Κατά τη χρονική περίοδο 2006-2007 απομονώθηκαν συνολικά 952 στελέχη P. aeruginosa στο Μικροβιολογικό Εργαστήριο του ΠΓΝΠ. Επιλέχθηκαν για μελέτη 240 στελέχη, τα πρώτα δέκα από κάθε μήνα και ένα στέλεχος από κάθε ασθενή. Τα στελέχη απομονώθηκαν μετά από καλλιέργεια κλινικών δειγμάτων: τραυμάτων-υγρών, κεντρικών φλεβικών καθετήρων, αναπνευστικού συστήματος, ούρων, κοπράνων και αίματος. Τα κλινικά δείγματα προέρχονταν από ασθενείς που νοσηλεύονταν στη ΜΕΘ, τις Παθολογικές Κλινικές, τις Χειρουργικές Κλινικές, την Παιδιατρική Κλινική και προσέρχονταν στα Εξωτερικά Ιατρεία του ΠΓΝΠ. Φαινοτυπικές και μοριακές μεθόδοι χρησιμοποιήθηκαν για την επιδημιολογική διερεύνηση των στελεχών. Ανιχνεύθηκε ο βιότυπος, έγινε έλεγχος της ευαισθησίας στα αντιβιοτικά, έλεγχος της παραγωγής MBLs και ορολογική τυποποίηση των στελεχών. Οι μοριακές μέθοδοι περιλάμβαναν την ανίχνευση των γονιδίων blaVIM, exoY, exoT, exoS και exoU με PCR, τυποποίηση του γονιδίου blaVIM με ανάλυση της αλληλουχίας και εφαρμογή των μεθόδων PFGE (SpeI) και MLST ταυτοποίηση κλώνων. Τα περισσότερα στελέχη εμπλέκονταν σε λοιμώξεις (65,42%). Τα περισσότερα δείγματα προήλθαν από τη ΜΕΘ (92/240, 38%), σημαντικό ποσοστό των οποίων αφορούσε τη χλωρίδα των ασθενών (56/92, 61%). Τα περισσότερα στελέχη ήταν MDRPA (63,33%) και άνηκαν στον ορότυπο Ο11 (49,16%). Το 33% των ιμιπενέμη ανθεκτικών στελεχών ήταν blaVIM θετικά (κυρίως blaVIM2, και blaVIM1). Με την PFGE τα στελέχη διακρίθηκαν σε 5 κύριους τύπους a, d, b, c και s, με επικρατούντες τους a (33,75%) και d (13,75%). Με την MLST τα στελέχη διακρίθηκαν κυρίως στους δύο παγκόσμιους κλώνους ST235 (PFGE τύποι a, d και b) και ST111 (PFGE τύπος b). Η παρούσα μελέτη αναδεικνύει μία επιδημική έξαρση από MDRPA στο ΠΓΝΠ. Τα MDRPA ανήκαν κυρίως στους PFGE τύπους a και d του ορότυπου Ο11 και κλώνου ST235, με γονοτυπικό προφίλ exoU +/exoS - που επικρατούσαν στη ΜΕΘ. Η παρατήρηση ότι τα περισσότερα στελέχη που απομονώθηκαν από δείγματα αποικισμού των ασθενών (49/83) ανήκαν στον κλώνο ST235 υποδεικνύει ότι ο αποικισμός των ασθενών της ΜΕΘ συμβάλλει στη λοίμωξη από στελέχη P. aeruginosa και στη διασπορά τους στις άλλες κλινικές του νοσοκομείου. Το γεγονός ότι τα περισσότερα των στελεχών (18/33) του PFGE τύπου d (ST235) φέρουν το γονίδιο blaVIM2 ενισχύει την άποψη ότι η κλωνική διασπορά διαδραμάτισε ρόλο στην επιδημική έξαρση από ιμιπενέμη-ανθεκτικά στελέχη P. aeruginosa. / During the period 2006-2007 a total of 952 P. aeruginosa strains were isolated in the Microbiology Laboratory of the University Hospital of Patras. Two hundred and forty, the first ten from every month no replicate isolates (one isolate per patient), were selected to be studied further. The strains were isolated after inoculation of clinical specimens: wound-liquids, intravenous catheters, respiratory samples, urine, stool and blood. P. aeruginosa was identified by standard phenotypic methods. The clinical samples were collected from patients hospitalized in the ICU, Internal Medicine, Surgical Units, Pediatric Unit and the Department of Outpatients. Phenotypic and molecular methods were applied for the epidemiological study. Phenotypic methods were: antibiotic susceptibility testing, metallo-beta-lactamases (MBL) production and serotyping. The molecular methods included detection of genes blaVIM, exoY, exoT, exoS, exoU by PCR, blaVIM gene sequencing, PFGE (SpeI) and MLST. The majority of isolates were infection-related (65,42%). Most of them were recovered from ICU patients (92/240, 38%), 61% (56/92) of which were colonizing isolates. Most strains were MDRPA (63,33%) and belonged to serotype O11 (49,16%). Thirty three percent (33%) of imipenem non-susceptible isolates were blaVIM positive (specifically blaVIM2, and blaVIM1). PFGE exhibited five main types: a, d, b, c and s [predominant a (33,75%), d (13,75%)]. By MLST, the strains were classified mainly in the two international clones ST235 (PFGE types a, d and b), and ST111 (PFGE type b). The present study revealed an outbreak of MDRPA in the University Hospital of Patras. MDRPA belonged mainly to PFGE types a and d of serotype O11 and clone ST235, showing the profile exoU +/exoS -, and predominaded in ICU. The observation that most colonizing isolates (49/83) belonged to ST235 indicates that colonization during ICU hospitalization contributes to infection and spread of MDRPA to other wards. The fact that the majority (18/33) of PFGE type d strains (ST235) carry blaVIM2 gene, reinforces that clonal spread may have played a role in the outbreak of imipenem non-susceptible P. aeruginosa strains.

