Anlass dieser Studie war die Erfassung und Beurteilung radiologischer Genauigkeit in Thoraxübersichtsaufnahmen bei der Diagnostik von ARDS und Pneumonie. Dazu wurden von 84 Patienten (35 mit ARDS, 46 Patienten mit zusätzlicher Pneumonie) drei aufeinander folgende Aufnahmen befundet und hinsichtlich verschiedener radiomorphologischer Merkmale qualitativ, quantitativ und statistisch analysiert. Es konnte nachgewiesen werden, daß es für eine sichere Befundung von Röntgenthoraces keine statistisches Korrelat gibt (p > 0.6). Die Irrtumswahrscheinlichkeit für falsch positive und falsch negative Ergebnisse lag bei 78% und entsprach dabei den Angaben in der Literatur. Die Ergebnisse unterstreichen zudem die Feststellung, daß auch Serienaufnahmen nicht zur Verbesserung der diagnostischen Sicherheit führen, die Wertigkeit von Röntgenthoraxaufnahmen beim ARDS daher nur im Rahmen einer allgemeinen Verlaufsbeurteilung zu sehen ist. / In addition to general clinical factors involved in the course of ARDS, the aspect of pneumonia superimposed on ARDS, its incidence, the predisposing factors and the underlying sources of infection were to be analysed and the reasons for the different radiological interpretation of this disease reported in literature and practice were to be established. Three consecutive radiographic chest views of 84 patients (35 with ARDS, 49 with ARDS and primary or secondary pneumonia) which were optically and statistically comparable as regards their radiological features were reviewed and evaluated comparatively by discriminance analysis. The study showed that no statistical correlate exists (p > 0.6) for a reliable interpretation of adiographic chest views with regard to ARDS and/or ARDS with additional pneumonia. Furthermore, the results underline the fact that even a series of films obtained within a 24-hour interval cannot help to improve the diagnostic safety and that, consequently, radiographic chest views are of value only for a general assessment of the course of ARDS, whether with or without accompanying pneumonia.

A infecção por Mycoplasma (M.) hyopneumoniae é responsável por perdas econômicas significativas na suinocultura, causando uma pneumonia crônica que normalmente afeta clinicamente suínos de crescimento e terminação. Considerando-se a importância das matrizes de menor ordem de parto na transmissão de M. hyopneumoniae e que uma grande quantidade de leitoas é introduzida nos planteis anualmente, este projeto teve como objetivo compreender aspectos pouco conhecidos da dinâmica de infecção de M. hyopneumoniae em leitoas de reposição. O primeiro estudo avaliou a dinâmica e persistência da infecção por M. hyopneumoniae em leitoas em condições naturais de campo. Quarenta e quatro leitoas foram selecionadas aos 20 dias de idade (ddi) e a detecção de M. hyopneumoniae por PCR foi avaliada mensalmente por suabe de laringe, resultando em um total de 12 coletas. Além disso, 220 leitões filhos dessas matrizes foram amostrados um dia antes do desmame para avaliação da transmissão vertical. Os resultados deste estudo demonstraram que o início da detecção ocorreu aos 110 ddi e um aumento significativo foi observado aos 140 ddi (p<0,05). Ao desmame, apenas 2,3% das fêmeas foi positiva e não foram detectados leitões desmamados positivos. Adicionalmente, 77,2% das leitoas foi detectada positiva por um a três meses, 4,6% por quatro a cinco meses e 18,2% nunca foi detectada positiva, indicando a presença de subpopulações de animais negativos em granjas positivas. Em um segundo estudo, avaliou-se a detecção de M. hyopneumoniae por PCR em leitoas de reposição interna e a variabilidade genética entre granjas foi avaliada por MLVA (Multiple Locus Variable-number tandem repeats Analysis). Um total de 298 leitoas provenientes de três multiplicadoras positivas foram selecionadas e coletadas uma vez para realização de ELISA e duas a três vezes para PCR em um estudo longitudinal. Ainda, a transmissão vertical foi avaliada em 425 leitões pré-desmame. Aos 150 ddi, 47 a 67,4% das leitoas foi detectada positiva por PCR, decréscimos foram observados até a última amostragem nas três granjas avaliadas (p<0,05), e nenhum leitão foi positivo pré-desmame. Ainda, 30,7% das leitoas não foi detectada positiva em nenhuma nas amostragens e os resultados de MLVA indicaram um ampla variabilidade genética de M. hyopneumoniae em leitoas aos 150 ddi. No terceiro estudo, 210 leitoas de reposição negativas