One of Africa’s neglected tropical diseases, African Trypanosomiasis, is not only fatal but also has a crippling impact on economic development. Heat shock proteins play a wide range of roles in the cell and they are required to assist the parasite as it moves from a cold blooded insect vector to a warm blooded mammalian host. The expression of heat shock proteins increases during these heat shock conditions, and this is considered to play a role in differentiation of these vector-borne parasites. Heat shock protein 70 (Hsp70) is an important molecular chaperone that is involved in protein homeostasis, Hsp40 acts as a co-chaperone and stimulates its intrinsically weak ATPase activity. In silico analysis of the T. brucei genome has revealed the existence of 12 Hsp70 proteins and 65 Hsp40 proteins to date. A novel Hsp70, TbHsp70.c, was recently identified in T. brucei. Different from the prototypical Hsp70, TbHsp70.c contains an acidic substrate binding domain and lacks the C-terminal EEVD motif. By implication the substrate range and mechanism by which the substrates are recognized may be novel. The ability of a Type I Hsp40, Tbj2, to function as a co-chaperone of TbHsp70.c was investigated. The main objective of this study was to biochemically characterize TbHsp70.c and its partnership with Tbj2 to further enhance our knowledge of parasite biology. TbHsp70.c and Tbj2 were heterologously expressed and purified and both proteins displayed chaperone activities in their ability to suppress aggregation of thermolabile MDH. TbHsp70.c also suppressed aggregation of rhodanese. ATPase assays revealed that the ATPase activity of TbHsp70.c was stimulated by Tbj2. The targeted inhibition of the function of heat shock proteins is emerging as a tool to combat disease. The small molecule modulators quercetin and methylene blue are known to inhibit the ATPase activity of Hsp70. However, methylene blue did not significantly inhibit the ATPase activity of TbHsp70.c; while quercetin, did inhibit the ATPase activity. In vivo heat stress experiments indicated an up-regulation of the expression levels of TbHsp70.c. RNA interference studies showed partial knockdown of TbHsp70.c with no detrimental effect on the parasite. Fluorescence microscopy studies of TbHsp70.c showed a probable cytoplasmic subcellular localization. In this study both TbHsp70.c and Tbj2 demonstrated chaperone activity and Tbj2 possibly functions as a co-chaperone of TbHsp70.c.

Obesity is very widespread and detrimental to health. Obesity brings with it many changes including heightened immune function, and a higher prevalence of major cardiovascular disorders, cancer, diabetes, and Alzheimer disease. Obesity is also associated with shortened lifespan. The detrimental effects of obesity are linked to the "metabolic syndrome", a broad range of changes in metabolic processes and immune function. As a first approximation, we agree with this formulation but we will then proceed to document some of its weaknesses. (i) Crude mortality rates increase with increasing body mass index (BMI) but as the BMI approaches the normal range, mortality rates reverse (the now classic "J-shaped curve") so that individuals with reduced BMI have elevated mortality. (ii) A multiplicity of medical and surgical conditions have been reported where short term and medium term outcomes are better for overweight patients. These conditions are placed under the heading of "obesity paradox". (iii) The medical community has introduced a binary system for the metabolic syndrome ---- yes, patient has it or no, the patient does not have it, despite the fact that all of the changes that are considered components of the metabolic syndrome are continuous variables. Our work is focused on sharpening focus and improving...

Obesity is very widespread and detrimental to health. Obesity brings with it many changes including heightened immune function, and a higher prevalence of major cardiovascular disorders, cancer, diabetes, and Alzheimer disease. Obesity is also associated with shortened lifespan. The detrimental effects of obesity are linked to the "metabolic syndrome", a broad range of changes in metabolic processes and immune function. As a first approximation, we agree with this formulation but we will then proceed to document some of its weaknesses. (i) Crude mortality rates increase with increasing body mass index (BMI) but as the BMI approaches the normal range, mortality rates reverse (the now classic "J-shaped curve") so that individuals with reduced BMI have elevated mortality. (ii) A multiplicity of medical and surgical conditions have been reported where short term and medium term outcomes are better for overweight patients. These conditions are placed under the heading of "obesity paradox". (iii) The medical community has introduced a binary system for the metabolic syndrome ---- yes, patient has it or no, the patient does not have it, despite the fact that all of the changes that are considered components of the metabolic syndrome are continuous variables. Our work is focused on sharpening focus and improving...

