatystomasp.). O experimento foi conduzido no Laboratório de Aquicultura da Unesp – Campus de Dracena, distribuído em um delineamento inteiramente casualizado com seis tratamentos e quatro repetições (38P/22CH; 38P/26CH; 38P/30CH; 42P/22CH; 42P/26CH; 42P/30CH). Os resultados obtidos foram submetidos à análise de variância (ANOVA) e as médias comparadas pelo Teste de Duncan (5%), através do programa estatístico SAS, versão 9.0. Não foram observadas diferenças significativas entre as dietas para os parâmetros de desempenho: ganho em biomassa, taxa de crescimento específico, conversão alimentar e taxa de eficiência protéica. Os grupos alimentados com a dieta 38P/22CH obtiveram melhor desempenho para comprimento padrão, peso final e ganho de peso. Não foram observadas diferenças significativas em albumina, atividade respiratória dos leucócitos e atividade hemolítica complemento. A dieta 38P/30CH obteve valores médios significativamente maiores para as concentrações de proteína, globulina e lisozima. Para os parâmetros hematológicos, entre as dietas, não houve diferença significativa para as concentrações de eritroblasto, linfócito, eosinófilo, volume corpuscular médio e hemoglobina corpuscular média. Após serem desafiados, os peixes apresentaram uma resposta significativa na ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed to evaluate the influence of diets with differentprotein levels (P) and carbohydrates (CH) in the immune response and growth performance of juvenile surubim (Pseudoplatystoma sp.). The experiment was conducted in the Aquaculture Laboratory - Unesp Dracena, distributed in a completely randomized design with six treatments and four replications (38P/22CH; 38P/26CH; 38P/30CH; 42P/22CH; 42P/26CH; 42P/30CH). The results were submitted to analysis of variance (ANOVA) and the means were compared by Duncan test (5%), through the SAS statistical software, version 9.0. No significant differences were observed among diets regarding the growth performance parameters: weight gain, specific growth rate, feed conversion and protein efficiency ratio. Fish fed diets with 38P/22CH diet performed better for standard length, body weight and weight gain. There were no significant differences in albumin, respiratory activity of leukocytes and complement hemolytic activity. The 38P/30CH diet achieved significantly higher average values for the concentrations of protein, globulin and lysozyme. For hematological parameters, there were no significant difference in the concentrations of erythroblast, lymphocytes, eosinophils, mean corpuscular volume, mean corpuscular hemoglobin. After being challenged fish showed a significant response in hemoglobin concentration, and a decrease in hematocrit in response to stress caused by challenge. The best productive response wasobserved in fis... (Complete abstract click electronic access below) / Mestre

6 Abstract Lipopolysaccharides are composed of covalently bound saccharides. They are a characteristic component of the cell wall of gram-negative bacteria. They are the cause of severe sepsis in humans and complications in human medicine. Lipopolysaccharides are a constant part of the infections of gram-negative bacteria. We expect an evolutionarily conserved non-specific immune response and protection. The question is whether there is an immune response in the model organism Caenorhabditis elegans. If so, what mechanism is controlled and regulated. We submitted lipopolysaccharides from the bacteria Pseudomona aeruginosa with the bacteria Escherichia coli OP50 and observed the influence of lipopolysaccharides on the expression of selected genes. We examined metabolism and development. We have shown the influence of lipopolysaccharides on gene expression of C-type lectine clec-60 a clec-71, nextna lys-5, hsp-60 a F44G.3.2.1 genes. We incubated Caenorhabditis elegans on some components of lipopolysaccharide. We found regulation of these selected genes with hydrophobic components of lipopolysacharide, lipid A. We did not observe regulation with saccharide components of lipopolysaccharide, glucose and galatose. The metabolism of lipids had changed. We demonstrated a reduction of neutral lipids and changes in...

