ABSTRACT Background Calprotectin is a protein found in the cytoplasm of neutrophile granulocytes. In the course of inflammatory bowel disease (IBD), calprotectin is released during chronic inflammation in the gut. Activation of neutrophils during the inflammation is followed by activation and secretion of pro-inflammatory molecules such as calprotectin. Calprotectin is stable in stool up to 7 days and can therefore be used as a non-invasive marker for diagnosis, treatment and measurement of the disease activity in patients with IBD. The most common method for analysis of calprotectin concentration is ELISA. This method is time-consuming and many manufactures have therefore developed rapid tests as a faster alternative for quantification of calprotectin in stool. Aim The aim of the study was to evaluate one ELISA and one rapid test from the same manufacture compare the data with the existing ELISA-method used in the laboratory for routine analysis. Methods A rapid test (CalFast) and an ELISA method (CalPrest) from Eurospital, were used for analysis of calprotectin in stool. These two methods were compared with known concentrations of calprotectin obtained by the ELISA method from Bühlmann used in the routine work.  Results The results showed poor correlation between the rapid test and the ELISA method. Furthermore, the comparison between the two ELISA-methods showed a poor correlation. Conclusion Evaluation of the two new methods showed poor correlation with the existing ELISA method from Bühlmann. Evaluation of the rapid test did not show any correlation with the two ELISA methods and the data cannot be trusted. It is difficult to conclude which of the two ELISA methods gives accurate results due to the absence of an international standard.

Background Calprotectin is a protein expressed in the cytoplasm inside the neutrophile granulocytes. During inflammatory bowel disease (IBD), the neutrophile granulocytes are involved in a complex interaction at the inflammatory area where they die and release their content into the intestinal lumen. Therefore, calprotectin in stool is a suitable marker for diagnosis and measurement of the disease-activity in patients with IBD. The most commonly used method to detect calprotectin in stool is ELISA, but the process of manual preparation of stool samples is time-consuming. Aim The objective of the study was to evaluate an extraction method that could replace manual preparation of fecal samples and to compare different methods for measuring Calprotectin in stool using two ELISA-methods from two manufacturers and one rapidtest. Methods For extraction of calprotectin from stool samples we used sample collector tubes from Epitope Diagnostics and fecal preparation kits from Roche. Two different ELISA-kits for measuring calprotectin concentration in stool were compared. Measurements of calprotectin with rapid-test from Epitope Diagnostics were also performed and were compared with the two ELISA kits. Results The results indicate a poor correlation between two extraction methods with Sample Collector Tube and Roche preparation kit. The comparison between the two ELISA-kits showed poor correlation. Evaluation of rapid test showed 33% false negative results with a cut-off value at 50 mg/kg. Conclusion Evaluation of products from Epitope Diagnostics showed poor correlation with the Bühlmann ELISA and an unreliable rapid test. Therefore, none of evaluated products from Epitope Diagnostics is accurate enough to be used for clinical diagnosis in the laboratory.

This dissertation sought to evaluate the efficacy of brief, HIV risk-reduction counseling (versus information only) among subgroups of substance abuse treatment clients by conducting a series of post-hoc analyses of data that were collected from the CTN 0032 trial. It was hypothesized that HIV risk-reduction counseling would be associated with decreased sexual risk behaviors in several subgroups as determined by baseline characteristics. Findings of this dissertation suggest that brief, HIV risk-reduction counseling delivered in conjunction with rapid HIV testing is not efficacious in reducing number of risky sex acts among subgroups of substance abuse treatment clients. Findings suggest that brief, HIV risk-reduction counseling may be efficacious in reducing total number of sex partners among some subgroups. Findings will potentially inform the national HIV prevention agenda by helping to determine whether the current CDC recommendation on HIV testing should be applied broadly versus to specific target groups and, therefore, determine whether monetary resources for risk-reduction counseling should be allocated to specific target groups.