Resumo: A tuberculose, doença infecto-contagiosa, acomete o homem há milênios. Em 1993, a tuberculose foi considerada pela Organização Mundial de Saúde (OMS) como emergência global. Este estudo visou caracterizar a tendência da tuberculose em internos do Hospital Nestor Goulart Reis, de Américo Brasiliense / SP, segundo alguns caracteres epidemiológicos da doença, conforme os registros do Hospital, no período de 1994 a 2004 e determinar também a prevalência da tuberculose infecção nos profissionais de saúde do referido hospital, durante o ano de 2005, através da realização do teste de Mantoux. Analisando o perfil predominante dos pacientes internos no Hospital durante o período observou-se que a tuberculose acometeu principalmente os pacientes do gênero masculino, na faixa etária dos 30 aos 50 anos e que viviam sós, a profissão relatada mais freqüentemente foi a de lavrador, o grau de escolaridade mais freqüente foi o de 1º grau incompleto, o alcoolismo esteve associado e a forma clínica da doença predominante foi a pulmonar. Quanto aos resultados do teste de PPD nos funcionários, as altas taxas de positividade sugerem que medidas mais eficazes de proteção ao trabalhador devam ser implementadas na Instituição, bem como o acompanhamento sistemático destes profissionais incluindo o teste de Mantoux nos exames de rotina do Hospital. / Abstract: The tuberculosis is an infect-contagious illness that has been affecting the people for thousand years. In 1993, the World Health Organization (WHO) considered the tuberculosis a global emergency. This study was aimed to characterize the trend of the tuberculosis in patients of the Nestor Goulart Reis's Hospital from Américo Brasiliense's City on São Paulo's State, Brazil. The study analyzed the epidemiological characters of the illness, according to the registers of the Hospital, in the period of 1994 to 2004. We also determined the prevalence of the tuberculosis infection in the health's staff of the Hospital, during the year of 2005, through the accomplishment of the Mantoux's test. We observed that the tuberculosis affected mainly patients of the masculine sex; within the 30 to the 50 years old and that lived alone. The profession more frequently related was the farmer, the more frequent school's degree was the incomplete's elementary degree, and alcoholism was associated with the tuberculosis. The predominant clinical form was the pulmonary one. The Mantoux's test showed high positives taxes in the Hospital's staff. These results suggested the necessity of more efficient measures to protect the staff on the Hospital. These data also suggested the increase of systematic accompaniment of these professionals including the Mantoux's test in the routine's examinations on the Hospital. / Orientador: Clarice Queico Fujimura Leite / Coorientador: Maria Jacira Silva Simões / Banca: Adalberto Farache Filho / Banca: Péricles Alves Nogueira / Mestre

Made available in DSpace on 2014-06-11T19:25:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-08-15Bitstream added on 2014-06-13T19:26:03Z : No. of bitstreams: 1 severo_npf_me_arafcf.pdf: 269557 bytes, checksum: f1ed701b603496c90cd8c9bd6c9ce123 (MD5) / Universidade Estadual Paulista (UNESP) / A tuberculose, doença infecto-contagiosa, acomete o homem há milênios. Em 1993, a tuberculose foi considerada pela Organização Mundial de Saúde (OMS) como emergência global. Este estudo visou caracterizar a tendência da tuberculose em internos do Hospital Nestor Goulart Reis, de Américo Brasiliense / SP, segundo alguns caracteres epidemiológicos da doença, conforme os registros do Hospital, no período de 1994 a 2004 e determinar também a prevalência da tuberculose infecção nos profissionais de saúde do referido hospital, durante o ano de 2005, através da realização do teste de Mantoux. Analisando o perfil predominante dos pacientes internos no Hospital durante o período observou-se que a tuberculose acometeu principalmente os pacientes do gênero masculino, na faixa etária dos 30 aos 50 anos e que viviam sós, a profissão relatada mais freqüentemente foi a de lavrador, o grau de escolaridade mais freqüente foi o de 1º grau incompleto, o alcoolismo esteve associado