para M. hyopneumoniae introduzidas em três granjas positivas foram selecionadas e avaliadas longitudinalmente por PCR e ELISA com o objetivo de comparar dois tipos de fluxo de aclimatação (all-in all-out ou fluxo contínuo). Ainda, a variabilidade genética foi analisada por MLVA. Observou-se um aumento significativo (p<0,05) nas prevalências de leitoas positivas para M. hyopneumoniae por PCR na segunda coleta e um decréscimo ao longo do tempo independentemente do tipo de fluxo de aclimatação utilizado. Os resultados de ELISA revelaram que as três granjas avaliadas tiveram um aumento significativo na prevalência de leitoas positivas da primeira para a segunda coleta (p<0,05), que se manteve alta até o fim do experimento. Ainda, baixa variabilidade genética de M. hyopneumoniae foi observada por MLVA. Um quarto estudo também foi conduzido com o objetivo de avaliar a absorção e detecção de M. hyopneumoniae utilizando-se suabes de nylon flocados e de ponta de rayon. Os resultados deste experimento indicaram uma maior absorção e uma maior detecção de M. hyopneumoniae por PCR (p<0,05) utilizando-se suabes de nylon flocados. / Mycoplasma (M.) hyopneumoniae infection is responsible for important economic losses to pig production, causing a chronic pneumonia that usually affects growing and finishing pigs. Regarding the importance of low parity dams on M. hyopneumoniae transmission and that a high proportion of gilts is introduced in the farms every year, this project aimed to better understand unknown aspects about the infection dynamics of M. hyopneumoniae in replacement gilts. The first study assessed the dynamics and persistence of M. hyopneumoniae infection in gilts in natural conditions. Forty-four gilts were selected at 20 days of age (doa) and M. hyopneumoniae detection was evaluated using laryngeal swabs for PCR testing every month, resulting in 12 samplings. Additionally, 220 piglets born from the selected dams were sampled one day prior to weaning to evaluate vertical transmission. The results of this study showed that the first detection occurred at 110 doa and a significant increase was observed at 140 doa (p<0.05). A small proportion (2.3%) of positive gilts was detected one day prior to weaning and no piglets were detected positive at the same sampling moment. Moreover, 77.2% of the gilts was detected positive for one to three months, 4.6% for four to five months, and a lack of detection was observed in 18.2% of the gilts, indicating the presence of negative subpopulations in positive farms. A second study assessed the M. hyopneumoniae detection in self-replacement gilts longitudinally. A total of 298 gilts from three positive multiplier farms were selected and sampled once for ELISA testing and two or three times for PCR. Moreover, vertical transmission was evaluated in 425 piglets one day prior to weaning, and the genetic variability within farms was assessed in gilts by MLVA (Multiple Locus Variablenumber tandem repeats Analysis). The prevalence of positive gilts at 150 doa ranged from 47 to 67.4% within farms by PCR, decreases were observed up to the last sampling in all farms (p<0.05), and no positive piglets were detected prior to weaning. A lack of detection was observed in 30.7% of the gilts during the study, and high genetic variability was detected within farms. In the third study, 210 M. hyopneumoniae negative purchased gilts were introduced in three farms with two types of acclimation flow (all-in all-out or continuous flow). The gilts were selected for ELISA and PCR testing in a longitudinal study, which aimed to compare the infection dynamics regarding the type of flow. Also, genetic variability was assessed by MLVA. The results showed a significant increase (p<0.05) in the prevalence of M. hyopneumoniae positive gilts by PCR in the second sampling, and a decrease over time regardless the type of flow. The ELISA results revealed a significant increase in the prevalence of positive gilts in the three farms (p<0.05) from the first to the second sampling, which remained high up to the completion of the study. Moreover, limited genetic variability of M. hyopneumoniae was observed by MLVA testing. A fourth study was also performed, which aimed to assess the absorption and detection of M. hyopneumoniae using two types of swabs (nylon-flocked and rayon-bud). The results indicated a higher absorption and M. hyopneumoniae detection by PCR using nylon-flocked swabs (p<0.05).