Made available in DSpace on 2015-06-24T12:29:06Z (GMT). No. of bitstreams: 2 priscilla_valente_iff_mest_2014.pdf: 843517 bytes, checksum: 5d0b8b8c520f337225a522fe642dbd04 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil. / Introdução: A evolução da epidemia de AIDS no Brasil, afeta cada vez mais as mulheres. Uma parcela considerável dos diagnósticos na população feminina ocorre durante o período gestacional. Segundo as recomendações do Ministério da Saúde (MS) a triagem sorológica para o vírus, no primeiro e no terceiro trimestres de gestação, é preconizada a todas as gestantes. A indicação a realização do teste rápido para HIV no momento do parto é restrito a situações especificas. Objetivos: Analisar a utilização do teste rápido para diagnóstico do HIV em gestantes em maternidades vinculadas ao SUS no município do Rio de Janeiro. Estimar o perfil sóciodemográfico e a proporção de gestantes que realizaram o teste rápido em maternidades do RJ. Comparar a prática observada no estudo com as diretrizes do MS para a realização do teste rápido de HIV em gestantes. Estimar o tempo que poderia ser evitado na realização do teste rápido de HIV desnecessário em maternidades do município do Rio de Janeio. Metodologia: Estudo transversal realizado em quatro maternidades, entre julho e dezembro de 2013 analisando a utilização do teste numa amostra de 384 gestantes. Após coleta das informações foi realizada a classificação das gestantes em grupos, baseada nas recomendações do MS para a realização do TR para HIV no momento do parto. O primeiro grupo foi considerado referência e foi formado por gestantes que realizaram o teste com indicação do MS. Todos os outros três grupos incluíram mulheres sem indicação de realizar o exame. Resultados: No total, 351 mulheres (91,4%) entrevistadas realizaram pré-natal dentre essas, 297 (84,6%) mulheres realizaram a sorologia para HIV na gestação. Somente 93 (31,3%) gestantes realizaram sorologia para HIV no primeiro e no terceiro trimestre de gestação. 54 (15,4%) mulheres que realizaram o pré-natal não foram testadas para HIV. Foram classificadas no grupo 1, 14,6% (n=56) do total de participantes do estudo. Foram incluídas nos demais grupos 85,4% das participantes, sendo 12,2% (n=47) no grupo 2, 70,3% (n=270) no grupo 3A e 2,9% (n=11) no grupo 3B. Os resultados encontrados indicam uma sobre-utilização dos testes rápidos nas maternidades públicas do município do Rio de Janeiro. O TR para HIV realizado nas maternidades é uma ótima alternativa para prevenir a transmissão vertical do vírus para o recém-nascido, entretanto esta prática deve ser utilizada quando indicada. / Introduction: The evolution of the SIDA epidemic in Brazil, affects women increasingly. A considerable number of diagnoses in the female population occur during pregnancy. According to the recommendations of the Ministry of Health (MS), serological screening for the virus in the first and third trimesters of pregnancy is recommended to all pregnant women. The indication to the rapid testing for HIV at birth is restricted to specific situations. Objectives: Analyze the use of rapid test for diagnosis of HIV in pregnant women in maternity hospitals of the Unified Health System in the city of Rio de Janeiro. Estimate the socio-demographic profile and the proportion of these women. Compare the practice observed in the study with the guidelines of the Ministry of Health. Estimate the time that could be avoided in the rapid testing of HIV unnecessary in hospitals in the city of Rio de Janeiro. Methods: Cross-sectional study in four hospitals between July and December 2013, which included the calculation of avoidable time in conducting this examination in pregnant women who have no indication to perform it according to the guidelines of the MS. The study included 384 pregnant women. After collecting the information, classification of pregnant women was carried into categories, based on the recommendations of MS for the rapid test for HIV at birth. The first group was considered reference and was formed by pregnant women who took the test with indication of MS. All the other three groups included women with no indication of the exam. Results: In total, 351 women (91.4%) interviewed had received prenatal care. 297 women underwent HIV testing during pregnancy. Only 31.3% (n = 93) of pregnant women received HIV testing in the first and third trimester of pregnancy. 54 (15,4%) women who underwent prenatal care were not tested for HIV. Were classified in group 01, 14.6% (n = 56) of the total study participants. 85.4% of participants were included in the other groups, with 12.2% (n = 47) in group 02, 70.3% (n = 270) in 3A and 2.9% (n = 11) in group 3B. The results indicate an over-use of rapid tests in public hospitals in the city of Rio de Janeiro. The rapid test for HIV performed in hospitals is a great alternative to prevent vertical transmission of the virus to the newborn, but this practice should be used when indicated.