The Efficacy of Kinesio Taping as an Adjunct Intervention to Traditional Physical Therapy in the Treatment of Nonspecific Acute Low Back Pain: A Prospective Randomized Controlled Trial Background: Acute low back pain (LBP) is a significant health problem worldwide and is one of the leading causes of disability. Objective: The purpose of this study was to examine the effect of Kinesio Taping (KT) on disability, fear-avoidance beliefs, and pain intensity in patients with acute, nonspecific LBP. Research Design and Methods: A prospective, randomized controlled study of consecutive patients referred to physical therapy with a primary complaint of LBP. Seventy-eight patients with acute, nonspecific LBP were randomized to an experimental group that received traditional physical therapy plus KT and a control group that received traditional physical therapy alone. Interventions were administered twice a week for 4 weeks. Assessment tools used were Ronald Morris Disability Questionnaire (RMDQ) for disability, Fear-Avoidance Beliefs Questionnaire (FABQ) for fear-avoidance beliefs, and Numerical Pain Rating Scale (NPRS) for pain intensity. Assessments were conducted at baseline, end of week 1, end of week 2, end of week 3, and end of week 4. Analysis: Repeated measures mixed model analysis of variance (ANOVA) was used to examine the effect of treatment on each variable. The group type was the between-subjects variable and the time was the within-subjects variable. A significance level of .05 was used in the analyses. Results: Both groups showed statistically significant lower disability, fear-avoidance beliefs, and pain levels over time compared with baseline scores (p < .0001). The experimental group showed statistically significant lower RMDQ scores at week 2, 3, and 4 (p < .05), statistically significant lower FABQ-physical activity subscale scores at the end of week 1 (p < .01), at the end of week 2 (p < .01), at the end of week 3 (p < .01), and at the end of week 4 (p < .05), statistically significant lower FABQ-work subscale scores at week 3 (p < .05) and week 4 (p < .01), and statistically significant lower NPRS scores at week 1, 2, 3, and 4 (p < .05). Conclusion: Kinesio Taping can be considered a useful adjunct intervention to reduce disability and pain and to modulate fear-avoidance beliefs in patients with acute, nonspecific LBP.

More individuals gets symptoms which relates to the indoor climate or the building at the workplace. Indoor climate investigations are often multifactorial, symptoms can come to existence from building-related problems as well from psychic- and social problems. To deal with the problem a working method called the Previa-model was manufactured. The Previa-model builds on working with both building-related symptoms (BRS) and nonspecific building-related symptoms (NBRS) side by side as far as it goes. Furthermore, chart the individuals symptoms, demands on management and a cooperation between psychologists, work environment engineers, company doctors and nurses. The focus is on helping individuals decrease their anxiety and stress as much as possible. The purpose of this study was to examine how the Previa-model have facilitated indoor climate investigations. Which components in the Previa-model could decrease anxiety and stress. Also, how psychologists could help individuals who have NBRS. The study builds on interviews with one work environment engineer and three psychologists. Data was collected from assignments based on the Previa-model, one ongoing and three finished and result from a survey. The result showed that the application of the Previa-model led to good results in the investigations and customers were in general very pleased with the outcome. Sixteen components that could decrease anxiety and stress were found. Furthermore, could psychologists support individuals by dealing with stress, anxiety and emotional impingement. Indoor climate problems are often very complex and difficult to solve, but working with several investigations and actions at the same time makes it possible to succeed.