Made available in DSpace on 2015-04-14T13:33:00Z (GMT). No. of bitstreams: 1 443441.pdf: 1273041 bytes, checksum: 2a726b258e4a6dcc629bd84b376aa191 (MD5) Previous issue date: 2012-08-31 / Background: Acute respiratory infection is the most frequent reason for children s use of emergency medical service. Chest radiography is widely used as a diagnostic method for the management of respiratory infections in children although its benefits are unknown. Aims: The aims of this study are to describe the clinical diagnostics, radiographic reports and the main indications for chest radiography in children attended at an emergency service of a Hospital in the South of Brazil. Methods: Medical records of 466 children with respiratory infection attended at the emergency service of S?o Lucas Hospital (Pontif?cia Universidade Cat?lica do Rio Grande do Sul) were analyzed. Data regarding the reasons for attendance, clinical findings, radiographic report were also collected and analyzed by three trained examiner. Results: From the total of the patients, 233 were boys (50%) and the mean age was 5.7 years-old. Cough (73.6%) and fever (73.0%) were the most frequent reasons for request chest radiography, followed by rhinorrhea (18%), respiratory difflculty (7.9%) and asthma / asthma attacks (5.6%). The most frequent clinical diagnosis was pneumonia (47.4%) and upper airway infection (39.9%). Pulmonary infiltrates (44.4%) and normal reports (43.1%) were the most prevalent findings seen in the radiological evaluation, followed by consolidation (11.2%). Conclusion: The majority of the children had cough and fever as the most common clinical manifestation. Pulmonary infiltrates and normal results were the most common radiological findings. The clinical diagnosis of pneumonia was approximately four times higher than that found in chest x-ray evaluation. / Introdu??o: A infec??o respirat?ria aguda de via a?rea ? a causa mais frequente para a busca de servi?os de emerg?ncia em pediatria. Nesse contexto, a radiografia de t?rax ? um m?todo diagn?stico amplamente utilizado para o manejo das infec??es respirat?rias em crian?as, apesar dos seus benef?cios n?o estarem completamente estabelecidos na literatura. Objetivos: Os objetivos deste estudo s?o descrever as principais indica??es cl?nicas de solicita??o de radiografias, diagn?sticos cl?nicos e os resultados dos exames radiol?gicos de crian?as atendidas na emerg?ncia de nosso hospital, com infec??o respirat?ria aguda. Material e M?todos: Foram revisados 466 prontu?rios de crian?as atendidas no setor de emerg?ncia do Hospital S?o Lucas da Pontif?cia Universidade Cat?lica do Rio Grande do Sul (HSL-PUCRS). No estudo, foram inclu?das crian?as com infec??o respirat?ria. Coletaram-se dados referentes a motivos de atendimento, achados do exame f?sico, diagn?sticos cl?nicos, laudos radiol?gicos de t?rax e de seios da face. Resultados: Do total de pacientes, 233 eram do sexo masculino (50%) e a m?dia de idade foi de 5,7 anos (1-17 anos). Tosse (73,6%) e febre (73,0%) foram os motivos mais frequentes de atendimento, seguidos de coriza (18%), dificuldade respirat?ria (7,9%) e crise asm?tica (5,6%). Dentre os achados do exame f?sico, febre (75%) e tosse (73%) tamb?m foram mais comuns. O diagn?stico cl?nico mais frequente foi pneumonia (47,4%) e infec??o de via a?rea superior (39,9%). Os resultados dos exames de imagem demonstraram que infiltrado pulmonar (44,4%) e laudos normais (43,1%), foram mais frequentes, seguidos de consolida??o (11,2%). Conclus?es: A maioria das crian?as apresentou tosse e febre como manifesta??o cl?nica mais comum. O diagn?stico cl?nico de pneumonia ocorreu aproximadamente quatro vezes mais do que o encontrado em exames de raios-x de t?rax. Infiltrado pulmonar e exames normais foram os achados radiol?gicos mais frequentes.

