published_or_final_version / abstract / toc / Medicine / Master / Doctor of Medicine

<p>Adekvatni nadzor nad zaraznim bolestima predstavlja aktuelni izazov ne samo kod nas već i u razvijenim zemljama. Savremeni epidemiolo&scaron;ki nadzor nad zaraznim bolestima zasniva se na odgovarajućim definicijama slučaja. Njihova osnovna funkcija je olak&scaron;avanje prepoznavanja određenih bolesti i njihovo registrovanje na jednoobrazan način. Definisanje slučajeva zaraznih bolesti nije jednostavno, jer uključuje kliničke, epidemiolo&scaron;ke i laboratorijske parametre, uz istovremeno očekivanje visoke senzitivnosti i specifičnosti. Ciljevi istraživanja su bili da se utvrdi primenljivost definicija slučaja hepatitisa B i C na Klinici za infektivne bolesti Kliničkog centra Vojvodine, te da se utvrdi senzitivnost i specifičnost primenjenih definicija slučaja hepatitisa B i C. Uz postojeći dijagnostički algoritam Klinike za infektivne bolesti Kliničkog centra Vojvodine, uvedena su tri seta definicija hepatitisa B i C: Evropskog centra za prevenciju i kontrolu bolesti (ECDC) iz 2008. i 2012.godine kao i američkih Centara za kontrolu bolesti (CDC) iz 2012. godine. Istraživanje je sprovedeno na Klinici za infektivne bolesti Kliničkog centra Vojvodine i tokom 12 meseci, u skladu sa predloženim definicijama slučaja, identifikovano je 150 ispitanika obolelih od hepatitisa B i C. Utvrđene su sledeće činjenice: preporučene definicije slučaja su primenljive u Republici Srbiji za laboratorijske i kliničke kriterijume, dok uključivanje epidemiolo&scaron;ke povezanosti u definicije slučaja ima malo praktičnog značaja za prijavljivanje hepatitisa; definicije slučaja koje uključuju i obavezno prisustvo kliničkih kriterijuma (najče&scaron;će definicije verovatnog slučaja) imaju nisku senzitivnost, a visoku specifičnost, kao posledica prisustva infekcije i u odsustvu bilo kakvih kliničkih manifestacija; definicije slučaja koje se zasnivaju samo na laboratorijskim kriterijumima imaju maksimalnu senzitivnost i specifičnost.</p> / <p>Adequate surveillance of communicable diseases is the actual challenge, not only in our country but also in developed countries. Modern epidemiological surveillance of communicable diseases is based on the appropriate case definitions. Their main purpose of them is to facilitate the recognition of certain diseases and their registration in a uniform manner. Case definition of communicable diseases is not easy, because it involves clinical, epidemiological and laboratory parameters, along with the expectated high sensitivity and specificity.The objectives of the study were to determine the applicability of the casedefinitions for hepatitis B and C in the Clinic for Infectious Diseases of the Clinical Center of Vojvodina and to determine the sensitivity and specificity of the applied definition of cases of hepatitis B and C. In addition to existing diagnostic algorithm of the Clinic for Infectious Diseases, three sets of hepatitis B and C case definitions were introduced: the European Centre for Disease Prevention and Control in 2008 and 2012 as well as the US Centers for Disease Control in 2012. The study was conducted at the Clinic for Infectious Diseases Clinical Center of Vojvodina over 12 months, and in accordance with the proposed case definitions, 150 patients suffering from hepatitis B and C were identified. We found following facts: recommended case definitions are applicable in the Republic of Serbia for laboratory and clinical criteria, while the inclusion of epidemiological connection between the case definition has little practical significance for reporting hepatitis; case definitions that include the obligatory presence of clinical criteria (most common definition of probable cases) have low sensitivity and high specificity, as a result of the presence of infection in the absence of any clinical manifestations; case definitions that are based solely on laboratory criteria showed maximum sensitivity and specificity.</p>

The purpose of this thesis is to scope the literature to understand how people who use injection drug (PWIDs) experience access to hepatitis C (HCV) testing and diagnosis. The design was a scoping review methodology, guided by Arksey and O’Malley, JBI, and PRISMA-ScR guidelines. A search was conducted through seven electronic databases using a peer-reviewed search strategy. Five studies were yielded through two-level screenings. The extracted data were synthesized using conventional data analysis and reported using tables and narrative summaries. Four categories were found: Awareness and Knowledge, Stigma, Healthcare Service, and Psychological Responses. The studies were conducted in Australia, UK, and US published between 2014 to 2018. A total of 19 participant characteristics were extracted to contextualize their experiences. The World Health Organization’s definition of accessibility should be defined through the guidance of the constructed truths of the individuals in the current context. The lack of demographic data and connection to client quotes further exacerbates the inequities among the population through overlooking their intragroup identities.