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Os tripanosomatídeos inferiores, que infectam plantas e insetos, apresentam propriedades bioquímicas e moleculares similares a Leishmania sp. e Trypanosoma cruzi. Similaridades antigênicas entre estes parasitas são conhecidas à muito tempo, mas somente alguns poucos estudos comparativos sobre a imunorreatividade humoral cruzada foram descritos. No presente trabalho nós analisamos a imunorreatividade cruzada de extratos antigênicos totais de oito tripanosomatídeos inferiores por ELISA, com soros de humanos e cães infectados com T. cruzi e Leishmania sp. Segundo as positividades e dados de reatividade média para ELISA os tripanosomatídeos inferiores foram divididos em dois grupos. ELISA-G1 compreendeu 4 parasitas para os quais se obtiveram 100% de positividade e elevadas médias de absorbância, similar aos dados obtidos para L. chagasi para hospedeiros humanos e cães. Nos casos humanos, soros de pacientes chagásicos crônicos apresentaram 100% de positividade somente para o ELISA com T. cruzi, sem diferenças entre os tripanosomatídeos inferiores. Por outro lado amostras de doenças não relacionadas apresentaram baixa reatividade cruzada com os tripanosomatídeos inferiores. Apesar da sua posição taxonômica em várias sessões e sua antiga divergência estes resultados mostraram semelhança antigênica entre os tripanosomatídeos inferiores e os patogênicos, e podem ser uma fonte alternativa de antígenos para a detecção de anticorpos principalmente em casos de leishmaniose visceral. / \"Lower trypanosomatids\", that infect plant and insect, present biochemical and molecular similarities to Leishmania sp. and Trypanosoma cruzi. Antigenic similarities between those parasites are known for a long time, but only few comparative investigations about immune humoral cross-reaction were described. In the current work we analyze the cross-immunoreactivity of crude extract from eight lower trypanosomatids by ELISA, with human and dog host samples infected with T. cruzi and Leishmania sp. ELISA positivity and data of mean title of human or dog visceral leishmaniasis cases, the lower trypanosomatids were divided in two groups. ELISA-G1 comprised by 4 parasites resulted in 100% positivity and high mean of absorbance, similar data to those obtained with L. chagasi, with human or dog hosts. In human cases, Chagas disease chronic cases showed 100% positive only with ELISA performed with T. cruzi, with no differences among lower trypanosomatids. Otherwise samples with other non correlated disease presented low cross-reaction with lower trypanososmatids. In spite of, their taxonomic position in various sections and their old divergence these results showed a strong antigenic similarity between pathogenic and lower trypanosomatids, and could be an alternative source of antigen for the detection of antibodies against host mainly with visceral leishmaniasis cases.

Made available in DSpace on 2017-07-20T12:40:17Z (GMT). No. of bitstreams: 1 Cleverson Santos.pdf: 2904178 bytes, checksum: 85140c2fc4cb486fe6c03e6a011296a3 (MD5) Previous issue date: 2016-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This thesis describes the preparation, characterization and application of electrochemical sensors and biosensors, using different modification techniques, based on Au as transducer. The enzymatic biosensor applied on the detection of pesticide carbaryl was built on a gold electrode functionalized with a monolayer of polyamidoamine dendrimer of fourth generation with a cystamine core (PAMAM-G4) on which it was immobilized the acetylcholinesterase enzyme (AChE), with the aid of glutaraldehyde. After evaluate and determine the best conditions for immobilization of the AChE enzyme (glutaraldehyde concentration of 1% (v/v) and the concentration of enzyme units 496 U. mL-1) on the monolayer of PAMAM, the catalytic activity of the enzyme was evaluated by chronoamperometry in presence of enzymatic substrate AChI obtaining = 2.9 . −1 . The biosensor response for carbaryl detection was based on the inhibition of the enzymatic activity caused by the pesticide. It was verified that 5 min in the pesticide solution is sufficient to block the enzyme active sites. After determining the best conditions for the construction of the biosensor, it was applied for carbaryl detection in the concentration range from 1.0 to 9.0 mol. L-1. The detection and quantification limits were found to be 0.0108 mol. L-1 and 0.032 mol. L-1, respectively. In the second chapter, it is reported the development of an immunosensor applied to qualitative detection of antibodies (AB) T. cruzi. The sensor was built on gold electrode modified with the thiol 3-mercaptopropionic acid (MPA) and the antigens (AG) T. cruzi were