Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2013-11-07T16:47:38Z No. of bitstreams: 1 Isadora dos Santos Lima Desorganização da Polpa Branca Esplênica está associada...pdf: 823516 bytes, checksum: 6c64973b1a470182971fdecded62d3c4 (MD5) / Made available in DSpace on 2013-11-07T16:47:38Z (GMT). No. of bitstreams: 1 Isadora dos Santos Lima Desorganização da Polpa Branca Esplênica está associada...pdf: 823516 bytes, checksum: 6c64973b1a470182971fdecded62d3c4 (MD5) Previous issue date: 2013 / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / O baço é o maior órgão linfoide secundário em seres humanos e em cães. Em ambos, a ausência do baço está associada com um risco aumentado de ocorrência de infecções localizadas e disseminadas, incluindo sepse generalizada. A leishmaniose visceral e outras infecções podem alterar a estrutura histológica do baço, o que leva a uma destruição dos microambientes da polpa branca. Trabalhos anteriores mostraram que a ruptura da estrutura de polpa branca é mais frequente em cães com marcadores laboratoriais de suscetibilidade à leishmaniose visceral, como a cultura esplênica positiva e LST negativo, do que nos animais em que estes marcadores de susceptibilidade estavam ausentes. Neste estudo, o nosso objetivo é examinar a relação entre a desorganização histológica da polpa branca esplênica e a gravidade da leishmaniose visceral. As amostras e os dados utilizados neste estudo foram coletados de 206 cães de rua provenientes de uma área endêmica para leishmaniose visceral, a cidade de Jequié (Bahia, Brasil). Os animais foram examinados clinicamente e foram realizados os testes ELISA e LST. Aspirados de baço foram coletados para a cultura, e fragmentos de baço foram coletadas para estudos de biologia molecular e de estudos morfológicos. Os animais foram classificados de acordo com o grau de organização estrutural da polpa branca esplênica em grupos com baço (a), bem organizado, (b) ligeiramente desorganizado, (c) a moderadamente a extensivamente desorganizado. Em relação à positividade no ELISA juntamente com a desorganização do baço, conjuntivite ( P= 0,0116), hiperproteinemia (p= 0,021) foram mais frequentes no grupo de animais com ELISA positivo e baço desorganizado, quando comparado com os outros grupos. Os animais polissintomáticos são mais frequentes no grupo com ELISA positivo e baço do tipo 3 (p= 0,004). Os scores clínicos atribuídos à intensidade da conjuntivite (P <0,05), dermatite (P <0,05) e linfadenopatia (P <0,01), alopecia (P <0,01), onicogrifose (P <0,05) foram mais elevados nos animais com ELISA positivo e baço desorganizado do que outros grupos, bem como o número de sinais clínicos atribuíveis à leishmaniose visceral canina (p= 0,0014).Em relação à análise da positividade na cultura esplênica juntamente com a desorganização do baço, a frequência de cães polissintomáticos foi maior em animais com baço ligeiramente desorganizado (P <0,05) e baço desorganizado (P <0,005), do que em animais com baço organizado. Alopecia (P <0,01), conjuntivite (P <0,05), desidratação (P <0,001), dermatite (P <0,05), onicogrifose (p <0,01), anemia (P <0,05), úlcera (P <0,001 ) e alto escore clínico (P <0,001) foram mais frequentes em animais com cultura esplênica positiva e baço desorganizado, do que nos animais com cultura negativa e baço organizado. Em conclusão, os cães com desorganização do baço associada com leishmaniose visceral têm mais sinais clínicos e pior estado clínico do que os animais com leishmaniose visceral, mas sem desorganização do baço. / The spleen is the largest secondary lymphoid organ in human beings and in dogs. In both in human beings and in dogs, the absence of the spleen is associated with increased risk of localized and disseminated infection including overwhelm sepsis. Visceral leishmaniasis and other infections alter the histological structure of the spleen, leading to a disruption of the white pulp microenvironments. Previous works have shown that the disruption of the white pulp structure is more frequent in dogs with laboratorial markers of susceptibility to visceral leishmaniasis such as positive spleen culture and negative leishmanin skin test than in animals in which these susceptibility markers were absent. In this study, our goal is to examine the relationship between the histological disorganization of splenic white pulp and severity of visceral leishmaniasis.The samples and data used in this study were collected from 206 stray dogs from an endemic area for visceral leishmaniasis, the city of Jequie (Bahia, Brazil). The animals were examined clinically and ELISA and LST were performed. Splenic aspirates were collected for culture, and fragments of spleen were collected for molecular and morphological studies. The animals were ranked according to the degree of structural organization of splenic white pulp of the spleen in groups (a), well-organized, (b) slightly