Introdução: A malária humana apresenta sintomas inespecíficos e exige diagnóstico laboratorial e identificação da espécie para o seu manejo. O diagnóstico baseia-se na microscopia, exame barato, que exige profissionais experientes. Nos últimos anos surgiram testes imunocromatográficos de execução rápida e custo mais elevado em comparação à microscopia. Estudos de validação demonstraram sensibilidade e especificidade comparáveis à microscopia, podendo ser alternativa confiável em áreas sem laboratório. Objetivo: Realizar análise de custo-efetividade do uso do OptiMAL® - teste rápido (TR) registrado no Brasil e validado em áreas endêmicas - comparado à microscopia. Métodos: A perspectiva da análise foi a do sistema público de saúde brasileiro SUS, o horizonte analítico de seis meses e o ano de 2006, a referência temporal. Doze municípios do Estado do Pará constituíram a área de estudo. Foi construído modelo de decisão considerando dois desfechos: casos diagnosticados adequadamente e casos conduzidos adequadamente em três cenários: o cenário 1 corresponde a 100% dos exames realizados, o cenário 2 considera somente os exames feitos nas áreas com laboratório e o cenário 3 corresponde a 30% dos exames, realizados em áreas isoladas. Os parâmetros epidemiológicos principais foram prevalência da malária entre indivíduos sintomáticos e acurácia - sensibilidade e especificidade - dos métodos diagnósticos, cujas estimativas foram obtidas a partir do Sistema de Informação de Vigilância Epidemiológica da Malária e literatura científica. Foram estimados custos diretos médicos e não-médicos, considerando diretrizes nacionais e dados municipais. Fontes de dados de custos incluíram o Sistema de Informação de Insumos Estratégicos, a Tabela de Procedimentos do SUS e o Sistema de Informação Hospitalar do SUS. Foram estimadas as razões média e adicional de custo-efetividade (RCEA) e realizada análise de sensibilidade. O software utilizado foi o TreeAge Pro 2005. Resultados: O TR foi dominado pela microscopia nos cenários 1 e 2. Em áreas isoladas a estratégia microscopia apresentou RCEA de R$1.193,00 por caso diagnosticado adequadamente e de R$1.016,67 por caso conduzido adequadamente quando comparada com o OptiMAL®. O TR tornou-se mais custo-efetivo nos dois desfechos dos três cenários com a redução da acurácia da gota espessa, na análise de sensibilidade. Conclusões: o TR foi menos custo-efetivo em todos os cenários, quando a acurácia da microscopia manteve-se elevada. / Introduction: Diagnosis of malaria is based on blood microscopy, a lowcost procedure that requires experienced technicians. Rapid immunochromatography tests (RDT) were developed with the advantage of being easy-to-use tools but with higher costs. RDT validation showed similar accuracy compared to microscopy suggesting that the RDT could be a reliable alternative in areas without lab facilities. Objective: To perform costeffectiveness analysis for the use of OptiMAL® in comparison with the thick blood smear microscopy. Methods: The study was conducted from the perspective of the Brazilian Public Health System, the analytic horizon was of six months, and the time frame was 2006. The analysis was performed through a decision tree with two outcomes: properly diagnosed cases and properly conducted cases. There were defined three scenarios in 12 municipalities of the State of Pará: the scenario 1 considered the whole malaria tests performed in 2006; the scenario 2 considered the malaria tests performed in the endemic areas with access to lab facilities; and the scenario 3 considered the 30% malaria tests performed in areas without lab facilities. The main epidemiological measures were the prevalence of malaria and the accuracy of the diagnostic methods. Epidemiological estimates were obtained from the Brazilian Malaria Surveillance Information System and the scientific literature. Direct medical and non-medical costs were estimated taking into consideration the national guidelines and the data obtained from the municipalities. Cost data sources were the Information System for Strategic Resources from the Health Surveillance Secretariat, the Reimbursement Values Table and the Hospital Information System of the Brazilian Public Health System. The average and the incremental costeffectiveness ratio (ICER) were estimated and it was conducted a sensitivity analysis. Data were analyzed with the TreeAge Pro 2005 software. Results: RDT strategy was dominated by the microscopy strategy in the scenarios 1 and 2. The ICER for the microscopy strategy in the scenario 3 was R$1,193.00 per properly diagnosed case and it was R$1,016.67 per properly conducted case compared with the OptiMAL® strategy. The sensitivity analysis showed that the RDT was cost-effective for both outcomes in all the scenarios when the thick blood smear accuracy was reduced. Conclusions: The RDT is the least cost effective strategy, providing that microscopy accuracy is high.