covalently immobilized on this surface by the reaction with EDC and NHS. The influence of concentration and of immersion time in the AG solution were evaluated using the techniques of cyclic voltammetry and electrochemical impedance spectroscopy in presence of [Fe(CN)6]3-/4- and the results showed that the best conditions were immersion time of 15 minutes and AG concentration of 0.5 g. L-1.The possible sites of non-specific binding were blocked with bovine serum albumin (BSA). The immersion time in the solution (AB) was also evaluated and the results showed that 30 minutes are sufficient for all specific bonds sites were occupied by AB T. cruzi. Selectivity tests in the absence of AB, only in the serum sample, and in the presence of AB Toxoplasma were performed. The results demonstrated that the immunosensor is selective, since it presented charge transfer resistance (Rct) values in the presence of AB T. cruzi 70% higher than the Rct values in presence of possible interferences.Therefore, the immunosensor presents itself as an alternative to qualitative diagnosis of american trypanosomiasis. In the third chapter, it is reported the modification of carbon graphite electrodes (CG) obtained from dry batteries zinc/carbon with Au microparticles obtained by potentiostatic electrodeposition. The variables involved in the electrodeposition process, such as the gold salt concentration, time and deposition potential were evaluated and optimized using cyclic voltammetry technique in the presence of redox couple [Fe(CN)6]3-/4-. The best conditions for the Au deposition were electrodeposition time of 700 s, potential of +0.3 V and concentration of 10.0 mmol. L-1. In these conditions, Au spherical particles were obtained with an average size of 420 nm, which were homogeneously deposited on the surface of GC electrode and promoted the increase of the electroactive area (GC electrode showed an area of 0.12 cm2 and GC/Au electrode presented an area of 0.25 cm2). The GC/Au electrode was applied for the separation and quantification of dopamine and uric acid present in a mixture. The voltammetric results showed that the GC/Au sensor is selective, once the potential peak separation between the DA and UA species was 370 mV. The detection and quantification limits were found to be 1.86 mol. L-1 and 6.09 mol. L-1 for dopamine and uric acid 17.5 mol. L-1 and 58.5 mol. L-1, respectively. In the development of the three electrochemical devices gold electrodes were used. From the results obtained for the three developed electrochemical devices it can be concluded that high electric conductivity, chemical stability, biocompatibility, ability to miniaturization in the form of microstructures and ease of functionalization of Au electrodes make them suitable conductive matrixes for construction of electrochemical sensors and particularly biosensors. / Esta tese descreve a preparação, caracterização e aplicação de sensores e biossensores eletroquímicos, utilizando diferentes técnicas de modificação baseadas no Au como transdutor. O biossensor enzimático aplicado na detecção do pesticida carbaril foi construído sobre um eletrodo de ouro funcionalizado com uma monocamada do dendrímero poliamidoamina de quarta geração com núcleo de cistamina (PAMAMG4),sobre o qual foi imobilizada com o auxílio de glutaraldeído a enzima acetilcolinesterase (AChE).Após avaliar e determinar as melhores condições de imobilização da enzima AChE (concentração de GLUT 1% (v/v) e concentração de unidades enzimáticas 496 U. mL-1) sobre a monocamada de PAMAM,a atividade catalítica da enzima AChE imobilizada foi avaliada por cronoamperometria na presença do substrato enzimático (AChI) obtendo-se o = 2,9 . −1. A resposta do biossensor na detecção de carbaril foi baseada na inibição da atividade enzimática causada pelo pesticida. Foi constatado que 5 min de imersão na solução do pesticida foram suficientes para que os sítios ativos da enzima fossem bloqueados. Após determinar as melhores condições de construção do biossensor, este foi aplicado na detecção de carbaril na faixa de 1,0 a 9,0 mol. L-1. Os limites de detecção e quantificação encontrados foram de 0,0108 mol. L-1 e 0,032 mol. L-1, respectivamente. No segundo capítulo é relatado o desenvolvimento de um imunossensor aplicado na detecção qualitativa de anticorpos (AB) T. cruzi. O sensor foi construído sobre eletrodo de ouro modificado com o tiol ácido 3-mercaptopropiônico (MPA) e sobre esta superfície foram imobilizados covalentemente pela reação com EDC e NHS, os antígenos (AG) T. cruzi. A influência da concentração da solução de AG e do tempo de imersão nesta solução para a construção do imunossensor foram avaliadas utilizando as técnicas de voltametria cíclica e espectroscopia de impedância