Made available in DSpace on 2016-04-26T20:23:01Z (GMT). No. of bitstreams: 1 Mauricio Pereira Simoes.pdf: 389168 bytes, checksum: 43d7724f2f72781ef6d18a7c60159273 (MD5) Previous issue date: 2014-08-21 / The present study deals with the employment status of their fundamental rights and forms of protection from the use of positivized institutes in domestic law. For both been the subject of research and analysis the theory of fundamental rights since its broadest conception through the emergence, insertion in the internal order, generations, and linkages being established until the effective integration of the working relationship. Then went through the analysis of classical hermeneutics and current influence of fundamental rights in labor law, especially in the aspect of employment protection, through the principles, its classical functions and evolution for the proposed regulatory function by post-positivism. The powers of command of the employer, in all forms, but especially on the right to waiver and potestative possible limitation applicable to the same power, considering the application of nonspecific labor rights under civil law in order to protect the rights of workers. Finally, the study of institutions already included in the Consolidation of Labor Laws and other laws, as sources of optimization in the preservation of contracts, applying a hermeneutic based on fundamental rights as a limiter abuse potestative right of waiver and building elements allowing the employer to use alternatives to dismissal as a corollary of the social function which it carries and effective means of preventing unemployment preserving contracts, especially in times of crisis forms. The final considerations seek to interlace all elements as a way to achieve the desired end that is reducing layoffs / O presente estudo trata do emprego, sua condição de direito fundamental e as formas de preservação a partir da utilização de institutos positivados no ordenamento jurídico interno. Para tanto foram objeto de pesquisa e análise a teoria dos direitos fundamentais desde sua concepção mais ampla passando pelo surgimento, inserção na ordem interna, gerações, vinculações e vias de aplicação até a efetiva integração à relação de emprego. Em seguida passou pela análise da hermenêutica clássica e da influência atual dos direitos fundamentais no direito do trabalho, especialmente na vertente de proteção ao emprego, passando pelos princípios, suas funções clássicas e a evolução para a função normativa proposta pelo pós-positivismo. Os poderes de mando do empregador, em todas as formas, mas especialmente quanto ao direito potestativo de dispensa e a limitação possível aplicável a esse mesmo poder, ponderando a aplicação de direitos laborais inespecíficos previstos no direito civil como forma de preservação de direitos ao trabalhador. Por fim, o estudo de institutos já consagrados na Consolidação das Leis do Trabalho e leis esparsas, como fontes de otimização na preservação de contratos, aplicação de uma hermenêutica baseada nos direitos fundamentais como um limitador do abuso do direito potestativo de dispensa e a construção de elementos que permitam ao empregador se utilizar de formas alternativas à dispensa como corolário da função social que a empresa exerce e meio eficaz de evitar o desemprego preservando contratos, especialmente em tempos de crise. As considerações finais buscam interlaçar todos os elementos como forma de alcançar o fim almejado que é a redução das dispensas imotivadas

A dengue à transmitida por mosquitos hematÃfagos do gÃnero Aedes das espÃcies aegypti e albopictus. O vÃrus dengue (DENV) pertence à famÃlia Flaviviridae do gÃnero FlavivÃrus e possui quatro sorotipos que foram designados como: DENV-1, DENV-2, DENV-3 e DENV-4. A doenÃa pode manifestar-se como uma enfermidade infecciosa aguda, caracterizada por um amplo espectro clÃnico que varia desde formas de infecÃÃo assintomÃtica ou febre indiferenciada atà as formas graves, com hemorragia e/ou choque. Este estudo apresentou como objetivo descrever os aspectos epidemiolÃgicos, clÃnicos e laboratoriais de pacientes com suspeita de dengue atendidos no Hospital SÃo Josà de DoenÃas Infecciosas (HSJ) e no Hospital Nossa Senhora da ConceiÃÃo (HDNSC) no perÃodo de fevereiro a dezembro de 2010. Dessa forma, foram recrutados 93 pacientes, sendo que, 86 preencheram os critÃrios de inclusÃo. Os pacientes foram recrutados por busca ativa nas emergÃncias e nas enfermarias dos referidos hospitais e submetidos a um protocolo de acompanhamento por meio de uma ficha de avaliaÃÃo clÃnica inicial (1 ao 5Âdia de doenÃa) e de uma ficha de avaliaÃÃo subsequente (6 ao 7 dia de doenÃa). Foram realizadas pelo menos duas mensuraÃÃes de hematÃcrito, plaquetas, alÃm de exames bioquÃmicos e exames especÃficos para dengue. Os