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published_or_final_version / Medicine / Master / Master of Public Health

Nasal AEC cultures were established from children (0.6-14.9 years) undergoing elective surgical procedures under general anaesthetic, categorised as atopic asthmatics (n=12), virus-induced wheezers (n=8) or healthy controls (n=32) using questionnaire and serum IgE levels. All subjects were free of current respiratory symptoms. Successful AEC cultures were maintained to passage 2 or 41 (79%) subjects. AEC from children with a history of wheeze produced significantly less IL-8, IL-6, MCP-1 and G-CSF than AEC from healthy controls. When the wheezing phenotypes were considered separately, AEC from atopic asthmatic children released significantly less IL-8, IL-6, MCP-1 and G-CSF than AEC from controls but there were no significant differences between AEC mediator release from children with virus-induced wheeze and either atopic asthmatics or controls. Similar results were found for cytokine-stimulated AEC. In non-wheezy subjects, there were no differences in AEC mediator release between atopic and non-atopic individuals. There were no differences between the study groups in the percentage increments in mediator release in response to stimulation. In multivariate analysis, taking into account age, gender, passive smoke exposure, use of inhaled corticosteroids, total serum IgE and specific responses to inhaled aeroallergens as possible confounders, wheeze was the only significant predictor of AEC mediator release. It was concluded that there are intrinsic differences in AEC from children with a history of wheeze compared to healthy controls and these are independent of atopic status. This study provides further evidence that the airway epithelium is implicated in the pathogenesis of childhood wheezing. It is hypothesised that different systemic factors, such as atopy and viral responsiveness, interact with common epithelial abnormalities to give rise to different wheezing phenotypes. Further work is required to establish whether these abnormalities are primary or secondary and to confirm these findings in well-differentiated AEC cultured with an air-liquid interface.

M.Cur. / The South African Nursing Act (Act 50 of 1978) views the professional nurse as an independent practitioner, her independent function being the right to make decisions and taking the full responsibility for such liability. The professional nurse's liability depends on her authority, skills and responsibilities. Her role in the intensive care unit is aimed at optimal care of the ventilated patient, thus providing physical, psychological and spiritual well-being. The incidence of micro-organism colonization in the lower airway of the ventilated patient is researched in this study and nursing guide-lines are set out for the correct use of the ventilator. A contextual, descriptive study was carried out to: (a) determine the sterility of the humidifier reservoir and ventilator tubes; (b) determine which micro-organisms are present in the lower airways of patients after they have been ventilated; (c) set out guide-lines for the nursing staff on how to correctly use the ventilator. Sample analysis was done from the following: The sterile water in the reservoir prior to ventilation. Sputum obtained prior to extubation. Water from the reservoir after extubation (waterbasin of the humidifier). The water present in the ventilator tubes after extubation. The following conclusions were made: contamination is caused by the nursing staff; there was no migration of micro-organisms from the water reservoir to the circuit; the organisms in the ventilator circuit differed from those found in the lower airways of the patient...