eletroquímica na presença de [Fe(CN)6]3-/4- e os resultados demonstraram que as melhores condições foram: tempo de 15 min e concentração de 0,5 g. L-1. Os possíveis sítios de ligações não específicas foram bloqueados com albumina de soro bovino (BSA). O tempo de imersão na solução de AB também foi avaliado. Os resultados mostraram que 30 min são suficientes para que todos os sítios de ligações específicos fossem ocupados pelos AB T. cruzi. Testes de seletividade na ausência de AB,apenas em amostra de soro e também na presença de AB de Toxoplasma foram realizados. Os resultados demonstraram que o imunossensor é seletivo, pois este apresentou valores de resistência de transferência de carga (Rct) na detecção de AB T. cruzi 70% maiores do que na detecção dos possíveis interferentes. Portanto, o imunossensor apresenta-se como uma alternativa no diagnóstico qualitativo de tripanossomíase americana. No terceiro capítulo é descrito a modificação de eletrodos de carbono grafite (CG) obtidos de pilhas secas de zinco/carbono com micropartículas de Au obtidas pela eletrodeposição potenciostática. As variáveis envolvidas no processo de eletrodeposição, tais como concentração do sal de ouro, potencial e tempo de deposição foram avaliadas e otimizadas utilizando a técnica de voltametria cíclica na presença do par redox [Fe(CN)6]3-/4-. As melhores condições foram: tempo de 700 s, potencial de +0,3 V e concentração de 10,0 mmol. L-1. Nestas condições, foram obtidas partículas de Au esféricas com tamanho médio de 420 nm, as quais se apresentaram homogeneamente dispersas sobre toda a superfície do eletrodo de CG e promoveram o aumento da área eletroativa, (o eletrodo CG apresentou uma área de 0,12 cm2 e o eletrodo CG/Au uma área 0,25 cm2). O desempenho do eletrodo CG/Au foi avaliado na separação e quantificação de dopamina e ácido úrico presentes em uma mistura. Os resultados voltamétricos demonstraram que o sensor CG/Au é seletivo, pois apresentou separação de potencial pico de 370 mV entre as duas espécies. Os limites de detecção e quantificação encontrados foram de 1,86 mol. L-1 e 6,09 mol. L-1 para dopamina, e 17,5 mol. L-1 e 58,5 mol. L-1 para ácido úrico, respectivamente. A partir dos resultados obtidos para os três dispositivos eletroquímicos desenvolvidos pode-se concluir que a elevada condutividade elétrica, estabilidade química, biocompatibilidade, possibilidade de miniaturização na forma de microestruturas e a facilidade de funcionalização dos eletrodos de Au fazem destes matrizes condutoras apropriadas para construção de sensores e particularmente biossensores eletroquímicos.

RESUME<p>La Trypanosomiase Humaine Africaine (THA) appelée également « maladie du sommeil» est une maladie parasitaire provoquée par un protozoaire du genre Trypanosoma dont deux sous-espèces (T. brucei gambiense et T. brucei rhodesiense) sont pathogènes à l’homme. La stratégie de lutte contre cette maladie est essentiellement basée sur le dépistage précoce et le traitement des malades, complété avec le contrôle du vecteur. Cependant, l’utilisation du service de dépistage de la THA par les communautés exposées représente un défi majeur. L’adhésion aux campagnes de dépistage actif avec des équipes mobiles spécialisées était en-dessous de 50% dans certains villages endémiques fin des années nonante. De surcroît, l’utilisation des services de santé fixes en RDC est si faible que ceci compromet le dépistage passif dans les formations sanitaires fixes. Notre hypothèse est que cette faible utilisation des services de santé pourrait elle-même être due à un problème d’acceptabilité du dépistage et traitement de la THA par les communautés vivant dans les zones de transmission de la THA. Tout ceci compromet l’élimination de la THA comme problème de santé publique, un but que s’est fixé la communauté internationale d’ici 2020.<p>Ce travail a comme objectif d’explorer cette dimension socioculturelle de la maladie qui est souvent négligée dans le contrôle de la THA et générer une meilleure connaissance de ces aspects.<p><p>Nous avons réalisé cinq études en total pour adresser la question de la sous-utilisation des services de dépistage et traitement de la THA par les communautés et sa relation avec l’acceptabilité des services. Nous avons d’abord développé une première étude qui évalue les résultats du traitement de la THA en analysant rétrospectivement les données de routine du programme de contrôle de la THA pour l’année 2006 à 2008. Ensuite, nous avons réalisé trois études qualitatives par focus group (groupe focalisé) et entretiens individuels pour documenter la dimension socioculturelle de la lutte contre la THA. D’abord une étude qui a exploré les perceptions sur la THA dans la communauté, suivi par une étude qui explore les perceptions sur le traitement de la THA et une autre qui se concentre sur les pratiques diagnostics des professionnels de santé face à un syndrome neurologique en contexte de ressources limitées. <p><p>Une cinquième étude combine une enquête-ménage avec des focus groups et des entretiens individuels pour explorer les perceptions de la communauté sur la santé en général et les services de santé. <p>Nous avons comparé les obstacles à l’utilisation des services de dépistage et traitement de la THA identifiés dans ce travail avec les messages de sensibilisation sur la THA utilisés au programme de contrôle de la THA en RDC et nous avons développé des recommandations stratégiques.