e a forma clínica da doença predominante foi a pulmonar. Quanto aos resultados do teste de PPD nos funcionários, as altas taxas de positividade sugerem que medidas mais eficazes de proteção ao trabalhador devam ser implementadas na Instituição, bem como o acompanhamento sistemático destes profissionais incluindo o teste de Mantoux nos exames de rotina do Hospital. / The tuberculosis is an infect-contagious illness that has been affecting the people for thousand years. In 1993, the World Health Organization (WHO) considered the tuberculosis a global emergency. This study was aimed to characterize the trend of the tuberculosis in patients of the Nestor Goulart Reis's Hospital from Américo Brasiliense's City on São Paulo's State, Brazil. The study analyzed the epidemiological characters of the illness, according to the registers of the Hospital, in the period of 1994 to 2004. We also determined the prevalence of the tuberculosis infection in the health's staff of the Hospital, during the year of 2005, through the accomplishment of the Mantoux's test. We observed that the tuberculosis affected mainly patients of the masculine sex; within the 30 to the 50 years old and that lived alone. The profession more frequently related was the farmer, the more frequent school's degree was the incomplete's elementary degree, and alcoholism was associated with the tuberculosis. The predominant clinical form was the pulmonary one. The Mantoux's test showed high positives taxes in the Hospital's staff. These results suggested the necessity of more efficient measures to protect the staff on the Hospital. These data also suggested the increase of systematic accompaniment of these professionals including the Mantoux's test in the routine's examinations on the Hospital.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Orientador: Maria Cecília Pereira Binder / Banca: Tarcísio Márcio Magalhães Pinheiro / Banca: Francisco Antonio de Castro Lacaz / Resumo: Estudo epidemiológico descritivo de acidentes ocupacionais envolvendo exposição a material biológico em cirurgiões-dentistas, auxiliares odontológicos, estudantes de Odontologia, atuando na cidade de Bauru-SP, de 2000 a 2004. As fontes de informações foram prontuários e fichas de notificação de acidentes. Os casos foram descritos segundo atributos dos acidentados, serviço de ocorrência, objeto causador da lesão, matéria orgânica envolvida na exposição, circunstância do acidente e coeficiente de incidência. As providências adotadas antes e depois da ocorrência do acidente, bem como acompanhamento sorológico dos acidentados também foram descritos. Comparou-se, para o mesmo período, os resultados obtidos em Bauru com os resultados do SINABIO em profissionais de Odontologia do Estado de São Paulo. Foram identificados 179 acidentes, envolvendo 174 profissionais. O maior número de casos, quarenta e nove, ocorreu em 2000. Houve predomínio de casos em mulheres e em jovens, sobretudo, estudantes de Odontologia. Constatou-se que o procedimento odontológico envolvendo exposição percutânea com agulha contaminada com sangue foi a circunstância do acidente predominante. Sondas, brocas curetas e limas foram outros instrumentos envolvidos. A maioria dos acidentados utilizava luvas e máscara, e estava vacinado contra hepatite B. Observou-se que a realização de Anti-HBs pós vacinal foi efetuada raramente. Grande parte dos pacientes-fonte era conhecido e, destes, apenas 39,2% teve resultados de exames sorológicos para HIV registrados, 10,7% para HBV e 2,1% para HCV. Medicação anti-retroviral foi ministrada em 85,5% dos casos; 3,9% dos acidentados receberam gamaglobulina hiperimune para hepatite B; 19,0 % foram vacinados contra hepatite B. Não foram registradas soroconversões para nenhum dos três vírus considerados (HIV, HBV e HCV)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A descriptive epidemiological study of occupational accidents involving biological material exposure to dentists, dental assistants, and dentistry students in Bauru-SP, from 2000 to 2004. Source information was obtained from patient charts and accident notification forms. All cases were described according to the accident victims' personal and professional details, the location of the accident, the device causing the injury, the organic material exposed to, the circumstances of the accident, and the index of accident incidence. Procedures taken before and after any accident are described, as are the resulting serological proceedings. Results from Bauru were compared with those of dentistry professionals from the State of São Paulo, during the same period, registered by SINABIO (Notification System for Biological accidents of the STD/AIDS programme of the Sao Paulo State Health Organization). 