As infecções respiratórias agudas (IRA) são as doenças infecciosas mais frequentes em seres humanos e os vírus respiratórios são os agentes de maior ocorrência na etiologia das mesmas. Os coronavírus humanos (HCoVs) são reconhecidos como causa comum de infecções do trato respiratório superior e, menos comumente, do trato respiratório inferior. Dados da ocorrência do HCoV na população brasileira são escassos. O presente estudo tem por objetivo avaliar a ocorrência de HCoV em crianças acometidas por IRA atendidas no Hospital Universitário da Universidade de São Paulo , São Paulo-SP, entre o período de 1995 a 2008. Amostras em cDNA foram utilizadas em ensaio de PCR em Tempo Real para detecção dos 4 tipos de coronavírus. Amostras positivas foram utilizadas em ensaio de PCR convencional e posteriormente tipificadas por sequenciamento. Amostras negativas pelo método de PCR convencional foram tipificadas através de PCR em Tempo Real e Nested PCR específico para cada tipo de HCoV. Quatrocentos e dez amostras foram positivas pelo ensaio de PCR Real Time, sendo o coronavírus detectado em 8.94% das amostras. Duzentos e noventa e oito amostras foram tipificadas, sendo o tipo OC43 o de maior ocorrência, seguido pelos tipos NL63; HKU1 e 229E. / Acute respiratory infections (ARI) are the most common infectious diseases in humans and respiratory viruses are the most frequent agents in the etiology of the same. The human coronaviruses (HCoVs) are recognized as a common cause of upper respiratory tract infections and, less commonly, lower respiratory tract. Data from the occurrence of HCoV in the Brazilian population are scarce, despite the high incidence of respiratory infections during the winter. This study aims to evaluate the occurrence of HCoV in children affected by acute respiratory infections treated at University Hospital of São Paulo (USP), São Paulo-SP, between the periods 1995 to 2008. Samples of cDNA were screened by Real Time PCR for detection of the four types of coronavirus. Positive samples were used in standard PCR assay and subsequently typed by sequencing. Samples positive by Real Time but negative by standard PCR assay were typed by specific Nested PCR and Real-Time for each type of HCoV. Four hundred and ten samples were positive by Real Time PCR assay, and the occurrence of coronaviruses in our samples of 8.94%. Two hundred and ninety eight were typed, the type OC43 being the most frequent, followed by the recently discovered types, NL63 ; HKU1 and HCoV-229E.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / As infecÃÃes respiratÃrias agudas (IRA) sÃo importantes causas de morbidade e mortalidade em todo o mundo, acometendo principalmente crianÃas menores de cinco anos de idade. Essas infecÃÃes podem ser causadas por diferentes microrganismos, porÃm os vÃrus sÃo os mais frequentes. Esse estudo teve como objetivo descrever aspectos clÃnicos e epidemiolÃgicos de IRA de etiologia viral em crianÃas de zero a 12 anos de idade atendidas em serviÃo de emergÃncia de um hospital terciÃrio da cidade de Fortaleza-CE, no perÃodo de janeiro de 2007 a dezembro de 2008. Para tanto foram coletadas 1318 amostras de secreÃÃo de nasofaringe das crianÃas. As amostras foram submetidas à tÃcnica de imunofluorescÃncia indireta para detecÃÃo dos seguintes vÃrus respiratÃrios: vÃrus sincicial respiratÃrio (VSR), metapneumovÃrus humano (MPVh), adenovÃrus, influenza A e B e parainfluenza 1, 2 e 3. Os resultados desse estudo mostraram que pelo menos um vÃrus respiratÃrio foi detectado em 383 (29,1%) amostras. O vÃrus mais prevalente foi o VSR (44,4%), tendo o mesmo apresentado um padrÃo de sazonalidade definido, com associaÃÃo a estaÃÃo chuvosa. A co-infecÃÃo ocorreu em 12 (3,1%) amostras e o VSR foi o mais frequentemente associado. A mÃdia de idade dos pacientes foi de 23 meses e nÃo houve associaÃÃo entre o gÃnero desses pacientes e a positividade dos exames, apesar da maioria das crianÃas serem do sexo masculino. Entre os diagnÃsticos clÃnicos de etiologia viral, houve predomÃnio de infecÃÃo da via aÃrea superior (IVAS) (51,2%), e em relaÃÃo ao diagnÃstico especÃfico das infecÃÃes da via aÃrea inferior (IVAI), destacou-se a pneumonia. Portanto, os resultados desse estudo ressaltam a importÃncia dos vÃrus como causadores de IRA em crianÃas na cidade de Fortaleza, com as maiores taxas ocorrendo entre os meses de marÃo a junho, diferenciando-se da regiÃo Sul do paÃs, onde as maiores taxas sÃo encontradas nos meses de julho a outubro. / Acute respiratory infections (ARI) are important causes of morbidity and mortality worldwide, affecting mainly children under five years old. These infections can be caused by different organisms, but viruses are the most frequent. This study aimed to describe clinical and epidemiological aspects of viral ARI in children 0-12 years of age treated in the emergency department of a tertiary hospital in the city of Fortaleza, from January 2007 to December 2008. Therefore, we collected 1318 samples of nasopharyngeal secretions of children. The samples were subjected to indirect immunofluorescence for detection of the following respiratory viruses: respiratory syncytial virus (RSV), human metapneumovirus (hMPV), adenovirus, influenza A and B and parainfluenza 1, 2 and 3. The results of this study showed that at least one respiratory virus was detected in 383 (29.1%) samples. The most prevalent virus was RSV (44.4%), and presented the same seasonal pattern of a defined association with the rainy season. Co-infection occurred in 12 (3.1%) samples and RSV was the most frequently associated. The average age of patients was 23 months and there was no association between gender of these patients and positivity of the tests, although most children were male. Among the clinical diagnoses of viral etiology, there was predominance of upper respiratory infection diseases (URID) (51.2%), and in relation to the specific diagnosis of the lower respiratory infections diseases (LRID), stood out pneumonia. Therefore, the results of this study highlight the importance of viruses as causes of ARI in children in Fortaleza, with the highest rates occurring between the months March to June, differing from the southern region, where the highest rates are found in the months from July to October.