INTRODUÇÃO: A doença pneumocócica invasiva (DPI) tem alta mortalidade sendo o pulmão órgão de intenso acometimento. Na DPI caracterizou-se localmente importante processo inflamatório agudo com expressivo aumento de macrófagos, polimorfonucleares e fenômenos exsudativos como edema e hemorragia intra-alveolar. Concretizou-se uma resposta inflamatória proeminente com redução dos fenômenos de apoptose que se traduziu por aumento significativo de citocinas pró-inflamatórias, exceto IL-6 e IL-8, aumento de Toll-2, ativação do complemento, aumento de expressão de ICAM- 1 e CD 14 que em conjunto favorecem o estabelecimento dos fenômenos inflamatórios. A diminuição significativa das células NK e das células de Langherhans, IL-6 e IL-8 reflete comprometimento da imunidade inata. Tal comprometimento poderia ser responsável pela diminuição dos linfócitos TCD4+ e TCD8+ com consequente baixa produção de IFN. Em resumo, as lesões teciduais graves na DPI seriam decorrentes do comprometimento parcial da imunidade inata, em especial das células NK e das células de Langherhans, do prejuízo da imunidade adaptativa e da redução da apoptose como possível estratégia defensiva do pneumococo / INTRODUCTION: Invasive pneumococcal disease (IPD) is a condition with high mortality rates, the lungs being intensely attacked. The in situ immune response was determined, in blocks recovered from 22 necropsies of adults who died from IPD in the lungs, by quantitative immune cell phenotype (CD57-NK, CD1a, CD68, antigen S-100, TCD4, TCD8, CD20), Complement-C3, ICAM-1, CD14, Caspase-3 and cytokine (interferon , TNF, TGF, interleukin - IL-1, IL-2, IL-4, IL-6, IL-8, IL- 10), Toll-2 and SP-A (surfactant). A locally important acute inflammation process was characterized in IPD, with significant rise in macrophages, neutrophils and exsudative phenomena such as edema and intra-alveolar hemorrhage. Compared with the lungs from age-matched controls, results from patients with IPD showed significant depletion of NK, CD1a,CD4+, CD8+, CD20+ cells, interferon , IL-4, IL- 6 , IL-8, TGF and Caspase-3 (apoptosis). On the other hand, S-100, Toll-2, IL-1, IL-2R, IL-10, ICAM-1, CD14 and SP-A were more frequently seen in the alveoli of patients with IPD than in controls. A pronounced inflammatory response was detected, with decrease in apoptosis phenomena that translated into significant increase of pro-inflammatory cytokines, except for IL-6 and IL-8, increase in Toll-2, complement activation, increased ICAM-1 and CD-14 expression, which altogether favored installation of the inflammatory processes. A significant decrease in NK and Langherhans cells, IL-6 and IL-8 reflect the harm to the innate immune system. This could respond for the decrease in TCD4+ and TCD8+ lymphocytes, with a consequent low IFNy output. Briefly, the severe tissue lesions in IPD could be a consequence of the partial damage to the innate immunity, particularly of NK and Langherhans cells, of adaptive immune dysfunction, and of apoptosis reduction possibly as a defense strategy of the pneumococcus

Introduction: The association between daily air pollution exposure and risk of mortality is well established. Few studies have investigated in detail the associations beyond a seven day lag. The aim of this thesis was to investigate the change in risk across longer (30 day) periods post exposure for three specific causes of death: pneumonia, chronic obstructive pulmonary disease (COPD), and ischaemic heart disease (IHD). Methods: Daily Scottish mortality data (1980-2011) was matched to measurements from local fixed site pollution (Black smoke, PM10, PM2.5, SO2, & NO2) and temperature monitors. Exposure on subjects' 'day of death' was compared with control days in a time-stratified case-crossover analysis. Exposure effects on 30 days prior to day of death were