Submitted by Priscila Nascimento (pnascimento@icict.fiocruz.br) on 2013-03-28T17:37:00Z No. of bitstreams: 1 Carlos_Augusto_S_Fernandes.pdf: 3137240 bytes, checksum: a923f912893f0a2f21b79d189189ec4a (MD5) / Approved for entry into archive by Priscila Nascimento(pnascimento@icict.fiocruz.br) on 2013-03-28T17:53:35Z (GMT) No. of bitstreams: 1 Carlos_Augusto_S_Fernandes.pdf: 3137240 bytes, checksum: a923f912893f0a2f21b79d189189ec4a (MD5) / Made available in DSpace on 2013-03-28T17:53:35Z (GMT). No. of bitstreams: 1 Carlos_Augusto_S_Fernandes.pdf: 3137240 bytes, checksum: a923f912893f0a2f21b79d189189ec4a (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / A partir da descoberta do vírus da hepatite C (HCV), vários testes sorológicos e moleculares têm sido desenvolvidos para auxiliar no diagnóstico da infecção pelo HCV. Os objetivos deste estudo foram avaliar a dinâmica dos anticorpos anti-HCV, obtida pela leitura em densidade ótica/ponto de corte (do/co) dos testes sorológicos e, principalmente, o desempenho de metodologias moleculares para detecção do RNA do HCV em pacientes com resultados intermitentes na fase inicial da doença. Nos estudos sorológicos, foram realizados levantamentos epidemiológicos e dos valores de do/co dos anticorpos anti-HCV em 65 amostras de pacientes acompanhados desde a fase inicial de infecção pelo HCV. No estudo molecular, 244 amostras seriadas, coletadas durante a fase inicial de infecção pelo HCV, foram obtidas de 50 indivíduos que apresentavam viremia intermitente. As amostras foram submetidas a várias técnicas qualitativas para detecção do RNA do HCV e que foram realizadas de acordo com a disponibilidade à época dos testes. Porém, todas foram testadas pela técnica de Amplificação Mediada por Transcrição (TMA), que possui o maior limite inferior de detecção atualmente (9,6 Ul/mL). Nos testes sorológicos constatamos uma relação significante entre os valores dos anticorpos, medidos em do/co, com a evolução da infecção pelo HCV em fase inicial da doença e, verificando a dinâmica dos anticorpos, observamos que a queda rápida dos valores de do/co do anti-HCV é um excelente preditor de cura espontânea. Todas as técnicas moleculares obtiveram percentual elevado de resultados discordantes e acurácia baixa ou moderada, demonstrando a dificuldade em detectar níveis muito baixos de viremia. Nossos dados sorológicos demonstraram que o comportamento dos valores de leitura do/co dos anticorpos anti-HCV, em amostras seriadas mais frequentes, podem auxiliar no prognóstico de cura do paciente e na decisão de iniciar ou não o tratamento antiviral ainda no início da doença. O resultado não detectável por técnicas moleculares, dependendo dos limites de detecção da técnica utilizada, deve ser avaliado com cautela e, em caso de dúvida, optar pela realização de metodologias mais sensíveis. / Since the discovery of the hepatitis C virus (HCV), several serological and molecular tests have been developed to aid in the diagnosis of HCV infection. The objectives of this study were to evaluate the dynamics of anti-HCV antibodies, obtained by reading optical density/cut-off (od/co) of serological tests, and especially the performance of molecular methods for detection of HCV RNA in patients with intermittent results in the initial phase of the disease. In the serological studies, epidemiological surveys were performed and values od/co from the anti-HCV antibodies of the samples from 65 patients treated at an early stage of HCV infection. In the molecular study, 244 serial samples collected during the initial phase of HCV infection were obtained from 50 individuals who presented intermittent viremia. The samples were subjected to several qualitative techniques for detection of HCV RNA which was performed according to the availability at the time of testing. However, all were tested by the Transcription Mediated Amplification (TMA), which currently has the highest sensitivity (9.6 IU / mL). In the serological tests we found a significant relationship between the values of antibodies measured in the od/co, with the evolution of HCV infection in the early stages of the disease, and verifying the dynamic of the antibodies, we observed that the quickly drop of the values of od/co from anti-HCV antibodies is an excellent predictor of spontaneous healing. All molecular techniques had a high percentage of discordant results and low or moderate accuracy, demonstrating the difficulty in detecting very low levels of viremia. Our serological data showed that the behavior of the reading values of od/co from anti-HCV antibodies in fresh serial samples may help in the healing prognosis of the patient and the decision to start or not the antiviral treatment yet in the initial phase of the disease. The results not detectable by molecular techniques, depending on the detection limits of the technique used, must be evaluated carefully and, if in case of doubt, choose to take more sensitive methodologies.