Thesis (M.P.H.)--Oregon State University, 2008. / Printout. Includes bibliographical references. Also available on the World Wide Web.

Objective: Acute lower respiratory infection (ALRI) is the leading cause of mortality in pediatric group all around the world. Vitamin D has been demonstrated to play a possible role in the prevention of ALRI in children because of its physiological importance in the immune system. This systematic review aims to explore the protective role of vitamin D on ALRIs among children and its preventive effectiveness by synthesizing RCTs. And the other objective is to determine dosage of vitamin D with the best effect by investigating the association of different level of vitamin D supplementation with risk of ALRIs. Methods: Studies were searched through three databases PubMed, ISI Web of Knowledge and Cochran Central Register of Controlled Trials and Cochran Library databases among publication from April2003 to April 2013 with a combination of key terms. Inclusion and exclusion criteria were used to select studies. And then CONSORT guideline and JADAD scale were used to assess quality of these studies. Data on outcome measurements including health outcomes (e.g. incidence of pneumonia and influenza A, duration of recovery of pneumonia and bronchiolitis, the risk of relapse of pneumonia, the number of parent-reported ARIs); and surrogate outcomes (e.g. measuring scores of ATAQ test) were extracted and tabulated. The association with vitamin D level of risk of ALRIs were explored as well. Results: Eight RCTs were found to be relevant and adopted in this systematic review of the 796 identified articles in English or Chinese. The findings were mixed, but most studies suggested vitamin D supplementation reduced risk or illness duration of ALRIs significantly among children with different levels of vitamin D deficiency. Four studies suggested statistically significant risk reduction on incidence of repeat pneumonia (by29%, 95%CI 6% to 46%), parent-reported ARIs (by 48%, 95%CI 11% to 69), influenza A (by 42%, 95%CI 1% to 66%), and asthma exacerbation triggered by ALRIs (P= 0.029), while one study showed an insignificant outcome. For recovery events and hospitalization of ALRIs, three studies suggested statistically significant reduction on recovery time from pneumonia (P= 0.008), severe asthma (P= 0.004) and bronchiolitis (P< 0.05), and two studies suggested significant decrease on duration of hospitalization for bronchiolitis (P< 0.05) and pneumonia (P= 0.005). The increasing changes in serum 25(OH)D were consistent with the significant difference of ALRIs events between intervention and control groups. Conclusion: Overall, the evidence is insufficient to conclude that vitamin D supplementation is beneficial to all kinds of children in preventing or assistant treating ALRIs. More number of high quality, large scale and unbiased RCTs should be conducted to confirm the effectiveness of vitamin D among children in Hong Kong and different areas in mainland China. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Respiratory tract infection is one of the major diseases to cause morbidity and mortality worldwide. Undiagnosed respiratory infection remains unclear. Picornavirus is most common to cause respiratory infection after the influenza virus and RSV. There were numerous notorious pathogens in the Picornaviridae family, for instance, human parechovirus and Saffold virus. These emerging and novel viruses are reported sporadically in respiratory infection and amongst children in particular. This study is aimed to assess the potential role of HPeV and SAFV in respiratory infection in Hong Kong. Methods: Between May 2013 and April 2014, nasopharyngeal aspirates (NPA) were collected from hospitalized patients who have respiratory infection. The collected samples were tested negative for respiratory syncytial virus, adenovirus, influenza A and B viruses, parainfluenza viruses types 1, 2 and 3 by direct immunofluorescence. RT-PCR was used to target the HPeV and SAFV corresponding region of 5'UTR and analyze by the BioEdit sequence Alignment Editor and Basic Local Alignment Search Tool. Results: 597 female and 603 male were included in 1200 NPA samples. 20% of these samples were under the age of 5. However, there were no HPeV and SAFV detected in all 1200 NPA samples. Conclusion: To reveal the possible association between viruses and respiratory infection, the sampling size and district area should be expanded. The single detection method may not be able to detect all the viruses in the current study. / published_or_final_version / Microbiology / Master / Master of Medical Sciences

Thesis (M. P. H.)--University of Hong Kong, 2007.