modelled using distributed lag non-linear, lag stratified, and cubic distributed lag models. Matching hospital admissions data inferred subject location during exposure, further analyses investigated extreme outliers and missing data using multiple imputation techniques. The analysis accounted for several confounders including accurately modelling temperature relationships unique for each cause of death. Results: Of the 919,301 deaths, 20% were classified as being caused by pneumonia, 9.5% as COPD, and 30% as IHD in the 'any' cause of death field. Non-linear effects for temperature and linear effects for the pollutants were present across all 30 days. Temperature-mortality was observed to be U-shaped at shorter lags. Consistently increased risk occurred for longer in cold temperatures with 1oC increase (30 days lag) = %RR -0.35% Pneumonia, -0.62% COPD, and -0.26% IHD. PM2.5 on all three outcomes, and all pollutants on COPD showed the greatest effect sizes. In general, COPD risk only occurred after a delay, peaking between 12-18 days. COPD risk due to PM2.5 was immediate (%RR (95% C.I.) = 1.05% (0.14%,2.01%)) and lasted the full 30 days. Pneumonia risk often reported the shortest lag of 10-15 days, whereas IHD risk occurred 2 days after exposure but lasted the remaining 30 days. There was some evidence especially for pneumonia of a smaller association between air pollution on mortality when subjects included were present in hospital. A simulation study indicated slight improvement in accuracy when 'multiple imputation' was performed compared to 'complete cases' analysis; though both techniques reported similarly underestimated effect estimates. Extreme outliers in the main analysis of pollution exposure did not appear to have a strong influence on the risk. However, large variability between monitor measurements of pollution exposure was present and appeared to be influencing the results. Conclusion: This study provides additional evidence on the link between air pollution, and temperature, and acute mortality. Particular focus was on three causes of death (pneumonia, COPD, and IHD) that are shown to be influenced by air pollution in subtly different ways. Results also indicated that the 'true' effect of air pollution on mortality might be greater than shown by mortality studies which do not use hospital admission location during exposure into account.

Introdução: A doença intersticial pulmonar (DIP) é uma forma de acometimento visceral grave pela esclerose sistêmica (ES), correspondendo na atualidade à principal causa de mortalidade pela doença. Atualmente, a tomografia computadorizada de alta resolução pulmonar (TCAR) é considerada o padrão-ouro no seu diagnóstico. Estudos recentes têm proposto diversos algoritmos clínicos para a predição diagnóstica e prognóstica da DIP-ES, objetivando ampliar sua detecção precoce e auxiliar na determinação de sua evolução e prognóstico. Objetivo: Testar os algoritmos clínicos propostos na literatura na predição diagnóstica e prognóstica na DIP-ES, estimar sua prevalência e avaliar a associação da extensão do acometimento pulmonar na TCAR com mortalidade em uma coorte de pacientes com ES. Métodos: Estudo de coorte prospectivo, incluindo 177 pacientes com ES recrutados no período de abril de 2000 a abril de 2009, avaliados através de entrevista, exame físico, exames laboratoriais, provas de função pulmonar e TCAR. Algoritmos clínicos (A, B e C), combinando dados da ausculta pulmonar, radiografia de tórax e capacidade vital forçada (CVF), foram aplicados para o diagnóstico de diferentes extensões da pneumopatia intersticial na TCAR. Curvas de Kaplan-Meier e Regressão de Cox uni e multivariada foram utilizadas para analisar a associação dos algoritmos e da extensão de DIP na TCAR com a mortalidade. Resultados: A prevalência estimada