179 accidents were identified, involving 174 professionals. The majority of cases, 49, occurred in 2000. Women and young people were more often affected, being mainly those among dentistry students. The predominant circumstance for accidents registered was during dentistry procedures involving percutaneous exposure with needles contaminated by blood. Other devices involved in accidents were probes, burs, curettes and files. The majority of accident victims were wearing gloves and masks when the accident occurred and were hepatitis B vaccinated. The Anti-HB S reaction test was rarely done. In most cases sources were known, and from these only 39.2% had serological exam results registered for HIV, 10.7% for HBV and 2.1% for HCV. 84.5% of the professionals involved in accidents did not follow all the postexposure... (Complete abstract click electronic access below) / Mestre

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22575号 / 情博第712号 / 新制||情||122(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 守屋 和幸, 教授 吉川 正俊 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

The goal of this master thesis is to construct a software system, named the LIFE Spatial Data Visualization System (LIFE-SDVS), to automatically visualize the data obtained in the LIFE project spatially. LIFE stands for the Leipzig Research Centre for Civilization Diseases. It is part of the Medical Faculty of the University of Leipzig and conducts a large medical research project focusing on civilization diseases in the Leipzig population. Currently, more than 20,000 participants have joined this population-based cohort study. The analyses in LIFE have been mostly limited to non-spatial aspects. To integrate geographical facet into the findings, a spatial visualization tool is necessary. Hence, LIFE-SDVS, an automatic map visualization tool wrapped in an interactive web interface, is constructed. LIFE-SDVS is conceptualized with a three-layered architecture: data source, functionalities and spatial visualization layers. The implementation of LIFE-SDVS was achieved by two software components: an independent, self-contained R package lifemap and the LIFE Shiny Application. The package lifemap enables the automatic spatial visualization of statistics on the map of Leipzig and to the extent of the authors knowledge, is the first R package to achieve boundary labeling for maps. The package lifemap also contains two self-developed algorithms. The Label Positioning Algorithm was constructed to find good positions within each region on a map for placing labels, statistical graphics and as starting points for boundary label leaders. The Label Alignment Algorithm solves the leader intersection problem of boundary labeling. However, to use the plotting functions in lifemap, the users need to have basic knowledge of R and it is a tedious job to manually input the argument values whenever changes on the maps are necessary. An interactive Shiny web application, the LIFE Shiny Application, is therefore built to create a user friendly data exploration and map generation tool. LIFE Shiny Application is capable of obtaining experimental data directly from the LIFE database at runtime. Additionally, a data preprocessing unit can transform the raw data into the format needed for spatial visualization. On the LIFE Shiny Application user interface, users can specify the data to display, including what data to be fetched from database and which part of the data shall be visualized, by using the filter functions provided. Many map features are also available to improve the aesthetic presentation of the maps. The resulting maps can also be downloaded for further usage in scientific publications or reports. Two use cases using LIFE hand grip strength and body mass index data demonstrate the functionalities of LIFESDVS. The current LIFE-SDVS sets a foundation for the spatial visualization of LIFE data. Suggestions on adding further functionalities into the future version are also provided.