<p><p>L’évaluation des indicateurs de performances sur l’issue de traitement montre que le taux de suivi post-thérapeutique est faible dans son ensemble :25 % pour le premier suivi de six mois et moins d’un pourcent des patients revient pour la dernière visite de contrôle au mois 24. Nous avons aussi observé dans cette étude un taux d’échec au mélarsoprol et à la pentamidine respectivement de 30% et de 22 % au Kasaï Oriental qui sont cependant difficilement interprétables, car le dénominateur est incomplet. Comme très peu de patients reviennent au contrôle post-thérapeutique, cette proportion est probablement biaisée vers ceux qui sont en échec de traitement.<p><p>L’étude de perception de la THA montre que la maladie est bien connue dans les communautés vivant dans les zones à risque. Par contre, plusieurs obstacles au dépistage et traitement de la THA ont été identifiés. Les plus importants sont :la toxicité des médicaments de la THA, les obstacles financiers, l’inadéquation entre le programme de dépistage des équipes mobiles et les occupations des communautés, les interdits qui accompagnent le traitement de la THA, le manque de confidentialité et la peur de la ponction lombaire. <p>L’étude sur la perception du traitement de la THA a montré que le mélarsoprol est perçu comme un médicament toxique et est surnommé « médicament des interdits ». Par contre, le régime NECT est perçu comme un nouveau médicament moins toxique qui a rendu les interdits liés au mélarsoprol obsolètes sauf un seul, celui de ne pas avoir de rapport sexuel pendant la période de traitement et de suivi post thérapeutique qui est de 6 mois. Les interdits ont été instaurés de manière empirique par les professionnels de santé et les communautés pour mitiger les effets indésirables du mélarsoprol. Leur violation pourrait entrainer des conséquences graves et mortelles. Ces interdits sont fortement ancrés dans les croyances de la communauté et constituent aujourd’hui un obstacle au dépistage et traitement. <p><p>L’étude sur les pratiques diagnostiques des professionnels de santé en matière de syndrome neurologique en contexte de ressources limitées a montré qu’en zone rurale le diagnostic est principalement clinique. Les obstacles perçus au diagnostic de confirmation sont essentiellement d’ordre financier puisque le patient doit tout financer de sa poche. Autres obstacles évoqués sont le manque d’outils de diagnostic et la perception de la communauté qui voit le clinicien comme un devin (petit dieu) ou oracle capable de « deviner » directement la maladie sans passer par un processus diagnostique de laboratoire.<p>L’étude sur les perceptions de la santé et des services de santé a montré que les capacités de travailler (82%) et les capacités de se mouvoir (66%) sont les signes de bonne santé les plus perçus. 90% des responsables des ménages perçoivent positivement la santé de leur ménage. Les opinions sur le service de santé sont partagées.<p><p>Les études présentées dans ce travail ont généré des nouvelles connaissances sur la dimension socioculturelle de la THA. L’analyse des messages de sensibilisation sur la THA utilisés par le programme de contrôle de la THA en RDC en termes de comparaison avec les obstacles au dépistage et traitement de la THA identifiés dans ce travail montre que ces aspects socioculturels bien qu’étant des véritables goulots d’étranglements dans la dynamique de la lutte contre la THA ne sont pas bien ciblés par la communication sur la THA. <p>Les perspectives des communautés exposées au risque de la THA doivent être adressées par un dialogue continu entre professionnels de santé et communautés adapté aux réalités locales. Ainsi il sera possible d’améliorer de manière opérationnelle les stratégies d’information, éducation et communication, et de façon plus large, le dépistage et traitement de la THA en intégrant la dimension socioculturelle de la THA dans la politique de lutte contre la THA. <p><p>SUMMARY<p>Human African Trypanosomiasis (HAT), also known as “sleeping sickness” is a parasitic disease caused by protozoa of the species Trypanosoma. There are