de DIP na TCAR do baseline foi de 57,1% e 79 pacientes (44,6%) morreram em uma mediana de 11,1 anos de seguimento. Para identificação de DIP com extensão ≥10 e ≥20% na TCAR, todos os algoritmos apresentaram uma alta sensibilidade (>89%) e um likelihoodratio negativo muito baixo (<0,16). Para fins prognósticos, sobrevida foi reduzida para todos os algoritmos, com destaque para o algoritmo C, o qual identifica DIP considerando a presença de crepitantes na ausculta pulmonar, alterações na radiografia de tórax ou CVF <80% (HR 3,47; IC 95% 1,62-7,42). Pacientes com doença extensa como proposto por Goh e Wells (extensão >20% na TCAR ou, em casos indeterminados, CVF <70%) apresentam uma significativa redução na sobrevida (HR 3,42; IC 95% 2,12-5,52). Sobrevida não foi diferente entre pacientes com extensão ≥10 ou ≥20% na TCAR e análise de mortalidade em 10 anos sugere que extensão >10% na TCAR apresenta uma boa capacidade preditiva para mortalidade, embora não haja um ponto de corte claro a partir do qual ocorra um maior incremento na mortalidade. Conclusão: Algoritmos clínicos apresentam uma alta sensibilidade e um likelihood ratio negativo muito baixo para o diagnóstico de extensões de DIP com relevância clínica e prognóstica (≥10 e ≥20%) e foram fortemente associados com mortalidade. Assim sendo, a utilização desses algoritmos pode evitar a necessidade de realização de TCAR em alguns casos. / Introduction: Interstitial lung disease (ILD) is a form of severe visceral involvement by systemic sclerosis (SSc) and currently is the primary cause of death by disease. Thoracic high-resolution computed tomography (HRCT) is considered the gold standard for diagnosis. Recent studies have proposed several clinical algorithms to predict the diagnosis of SSc-ILD, aiming to expand its early detection and estimate prognosis. Objective: To test the clinical algorithms to predict the presence and prognosis of SSc-ILD, to estimate the prevalence of SSc-ILD, and to evaluate the association of extent of ILD with mortality in a cohort of SSc patients. Methods: Prospective cohort study, including 177 SSc patients assessed by clinical evaluation, laboratory tests, pulmonary function tests, and HRCT. Clinical algorithms, combining lung auscultation, chest radiography and % predicted forced vital capacity (FVC), were applied for the diagnosis of different extents of ILD on HRCT. Univariate and multivariate Cox proportional models were used to analyze the association of algorithms and the extent of ILD on HRCT with the risk of death using hazard ratios (HR). Results: The prevalence of ILD was 57.1% on baseline HRCT and 79 patients died (44.6%) in a median follow-up of 11.1 years. For identification of ILD with extent ≥10 and ≥20% on HRCT, all algorithms presented a high sensitivity (>89%) and a very low negative likelihood ratio (<0.16). For prognosis, survival was decreased for all algorithms, especially the algorithm C (HR 3.47, 95% CI 1.62-7.42), which identified the presence of ILD based on crackles on lung auscultation, findings on chest X-ray or FVC <80%. Extensive disease as proposed by Goh and Wells (extent of ILD >20% on HRCT or, in indeterminate cases, FVC <70%) had a significantly higher risk of death (HR 3.42, 95% CI 2.12 to 5.52). Survival was not different between patients with extent of 10 or 20% of ILD on HRCT, and analysis of 10-year mortality suggested that a threshold of 10% may also have a good predictive value for mortality. However, there is no clear cutoff above which mortality is sharply increased. Conclusion: Clinical algorithms had a good diagnostic performance for extent of SSc-ILD on HRCT with clinical and prognostic relevance (≥10 and ≥20%), and were also strongly related to mortality. Therefore, they probably could be used to obviate the requirement of HRCT in some cases.