disordered, (c) moderately extensively disorganized. In relation to the positive in the ELISA with the disorganization of the spleen, conjunctivitis (P = 0.0116) hyperproteinemia (p = 0.021) were more frequent in the group of animals with positive ELISA and disorganized spleen when compared to the other groups. Polisymptomatic animals are more frequent in the group with positive ELISA and spleen type 3 (p = 0.004). Clinical scores attributed to the intensity of conjunctivitis (P <0.05), dermatitis (P <0.05) and lymphadenopathy (P <0.01), alopecia (P <0.01), onychogryphosis (P <0.05 ) were higher in animals with positive ELISA and disorganized spleen than other groups, as well as the number of clinical signs attributable to canine visceral leishmaniasis (p = 0.0014). Regarding the analysis of positive spleen culture together with splenic disorganization, the frequency of polisymptomatic dogs was higher in animals with slightly disordered spleen (P <0.05) and disorganized spleen (P <0.005) than in animals with organized spleen. Alopecia (P <0.01), conjunctivitis (P <0.05), dehydration (P <0.001), dermatitis (P <0.05), onychogryphosis (p <0.01), anemia (P <0.05 ), ulcers (P <0.001) and high clinical score (P <0.001 were more frequent in animals with positive spleen culture and disorganized spleen than in animals with negative culture and organized spleen . In conclusion, dogs with disorganization of the spleen associated with visceral leishmaniasis have more clinical signs and worse clinical status than animals with visceral leishmaniasis, but without disruption of the spleen.

Researchers examining clinically-relevant trends for sexual minority women have found evidence of psychological distress and greater utilization of mental health services compared to heterosexually-identified women. However, the results of many research studies with this population have methodological limitations surrounding recruitment of participants, cross-sectional methods, and participant report of clinical services utilized. Few researchers have sought to analyze actual clinical presentation, service utilization, or clinical outcome of sexual minority women in a treatment-setting. This study is an in-depth clinical analysis of 215 sexual minority woman who sought services at a large Midwestern university counseling center over a period of two years and nine months. The analyses conducted allowed for the initial clinical presentation, service utilization, and clinical outcome of sexual minority women to be described and compared to comparative samples of service-seeking female college students. Sexual minority women were found to have a greater incidence of prior suicidality and prior counseling compared to heterosexual women at the same agency. Sexual minority women also reported greater symptoms of social anxiety, eating concerns, and family distress than heterosexual women at the same agency. Of seven examined predictors of service utilization, sexual minority identity label, age, and academic term of service initiation differentiated brief and extended service utilization from moderate service utilization. Prior use of counseling, psychological distress, racial-ethnic minority status, and time in the semester of initiation of services were not significant predictors of service utilization. Implications and limitations of these findings are presented, and future directions for research and intervention are discussed.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-08-22T19:48:35Z No. of bitstreams: 1 FranciscoMagalhaes.pdf: 1065814 bytes, checksum: ed97c291154490e367bbb044c576aefa (MD5) / Made available in DSpace on 2017-08-22T19:48:35Z (GMT). No. of bitstreams: 1 FranciscoMagalhaes.pdf: 1065814 bytes, checksum: ed97c291154490e367bbb044c576aefa (MD5) Previous issue date: 2015-06-24 / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / Hepatitis B virus (HBV) chronic infection has a heterogeneous distribution around the world. Its clinical presentation depends on factors of the carrier such as the age at which he got infected, immunological status and associated diseases. Viral characteristics like the genotype can also influence. The aim of this study was to evaluate the influence of the HBV genotype in the clinical presentation of the chronic infection. This study was performed at the Clinical Research Center and the Liver Unit of the Federal University of Maranhão, with 119 chronic carriers of HBV with defined genotypes. We identified those followed for at least 12 months for their clinical definition. It was included 101 patients: 68 (68%) with genotype A1, 26 (26%) D4, 4(3%) F2a, 2 (2%) D3 and 1 (1%) D2. For the purpose of comparison, two groups were defined: A (n=68) and D (n=29). In the HBV-D group the presence of HBeAg (28% vs 10% P=0.03) and immune tolerant (21.5% vs 1.5% P=0.006) patients were more frequent when compared to