two types that infect humans, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. The strategy used to control sleeping sickness consists of early case detection and treatment of patients, together with vector control. Meanwhile, utilization/access to HAT screening by the affected communities remains a major challenge. Adherence to active screening programs with mobile units was below 50% in certain endemic villages end of the 90’s. Moreover, utilization of fixed health facilities in DRC is so low that it compromises passive case finding. Our hypothesis is that this low utilization of health services is caused by a problem of acceptance of case detection and treatment of HAT by the communities living in the HAT transmission zones. This compromises the target of the international community to eliminate HAT as a public health problem by 2020. This thesis wants to explore and tries to generate more knowledge on the socio-cultural aspect that is often neglected in the control of HAT. <p><p>We conducted five studies to address the lack of community participation in HAT screening and treatment activities and the relation with acceptance of these services. <p>The first study evaluated the results of HAT treatment by retrospectively analyzing data of the routine HAT control program for the period 2006-2008. <p><p>Afterwards we performed three qualitative studies consisting of focus group discussions and individual interviews to document the socio-cultural dimension of the fight against HAT. The first study explored the community perceptions regarding sleeping sickness. The second study explored the perceptions regarding HAT treatment and a third study focused on diagnostic practices of health professionals in low-resource settings facing a neurological syndrome. <p><p>The fifth study consists of a household survey, focus group discussions and individual interviews to explore community perception regarding health in general and health services. We compared the identified barriers to screening and treatment of HAT with awareness messages on sleeping sickness used by the HAT control program in DRC and we developed strategic recommendations. The evaluation of performance indicators for treatment showed that compliance with post-treatment follow-up is very poor: 25% for the first post-treatment follow-up examination at six months and less than 1% of the patients returns for the final examination at 24 months. In this study we also observed a treatment failure rate of respectively 30% and 22% for melarsoprol and pentamidine in Kasai-Oriental. However, these date are difficult to interpret because of an incomplete denominator. As only few patients return for follow-up visits, this proportion is probably biased towards those in treatment failure.<p> <p>The study on the perception of sleeping sickness shows that the disease is well known amongst the communities living in the endemic areas. However, several screening and treatment barriers were identified. The most important are: drug toxicity, financial barriers, the incompatibility between the itineraries of the mobile screening teams and the local communities’ activities, the prohibitions related to HAT treatment, lack of confidentiality and fear of lumbar punctures. The study on the perceptions regarding HAT treatment show that melarsoprol is perceived as a toxic drug and is nicknamed the ‘taboo drug’. On the other hand the NECT regime is perceived as the new drug that is less toxic and that has abolished all the taboos of melarsoprol with the important exception of sexual intercourse during the treatment period and the post-treatment follow-up period of six months. <p><p>The prohibitions have been established empirically by healthcare providers and communities to mitigate the side effects of the melarsoprol regimen. Violating these restrictions is believed to cause severe and sometimes mortal complications. Communities adhere strictly to these prohibitions and this constitutes a barrier for HAT screening and treatment.<p><p>The study focusing on diagnostic work-up of neurological syndromes in low-resource settings by health care providers has shown that in rural areas diagnosis is usually clinical. Barriers to confirmation of diagnosis are mainly related to the purchasing power of the patient. Other reported barriers are a lack of diagnostic tools and the communities’ perceptions associated with the care provider. Clinicians are perceived as diviners being able to directly identify the cause of the illness without using laboratory tests. The study regarding the perceptions on health and health services has shown that ability to work (82%) and ability to move (66%) are the most perceived signs of good health. 