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-10-02T17:20:16Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PneumoniaAssociadaVentilacao.pdf: 1073578 bytes, checksum: d8c258af6c25ed2660c6e85d1a3ae93e (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-10-04T13:28:13Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PneumoniaAssociadaVentilacao.pdf: 1073578 bytes, checksum: d8c258af6c25ed2660c6e85d1a3ae93e (MD5) / Made available in DSpace on 2017-10-04T13:28:13Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PneumoniaAssociadaVentilacao.pdf: 1073578 bytes, checksum: d8c258af6c25ed2660c6e85d1a3ae93e (MD5) Previous issue date: 2012 / As pneumonias nosocomiais, apesar de acometerem pacientes internados em diversas áreas do hospital ocorrem com mais frequência nos centros de terapia intensiva em pacientes entubados e em ventilação mecânica, e representam a primeira causa de infecção hospitalar nesses centros. O objetivo deste estudo foi avaliar a prevalência e os fatores de riscos associados à pneumonias causadas por entubação orotraquial em uma UTI adulto no municipio de Imperatriz - MA. Participaram do estudo, pacientes internados na unidade de terapia intensiva no Hospital Municipal de Imperatriz- MA, que foram submetidos à ventilação mecânica no período de 2008 a 2010. Dentre os 1.618 pacientes distribuídos por ano, a prevalência de pneumonia adquirida na UTI foi 12,9% em 2008, 18,97% em 2009 e 14,7% em 2010. Considerando o gênero, a prevalência foi maior no sexo masculino e a faixa etária mais comprometida foi a de 61-80 anos com 54,55% dos casos em 2008. A antibioticoterapia antes da PAVM, a imunossupressão do paciente e o tempo de início da PAVM foram os fatores associados ao risco de desenvolver a pneumonia na UTI. A pneumonia nosocomial representa um sério problema no Município de Imperatriz e novos estudos para avaliar prevalência e fatores de risco serão úteis para guiar a implantação de medidas de prevenção destinadas a redução dessa prevalência. / The nosocomial pneumonia, although they involve patients in various hospital areas occur more frequently in intensive care units in patients intubated and mechanically ventilated, and represent the leading cause of nosocomial infection in these centers. The aim of this study was to evaluate the prevalence and risk factors associated with pneumonia caused by intubation in an adult UTI orotraquial in the municipality of Imperatriz - MA. The study, patients admitted to the intensive care unit at the Hospital Municipal Imperatriz-MA, who underwent mechanical ventilation in the period from 2008 to 2010. Among the 1618 patients assigned per year, the prevalence of UTI-acquired pneumonia was 12.9% in 2008, 18.97% in 2009 and 14.7% in 2010. Considering the gender, the prevalence was higher in males and most affected age group was 61-80 years with 54.55% of cases in 2008. Antibiotic therapy before PAVM, immunosuppression of the patient and the time of onset of PAVM were factors associated with the risk of developing pneumonia in the UTI. Nosocomial pneumonia is a serious problem in the city of Imperatriz and new studies to assess prevalence and risk factors will be useful to guide the deploytion of preventive measures aimed at reducing this prevalence.