L’utilisation des pesticides peut être à l’origine de graves nuisances pour la santé humaine,comme l’ont montré les études en milieu professionnel agricole.L’objectif de cette thèse était d’étudier les manifestations, principalement respiratoires etsurvenant à court terme, dans la population générale exposée aux pesticides utilisés enagriculture.Les résultats de deux études épidémiologiques, Phytoriv, menée en Gironde et Phytoniger, plusexploratoire, sont présentés, toutes deux menées au sein de population d’adultes et d’enfantsvivant en milieu rural.L’étude Phytoriv a mis en évidence la présence de concentrations faibles mais plus élevées depesticides dans l’air ambiant à proximité de zones viticoles traitées et a permis de recueillir surune période de une à trois semaines les symptômes ressentis par les riverains de manièrejournalière. L’absence d’effet majeur de l’exposition sur la santé respiratoire chez les riverainsobservée dans cette étude demande à être confirmée, en améliorant notamment l’estimationtemporelle et spatiale de l’exposition.L’étude Phytoniger a permis de démontrer la faisabilité d’une étude de santé environnementaledans un pays en développement. L’utilisation de pesticides non autorisés et potentiellementdangereux, pour des usages agricoles mais également domestiques, est importante au Niger etpose la question de leur impact sur la santé des populations. Certains symptômes respiratoiresétaient plus fréquemment observés en zone agricole humide, où les usages de pesticides, maiségalement les feux de démoustication, sont plus importants qu’en zone sahélienne agropastorale.Enfin, dans les deux études Phytoriv et Phytoniger, des risques plus élevés de symptômesrespiratoires étaient observés, notamment chez les enfants, en lien avec l’utilisation domestiquede pesticides.A l’avenir, une caractérisation plus précise des sources, niveaux et déterminants d’exposition dela population générale permettrait d’améliorer les connaissances sur le lien avec la survenue desymptômes et pathologies respiratoires et d’identifier les axes d’intervention les plus pertinents. / Pesticides are widely used in agriculture worldwide. However, it is now recognised thatoccupational pesticide exposure, especially in agriculture, can pose serious health concerns. Weaimed to study short term respiratory symptoms in general populations exposed to pesticidesused in agriculture.Here we present results of two epidemiological studies, Phytoriv, performed in Bordeaux area,France, and Phytoniger, performed in a Sahelian African country, both among rural adult andchildren populations.Higher pesticide levels in ambient air were observed in the surrounding of vineyards in Phytoriv.However, no major effect was observed on resident’s respiratory health. This need to beconfirmed by studies with improved temporal and spatial exposure assessment.Phytoniger allowed us to show the feasibility of environmental health studies in a developingcountry. Unauthorized and hazardous pesticides are widely used in Niger, for agricultural as wellas for residential purposes, and concerns are growing on their potential health effects. Some ofthe short term respiratory symptoms were more frequent in the agricultural wetland area,compared to the Sahelian agro-pastoral area. Pesticides are more susceptible to be used in thefirst area, but it is also more subject to mosquito control fires.Finally in both surveys, higher risks of respiratory symptoms have been observed for peopleliving in houses treated with indoor pesticides, and especially in children.All these results warrants further studies to improve assessment of sources, exposure levels anddeterminants of pesticide exposure in the general population, in order to improve knowledge onits respiratory and short term health effects. Thus, relevant public health interventions could beperformed.

8 Abstract Human Herpes Virus 6 (HHV-6) consists of two closely related DNA viruses: HHV-6A and HHV-6B. The primoinfection proceeds at an early childhood usually as sixth exanthem disease or without any clinical symptoms. Both HHV-6 viruses are able to integrate to human genome using recombinant mechanisms which is unique compared to other human herpesviruses. The aim of the thesis is to study Ci-HHV-6 in a group of patients with malign disease and in the healthy population. We analysed 812 patients with malign disease and 420 healthy subjects from general population. The Ci-HHV-6 was assessed by real-time PCR, the specific localization of Ci-HHV-6 was determined using fluorescent in situ hybridization (FISH). Using comparative study, we did not identify significant difference between frequency of Ci-HHV-6 in patients with malign disease (1.11%) and healthy subjects (0.95%) (P-value 0.8). Consequently, we proved the heritability of Ci-HHV-6 in affected families. We determined the localization of Ci-HHV-6 to telomeric regions of chromosomes 2 and 18. We studied the production of viral proteins in the subjects with Ci-HHV-6. In this work, we conducted the first epidemiological study of Ci-HHV-6 in the Czech Republic. We also introduced novel methods which contribute to better characterization of this phenomenom.