90% of the household responsibles positively perceive the health of their family. The opinions on the health services are divided. <p><p>The studies presented in this thesis have generated new insights on the socio-cultural dimension of HAT. The analysis of the awareness messages on HAT in DRC compared with the reported HAT screening and treatment barriers have shown that <p>although these sociocultural aspects are real bottlenecks in the dynamic of the fight against HAT, they are not targeted by the communication on HAT. <p><p>The prospects for communities at risk of HAT should be addressed through continuous dialogue between health professionals and communities adapted to local realities.<p><p>It will thus be possible to operationally improve the information strategies, education and communication, and more broadly, screening and treatment of HAT by integrating the socio-cultural dimension in the fighting policy against sleeping sickness.<p> / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Made available in DSpace on 2016-01-26T12:51:28Z (GMT). No. of bitstreams: 1 kellycristinadourado_tese.pdf: 1236106 bytes, checksum: 8172f7b7f0adad230b6aca59e79174ce (MD5) Previous issue date: 2009-11-20 / In patients with chronic heart failure due to Chagas disease-Systemic Arterial Hypertension (Chagas-SAH) no data exist regarding physical capacity as detected by the 6-minute walk test. Methods: A total of 140 patients routinely followed at the Cardiomyopathy Outpatient Service of Hospital de Base from January, 2004 to January, 2008 were recruited for the study. Of them, 60 (44%) were diagnosed as having Chagas disease, 38 (27%) Chagas-SAH, and 42 (30%) chronic heart failure due to Systemic Arterial Hypertension (SAH). Results: The distance walked during 6 minutes was 357,9 ± 98 meters in Chagas-SAH patients, 395,8 ± 121 meters in Chagas disease patients (p >0,05), 272,7 ± 92,5 meters in SAH patients (p=0,002 versus Chagas disease patients; p <0,05 versus Chagas-SAH). The proportion of patients who walked less than 300 meters, a marker of dismal prognosis in patients with chronic heart failure, were 11 (29%) out of 38 patients in Chagas-SAH patients, 9 (15%) out of 60 patients in Chagas disease patients (p >0,05), and 25 (59%) out of 42 patients in the SAH patients (p<0,01, SAH versus Chagas-SAH patients, p<0,0005 versus Chagas disease patients). In patients with Chagas-SAH, there was a negative correlation between the 6-minute walk test and the total score of the Minnesota Living with Heart Failure Questionnaire (r= -0,51; p=0,001). Conclusions: Results of the 6-minute walk test in Chagas-SAH patients are similar to those found in Chagas disease patients with chronic heart failure. There is a negative correlation between the 6-minute walk test and total score of the Minnesota Living with Heart Failure Questionnaire. Coexistence of SAH seems not to affect functional capacity of Chagas disease patients with chronic heart failure. / Pacientes com insuficiência cardíaca crônica devido à doença de Chagas e Hipertensão Arterial Sistêmica (Chagas-HAS) não apresentam dados que avaliem sua capacidade física com o teste da caminhada de 6 minutos (TC6 ). Casuística e Método: Um total de 140 pacientes seguidos rotineiramente no Ambulatório de Cardiomiopatia do serviço do Hospital de Base, de janeiro de 2004 a janeiro de 2008 foi recrutado para o estudo. Destes, 60 (44%) foram diagnosticados como portadores de doença de Chagas, 38 (27%) com Chagas associada à hipertensão (Chagas-HAS) e 42 (30%) com insuficiência cardíaca crônica devido a Hipertensão Arterial Sistêmica (HAS). Resultados: A distância percorrida durante 6 minutos foi de 357,9 ± 98 metros em pacientes com Chagas-HAS; 395,8 ± 121 metros em pacientes com doença de Chagas (p>0,05) e 272,7 ± 92,5 metros em pacientes com HAS (p=0,002 versus pacientes com Chagas; p<0,05 versus Chagas-HAS). A proporção de pacientes que caminhou menos de 300 metros, um marcador de prognóstico sombrio em pacientes com insuficiência cardíaca crônica, foi 11 (29%) dos 38 pacientes com Chagas-HAS; 9 (15%) dos 60 pacientes com Chagas (p>0,05) e 25 (59%) dos 42 pacientes com HAS (p<0,01 HAS versus pacientes com Chagas-HAS, p<0,0005 versus pacientes com doença de Chagas). Em pacientes com Chagas-HAS houve uma correlação negativa entre o TC6 e a soma dos pontos do Minnesota Living with Heart Failure Questionnaire (r = -0,51; p = 0,001).Conclusões: Os resultados do TC6 em pacientes com Chagas-HAS são semelhantes aos encontrados em pacientes chagásicos com insuficiência cardíaca crônica. Existe uma correlação negativa entre o TC6 e o total de pontos do Minnesota Living with Heart Failure Questionnaire. A coexistência viii 13 de HAS parece não afetar a capacidade funcional dos pacientes chagásicos com insuficiência cardíaca crônica.