"December 2004" / Includes bibliographical references (leaves 342-379) / xiii, 379 leaves : ill. (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine, 2005

Patients who require mechanical ventilation (MV) are at risk for developing ventilator associated pneumonia (VAP). Nurses’ adherence to sedation vacations (SVs) has a direct impact on the development of VAP, because SVs have been shown to reduce patients’ average duration of MV and length of stay (LOS) in the intensive care unit (ICU). The purposes of this study guided by Donabedian’s (1966) model were to quantify nurses’ level of adherence to SVs, in relation to the health outcomes of critically ill patients, and identify the barriers and facilitators to performing SVs. A correlational design was used. The design included three components: abstraction of patient data from the electronic medical record (EMR) (n=79 with VAP and n=79 without VAP), administration of surveys to ICU nurses (N =34), and vignettes related to SVs. Analyses included descriptive statistics, t-tests, correlations, and analyses of covariance. Most nurses held a Bachelors degree (70.6%), had < 9 years of ICU experience (52.9%), worked in a medical ICU (47.1%), and reported high confidence in managing SVs (M =8.88, SD =1.25). The majority of patients (N =158) were Black (58.2%), males (56.3%), and on average middle-aged (M =61.5, SD =14.91), with a long ICU LOS (M =15.5, SD =11.84), extended duration of MV (M =9.5, SD =8.47), and high acuity (APACHE III) (M =70.2, SD =25.42). The nurses’ education, advanced certification, and ICU experience were not associated with the appropriate implementation of SVs in the vignettes. On average nurses’ had low scores on the vignettes (M =6.97, SD =2.21; possible range =0-14). The adherence rate of nurses’ implementation of SVs, determined using EMR data, was also low (M =24%; SD =23%). There were higher rates of SV adherence in patients without VAP (p (p < .01), and a duration of MV < 6 days (p =.04). These findings indicate that even with established protocols, nurses may not consistently implement the evidenced-based interventions that have been shown to prevent nosocomial infections. Future research is needed to improve nursing practice and the quality of care in this patient population.

Discovery of a new host-parasite relationship, <i>Parelaphostrongylus odocoilei</i> in Dalls sheep (<i>Ovis dalli dalli</i>) in the Canadian North, prompted the first investigation of the geographic distribution, pathogenesis, ecology and epidemiology of this parasite, as well as the related protostrongylid <i>Protostrongylus stilesi</i>, at Subarctic latitudes (60-65ºN). All protostrongylid parasites have an indirect life-cycle, where first-stage larvae are shed in the feces of a mammalian definitive host, penetrate the foot of a gastropod intermediate host, and develop to infective third-stage larvae. <p> Protostrongylid larvae were recovered from over 2000 fecal samples from thinhorn sheep (<i>Ovis dalli</i>) and other hosts for <i>P. odocoilei</i> and <i>P. stilesi</i> across northwestern North America (38-69 ºN). Through novel application of molecular techniques to identify morphologically indistinguishable first-stage larvae, new records for <i>P. odocoilei</i> were established at 20 locations. This provided insight into the historical origins and biogeography of this new host-parasite relationship, and greatly expanded the known geographic range of both protostrongylids. <p> Clinical effects, including a neurological syndrome, were described in five thinhorn sheep experimentally infected with <i>P. odocoilei</i>. Neural and respiratory pathology in these five sheep were compared with over 50 wild Dalls sheep from a population naturally infected with <i>P. odocoilei</i> and <i>P. stilesi</i>. In the end stages, diffuse verminous interstitial pneumonia associated with P. odocoilei led to respiratory failure, and may have acted as a predisposing factor for bacterial pneumonia, which caused sporadic mortalities in this wild population. <p> At Subarctic latitudes, seasonal patterns in host and parasite availability, including larval shedding by Dalls sheep and larval development in experimentally infected gastropods, suggested that lambs become infected with <i>P. odocoilei</i> in a narrow seasonal window in their first fall on winter range. In combination with laboratory experiments, a degree day model for temperature-dependent larval development was developed, validated, and applied to describe and predict the effects of climate warming on protostrongylid parasites of thinhorn sheep in northern North America. In a future of climate warming, the narrow seasonal window for parasite development and transmission would be significantly extended, leading to amplification of populations of <i>P. odocoilei</i> and <i>P. stilesi</i> in endemic regions, and possibly range expansion of <i>P. odocoilei</i>. This may have consequences for the health of thinhorn sheep, as well as other wildlife that are important resources in the Canadian North.