sinais e os sintomas mais prevalentes nos pacientes com suspeita de dengue foram: febre, cefaleia e mialgia. Vinte e cinco pacientes (29%) apresentavam manifestaÃÃes hemorrÃgicas espontÃneas, sendo que, as hemorragias cutÃneas (petÃquias e equimoses) foram as mais encontradas (15%). Quando avaliada a populaÃÃo feminina em idade reprodutiva, 6% apresentaram metrorragia. A prova do laÃo foi realizada em 80 pacientes, sendo positiva em 20 pacientes (25%). Dos 86 pacientes, 48 (55,8%) foram positivos para dengue por pelo menos uma das tÃcnicas: imunocromatografia NS1 (16%), RT-PCR (19%), ELISA IgM (44%), imunocromatografia IgM (42%) e ELISA NS1 (27%). O vÃrus dengue foi detectado em 16 pacientes, sendo, DENV-1 em 1 paciente (6,2%), DENV-2 em 14 pacientes (87,5%) e DENV-3 em 1 paciente (6,2%). Vinte e seis pacientes (54,1%) preencheram os critÃrios do MinistÃrio da SaÃde (MS) de Dengue ClÃssica (DC), 10 (20,8%) de Febre HemorrÃgica de Dengue (FHD) e 12 (25%) de Dengue com ComplicaÃÃo (DCC). A relaÃÃo entre sexo feminino e masculino foi de aproximadamente 1,1/1, com predomÃnio maior de adultos jovens. Quanto ao critÃrio de gravidade do MS, 60% dos casos suspeitos de dengue foram classificados como grau II e nenhum caso como grau IV. Dos critÃrios de extravasamento plasmÃtico preconizado pelo MS, a hipoalbuminemia esteve presente em 5 pacientes (10,4%). A queda do hematÃcrito acima de 20% apÃs hidrataÃÃo foi observada em apenas 4 pacientes (8,3%). No perÃodo do estudo, foram diagnosticados dois pacientes com dengue e leptospirose, sendo que um paciente complicou com pÃrpura trombocitopÃnica idiopÃtica, esses pacientes tiveram evoluÃÃo benigna. Portanto salientamos a necessidade de um diagnÃstico precoce, antes do desenvolvimento das manifestaÃÃes graves, de polÃticas de erradicaÃÃo do Aedes e da estruturaÃÃo de um serviÃo de referÃncia. / Dengue is transmitted by blood-sucking mosquitoes of the species of the genus Aedes aegypti and albopictus. Dengue virus (DENV) belongs to the genus Flavivirus of the Flaviviridae family and has four serotypes that were designated as: DENV-1, DENV-2, DENV-3 and DENV-4. The disease can manifest as an acute infectious disease characterized by a wide clinical spectrum ranging from asymptomatic forms of infection or undifferentiated fever to severe forms, with bleeding and / or shock. This study had as objective to describe the epidemiological, clinical and laboratory features of patients with suspected dengue fever treated at the St Joseph Hospital of Infectious Diseases (HSJ) and the Hospital Nossa Senhora da ConceiÃÃo (HDNSC) in the period from February to December 2010. Thus, we recruited 93 patients, 86 met the inclusion criteria. Patients were recruited by an active search in emergencies and in the ward of these hospitals and underwent a follow-up protocol through an initial clinical evaluation form (from day 1 to day 5 of illness) and an evaluation form following (from the 6 to 7 day of illness). Were performed at least two measurements of hematocrit, platelets, and biochemical tests and specific tests for dengue. The signs and symptoms more prevalent in patients with suspected dengue were fever, headache and myalgia. Twenty-five patients (29%) had spontaneous bleeding manifestations and the cutaneous bleeding (petechiae and ecchymosis) were the most frequent (15%). When evaluating the female population of reproductive age, 6% had metrorrhagia. The tourniquet test was performed in 80 patients and was positive in 20 patients. Of 86 patients, 48 (55,8%) were positive for dengue at least one of the techniques: immunochromatography NS1 (16%), RT-PCR (19%), IgM ELISA (44%), IgM immunochromatography (42%) and NS1 ELISA (27%). The dengue virus was detected in 16 patient and, DENV-1 in 1 patient (6.2%), DENV-2 in 14 patients (87.5%) and DENV-3 in 1 patient (6.2%). Twenty- six patients (54,1%) met the criteria of the Ministry of Health (MOH) Classic Dengue (DC), 10 (20,8%) of Dengue Hemorrhagic Fever (DHF) and 12 (25%) of Dengue with complication (DCC). The relationship bet ween females and males were approximately 1.1/1, with higher prevalence in young adults The criterion for severity of MOH, 60% of suspected dengue cases were classified as grade II and none as grade IV. Plasma extravasation of criteria recommended by MOH, hypoalbuminemia was present in 5 patients (10,4%). The drop in hematocrit higher than 20% after hydration was observed in only 4 patients (8,3%). During the study period, two patients were diagnosed with dengue and leptospirosis, and one patient complicated with idiopathic thrombocytopenic purpura, these patients had a benign outcome. Therefore we stress the need for early diagnosis, before the development of severe manifestations, of policies to eradicate Aedes and structure a reference service.