Human African trypanosomiasis (sleeping sickness) is a devastating disease which is endemic in parts of sub-Saharan Africa. It is caused by the protozoan parasite T. brucei, which are transmitted by the bite of infected tsetse flies. Although the disease is fatal if left untreated, there is a lack of safe, effective and affordable drugs available; therefore new drugs are urgently needed. The aim of the work presented in this thesis is to develop novel trypanocidal compounds. It is divided into two parts to reflect the two distinct strategies employed to achieve this aim. The first part focuses on the inhibition of glycophosphoinositol (GPI) anchor synthesis by inhibiting the Zn2+-dependent enzyme, GlcNAc-PI de-N-acetylase. Trypanosomes have a variable surface glycoprotein (VSG) coat, which allows them to evade the human immune system. The GPI anchor attaches the VSG to the cell membrane; therefore inhibiting GPI synthesis should expose the parasite to the immune system. Initially, large substrate analogues were synthesized. These showed weak inhibition of the enzyme. Zinc-binding fragments were screened, and small molecule inhibitors based on salicylhydroxamic acid were then synthesized. These compounds showed modest inhibition, but the excellent ligand efficiency of salicylhydroxamic acid indicates this may be a promising starting point for further inhibitors. The second part details the P2 strategy. The P2 transporter is a nucleoside transporter unique to T. brucei, which concentrates adenosine. The transporter also binds and selectively concentrates compounds that contain benzamidine and diaminotriazine P2 motifs, which can enhance the potency and selectivity of these compounds. The sleeping sickness drugs melarsoprol and pentamidine contain P2 motifs. Compounds comprising a P2 targeting motif, a linker and a trypanocidal moiety were synthesized. Initially, a diaminotriazine P2 motif was attached to a trypanocidal tetrahydroquinoline (THQ) protein farnesyl transferase (PFT) inhibitor, with limited success. The P2 strategy was also applied to a non-selective, trypanocidal, quinol moiety. The quinol moiety was attached to diaminotriazine and benzamidine P2 motifs, and an increase in selectivity for T. brucei over MRC5 cells was observed.

This thesis describes bioanalytical methods for drug determination in biological matrixes, with drugs in focus used against diseases largely affecting low-income countries. Solid-phase extraction is used for sample cleanup, and processed samples are analyzed by liquid chromatography. Developed bioanalytical methods are validated according to international guidelines. Eflornithine (DFMO) is a chiral drug, used for treating human African trypanosomiasis. A bioanalytical method for determination of DFMO enantiomers in plasma is presented. The enantiomers are detected by evaporative light-scattering detection. The method has been applied to determination of D-DFMO and L-DFMO in rats, after intravenous and oral administration of racemic DFMO. It is concluded that DFMO exhibits enantioselective absorption, with the more potent enantiomer L-DFMO being less favored. Sulfadoxine (SD) and sulfamethoxazole (SM) are sulfa-drugs used for malaria and pneumonia respectively. Two methods are described for simultaneous determination of SD and SM in capillary blood sampled on filter paper. The former method allows direct injection of extracts from dried blood spots (DBS), while for the latter method solid-phase extraction is added. Pre-analytical factors contributing to measurement uncertainty is also discussed, and it is concluded that it is of high importance that homogeneity in type of sampling paper and sampling volume is assured. Piperaquine (PQ) is an antimalarial, increasingly used in artemisinin combination therapy. A method for determination of piperaquine in DBS is presented. By using a monolithic LC column, a very short LC analysis of two minutes per sample is achieved. A method for simultaneous determination of three antiretroviral drugs i.e. lamivudine (3TC), zidovudine (AZT) and nevirapine (NVP), in DBS samples is described. The method is applied to drug determination in two subjects after receiving standard antiretroviral treatment. Conclusion is that the method is suitable for determination of 3TC and NVP, and to some extent for AZT.