carriers of genotype A. There was no age difference between groups (39±13 vs 42±11 P=0.26). In conclusion, we can suggest that among the carriers of genotype D, especially the subgenotype D4, which corresponds to 90% of this, there might be late seroconversion of HBeAg, favoring a higher risk of virus transmission. / A infecção crônica pelo vírus da hepatite B tem distribuição heterogênea em todo o mundo. Sua apresentação clínica depende de fatores do hospedeiro tais como a idade em que o indivíduo se infectou, estado imunológico e doenças associadas. Características virológicas também podem influenciar tais como o genótipo do vírus. Este estudo teve o objetivo de avaliar a influência do genótipo do HBV na apresentação clínica. A pesquisa foi conduzida no Centro de Pesquisa Clínica e no Núcleo de Estudos do Fígado da Universidade Federal do Maranhão, com 119 portadores crônicos do HBV com genótipos definidos. Foram identificados aqueles acompanhados por pelo menos 12 meses para definição clínica. Incluídos 101 pacientes: 67 (68%) com genótipo A1, 26 (26%) D4, 4 (3%) F2a, 3 (2%) D3 e 01 (1%) D2. Para fins de comparação foram definidos dois grupos: A (n=67) e D (n=30). No grupo HBV-D foram mais frequentes a presença do HBeAg (28% vs 10% P=0.03) e de imunotolerantes (21,5% vs 1.5% / P=0.006) quando comparados com portadores do genótipo A. Não houve diferença entre as idades nos dois grupos (39±13 vs 42±11 / P=0.26). Em conclusão, pode-se sugerir que entre os portadores do genótipo D, especialmente o subgenótipo D4, que corresponde a 90% do total, pode haver soroconversão tardia do HBeAg, favorecendo maior risco de transmissão do vírus.

The epidemiology of urinary tract infection (UTI) in the population of Vännäs (8 000 inhabitants) was studied during one year. The annual incidence increased from 0.5% in the first decade of life to more than 10% in the age group 90-100 years. Male UTI comprised only 13% of the episodes, increased after middle age and contributed 4 0% by &gt; 80 years of age. At 17 PHC centres (PHCCs) a prevalence study (McPHC) of mainly uncomplicated UTI was performed. Most episodes were acutely symptomatic (lower 75%, upper 5%). Microscopy of wet-stained urinary sediment with a minimum of moderate amount of bacteria and/or 5 leukocytes per high power field (4 00 x) as breakpoint resulted in a desired high sensitivity (97%) and 86% efficacy in acutely symptomatic patients. Diagnosis of bacteriuria using Uricult dipslides yielded acceptable results with an overall efficacy of 88%. Nitrite test and Uriglox showed an unacceptable low mean sensitivity ofR56 and 69%, respectively. A positive nitrite, sediment or Uricult , when used in combination, was optimal in diagnosing UTI with a sensitivity of 98% in acutely symptomatic patients during their office visits. The average risk of drug resistance was 17% in the Vännäs study. Sensicult satisfactorily predicted drug sensitivity (93%) but not bacterial drug resistance (50%). Using Uricult with classification of bacteriuria by Gram-grouping, lactose and catalase reactions for targeting UTI therapy, according to local guidelines, resulted in a similar low risk (6 %) of prescribing drugs to which the organisms were resistagt as when using Sensicult (7%). This development of the Uricult method is simple and can be recommended for office practice in PHC. The spectrum of bacteria causing UTI and their drug resistance was more associated with the selection of patients, sex and age than with symptoms. The pattern of drug resistance was little influenced by UTI history and the mean pretherapy resistance for the seven drugs tested in McPHC was low (7%). Drug resistance was increased in failure (mean 24%) but not in early or repeated recurrence. In McPHC therapy resulted in 8% bacteriological failure and 12% early recurrence, irrespective of whether the bacteria were classified as sensitive or resistant in vitro to the drug given. Thus, in order to be of prognostic value for therapy of uncomplicated UTI, high-level breakpoints focusing more on peak urinary drug concentrations need to be studied. UTI symptoms in McPHC were eradicated in only 2/3 of the bacterio- logically cured episodes and in 1/3 of the failures at control 1-3 days posttherapy showing that symptoms are an unreliable indicator of UTI. From current literature, it seems unlikely that asymptomatic bacteriuria (ABU) plays a major role in the development of uremia due to chronic pyelonephritis. With the exception of ABU in pregnancy, therapy seems to yield no benefit. Omitting posttherapy bacteriuria controls in patients with symptoms eradicated, at least in women with uncomplicated UTI, would lead to considerable savings both for patients and the health care system. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1988, härtill 6 uppsatser.</p> / digitalisering@umu

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