Antimicrobial resistance is mainly caused by inappropriate and abundant use of antibiotics. To enlighten the most relevant problematic areas in antibiotic use, where the decisions should be made, the different levels were analysed in this study: the self-medication with antibiotics of the population, ambulatory and also hospital antibiotic use. The results showed that wrong perception about antibiotics is characteristic to Lithuanian population, as there is lack of privity, while traditions of self-medication and also habits to apply the previous experience, when doctor prescribed antibiotics, are entrenched. As the ambulatory care covers the most of the population, the most antibiotics are consumed in this level. However often they are prescribed irrationally for non-bacterial infections just on the basis of clinical symptoms. The antibiotic prescribing for one of the most frequent infection acute pharyngitis / tonsillitis might be improved by implementation of rapid antigen detection tests. The extent of antibiotic consumption in nursing hospitals is low, but it is uncontrolled. Therefore the development of correct population approach, education of health care professionals, implementation of diagnostic tools, antibiotic sales‘ control, guidelines for diagnostics and treatment, approvement of antibiotic prescribing procedures – all those items would promote rational antibiotic use. / Pagrindinė mikrobų atsparumo antibiotikams priežastis – neteisingas ir gausus jų vartojimas. Siekiant išsiaiškinti problemiškiausias antibiotikų vartojimo sritis, kur būtini sprendimai, šiame darbe kompleksiškai ištirtas antibiotikų vartojimas įvairiose gyventojų grupėse, ambulatorinėje ir stacionarinėje (slaugos ligoninėse) grandyse. Rezultatai parodė, jog Lietuvos gyventojams būdingas klaidingas supratimas apie antibiotikus, kadangi stinga informacijos apie šiuos vaistus, įsigalėjusios tradicijos patiems gydytis vaistais, taip pat įpročiai remtis buvusia patirtimi, kai gydytojas skyrė antibiotikų. Kadangi ambulatorinė grandis aptarnauja didžiausią populiacijos dalį, joje ir antibiotikų vartojama daugiausia, tuo pačiu jų gausiai neteisingai skiriama nebakterinės kilmės infekcijoms gydyti, kai remiamasi vien klinikiniais požymiais. Vienos iš dažniausių infekcijų – ūminio faringito / tonzilito gydymas būtų veiksmingesnis, jei optimizuojant antibiotikų skyrimą būtų atliekami greitieji A grupės beta hemolizinio streptokoko testai. Slaugos ligoninėse suvartojama antibiotikų nedaug, bet tai nėra kontroliuojama. Todėl itin svarbu gyventojų požiūrio formavimas, medikų mokymas, diagnostikos priemonių diegimas, antibiotikų pardavimo kontrolė, gydymo rekomendacijų ir antibakterinių vaistų skyrimo taisyklių tvirtinimas. Visa tai skatintų teisingą antibiotikų vartojimą.

External sulphate attack on concrete can lead to cracking, expansion and sometimes loss of cohesiveness of hardened cement paste. Therefore, aside from using sulphate resistant cementitious binders, it is important to design concrete which can resist sulphate penetration. In this research, both ASTM C1202 and NT Build 492 electrical migration tests were modified such that sulphate rather than chloride penetration resistances were measured. Modifications included exposing concrete specimens to Na2SO4 rather than NaCl solutions and measuring the depth of sulphate penetration visually using BaCl2+KMnO4 rather than AgNO3 solution. Nine concrete mixtures of varying w/cm, slag replacement and cement types were tested in both original standard tests and modified tests to evaluate the influence of these material variables on test results and compare chloride to sulphate results. It was found that while migration coefficients and total charge passing were lower for sulphate, the influence of material variables were relatively similar.

External sulphate attack on concrete can lead to cracking, expansion and sometimes loss of cohesiveness of hardened cement paste. Therefore, aside from using sulphate resistant cementitious binders, it is important to design concrete which can resist sulphate penetration. In this research, both ASTM C1202 and NT Build 492 electrical migration tests were modified such that sulphate rather than chloride penetration resistances were measured. Modifications included exposing concrete specimens to Na2SO4 rather than NaCl solutions and measuring the depth of sulphate penetration visually using BaCl2+KMnO4 rather than AgNO3 solution. Nine concrete mixtures of varying w/cm, slag replacement and cement types were tested in both original standard tests and modified tests to evaluate the influence of these material variables on test results and compare chloride to sulphate results. It was found that while migration coefficients and total charge passing were lower for sulphate, the influence of material variables were relatively similar.

Orientador:Caris Maroni Nunes / Co-orientador:David Anthony Orin Courtenay / Banca:Márcia Dalastra Laurenti / Banca:Mary Marcondes / Resumo:As estratégias de controle da leishmaniose visceral (LV) no Brasil estão baseadas no diagnóstico e tratamento precoce de casos humanos, no controle dos vetores, através do uso de inseticidas e na triagem sorológica com posterior eutanásia de cães positivos para leishmaniose. Assim, o diagnóstico da leishmaniose visceral canina (LVC) deve ser capaz de identificar adequadamente o reservatório canino, garantindo a eficiência desta medida de controle. Considerando-se que a resposta imune humoral desenvolvida por cães à infecção natural por Leishmania spp. é dependente da carga parasitária, o objetivo desta pesquisa foi avaliar se o resultado dos testes diagnósticos atualmente utilizados em inquéritos soro epidemiológicos no Brasil (teste rápido-DPP BioManguinhos® e teste ELISA indireto EIE-ELISA BioManguinhos®) apresentam relação com a carga parasitária do sangue de cães. Para tal foram avaliadas amostras de 610 cães da região noroeste do Estado de São Paulo a qual é endêmica para LV. A positividade variou de 15,9 a 68.4% acordo com as técnicas utilizadas, devido às diferenças na sensibilidade e especificidade dos testes. De modo geral, cães sorologicamente positivos apresentaram carga parasitária média maior que a dos cães negativos. Entretanto, a avaliação do potencial de transmissão dos cães sorologicamente negativos faz-se necessária / Abstract:Visceral leishmaniasis (VL) control strategies in Brazil are based on the early detection and treatment of the patients, vector control by insecticide and the serological screening and euthanasia of positive dogs. Thus, canine visceral leishmaniasis (CVL) diagnosis must accurately identify canine reservoir hosts to ensure the efficiency of screening. Considering that the humoral immune response of dogs to natural Leishmania spp. infection is dependent on parasite load, our aim was to evaluate if outcomes of the diagnostic kits currently used in canine seroepidemiological surveys in Brazil (DPP-BioManguinhos™ rapid test and EIA-ELISA Indirect ELISA BioManguinhos™) could be related to the blood parasite loads in dogs. Six hundred and 10 dogs from the VL endemic region of Northwest São Paulo State were sampled for this evaluation. Positivity varied from 15.9 to 68.4% between diagnostic techniques, due to differences in test sensitivity and specificity. Overall, positive dogs had higher mean parasite loads than negative dogs. Nevertheless, the potential of transmission of the negative dogs shall be investigated / Mestre

Made available in DSpace on 2015-10-06T13:02:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-07-17. Added 1 bitstream(s) on 2015-10-06T13:19:32Z : No. of bitstreams: 1 000849010.pdf: 646917 bytes, checksum: 6ff31432c39a9bdc92b648de138b7639 (MD5) / Visceral leishmaniasis (VL) control strategies in Brazil are based on the early detection and treatment of the patients, vector control by insecticide and the serological screening and euthanasia of positive dogs. Thus, canine visceral leishmaniasis (CVL) diagnosis must accurately identify canine reservoir hosts to ensure the efficiency of screening. Considering that the humoral immune response of dogs to natural Leishmania spp. infection is dependent on parasite load, our aim was to evaluate if outcomes of the diagnostic kits currently used in canine seroepidemiological surveys in Brazil (DPP-BioManguinhos™ rapid test and EIA-ELISA Indirect ELISA BioManguinhos™) could be related to the blood parasite loads in dogs. Six hundred and 10 dogs from the VL endemic region of Northwest São Paulo State were sampled for this evaluation. Positivity varied from 15.9 to 68.4% between diagnostic techniques, due to differences in test sensitivity and specificity. Overall, positive dogs had higher mean parasite loads than negative dogs. Nevertheless, the potential of transmission of the negative dogs shall be investigated