Healthcare Associated Infections (HCAI) are complications resulting from patient handling at health services, which have turned into an important care focus in recent decades and represent an important public health problem, due to the fact that they are preventable through simple care acts like hand washing. The aim in this study was to characterize the knowledge, skills and attitudes of nursing and medical students about HCAI. A descriptive and analytical observation study was undertaken in the undergraduate programs in nursing and medicine offered at a federal public university in Fortaleza-CE, Brazil. Data were collected between September and December 2011, in a non-casual and judgment sample of 61 students, 28 from the nursing program (6th semester) and 33 from the medicine (7th semester). Data were collected with the help of a questionnaire and an observation instrument. For the statistical processing of the data, the software SPSS was used, and the Chi-Square test was applied to measure the correlation between knowledge, skills and attitudes among nursing and medical students. The ethical premises of resolution 196/96 were complied with. The study group was 70.5% female, with a mean age of 22.6 years ( 1.9). Most students indicated they had contact with the theme HCAI in their undergraduate program, 100% in nursing and 87.9% in medicine, but informed that the contents addressed were only partially sufficient for the sake of professional performance with emphasis on this theme. As observed, the knowledge of most nursing and medical students about HCAI is good; concerning attitude, 100% of the nursing and 93.9% of the medical students are interested in enhancing their knowledge about HCAI; with regard to attitude, 100% of the nursing and 93.9% of the medical students are interested in expanding their knowledge about HCAI: only 35.7% of nursing and 15.1% of medical students employed the correct hand washing technique. In conclusion, nursing and medical students tend to graduate with deficient knowledge and skills about HCAI, as the contents addressed during their undergraduate program do not produce solid knowledge, resulting in deficient skills to prevent HCAI in patient care, and do not arouse interest in assuming an attitude to gain further knowledge about the theme. / As InfecÃÃes Relacionadas à AssistÃncia à SaÃde (IRAS) sÃo complicaÃÃes decorrentes da manipulaÃÃo do paciente em serviÃos de saÃde, que se tornaram importante foco de atenÃÃo nas Ãltimas dÃcadas, representando sÃrio problema de saÃde pÃblica, pelo fato de ser prevenÃvel por meio de simples cuidado, como a higiene das mÃos. O objetivo do estudo foi caracterizar o conhecimento, a habilidade e atitude de acadÃmicos de enfermagem e medicina relacionados Ãs IRAS. Trata-se de um estudo observacional, de carÃter descritivo e analÃtico, realizado nos cursos de graduaÃÃo em Enfermagem e Medicina de universidade pÃblica federal de Fortaleza-CE, Brasil. A coleta de dados ocorreu de setembro a dezembro de 2011, a amostra foi nÃo casual e de julgamento com 61 acadÃmicos, sendo 28 do curso de Enfermagem (6 semestre) e 33 de Medicina (7 semestre). A coleta de dados foi atravÃs de questionÃrio e instrumento de observaÃÃo. Os dados foram processados estatisticamente com o software SPSS e o teste Qui-Quadrado foi utilizado para medir a correlaÃÃo entre conhecimento, habilidade e atitude entre os acadÃmicos de Enfermagem e Medicina. Foram respeitados os preceitos Ãticos da resoluÃÃo 196/96. O grupo estudado foi constituÃdo por 70,5% de mulheres, com mÃdia de idade de 22,6 anos ( 1,9). A maioria dos acadÃmicos relatou contato com o tema IRAS durante a graduaÃÃo, 100% Enfermagem e 87,9% Medicina, porÃm informaram que o conteÃdo abordado foi parcialmente suficiente para o desempenho profissional com Ãnfase nessa temÃtica. Observou-se que os acadÃmicos de Enfermagem e Medicina possuÃam na sua maioria conhecimento eficaz sobre IRAS; quanto à atitude 100% dos acadÃmicos de Enfermagem e 93,9% de Medicina possuÃam interesse em ampliar seus conhecimentos em IRAS; quanto à habilidade em higiene das mÃos, apenas 35,7% dos acadÃmicos de enfermagem e 15,1% de medicina empregaram a tÃcnica correta. Concluiu-se com este estudo que os acadÃmicos de enfermagem e medicina tendem a egressar da graduaÃÃo com dÃficit de conhecimento e habilidade sobre IRAS, pois os conteÃdos abordados durante a graduaÃÃo de ambos nÃo gera conhecimento sÃlido, portanto estes acadÃmicos passam a ter habilidades deficientes para assistÃncia ao paciente, prevenindo IRAS, assim como nÃo gera interesse para que detenham de atitude de busca por maior conhecimento sobre tal temÃtica.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / As infecÃÃes relacionadas à assistÃncia à saÃde estÃo entre as principais complicaÃÃes em pacientes que se submetem a transplante de rim, em virtude, nÃo somente, dos regimes de imunossupressÃo a que estÃo submetidos, como a cuidados desempenhados pelas equipes de saÃde. O objetivo deste estudo foi analisar infecÃÃes relacionadas à assistÃncia à saÃde em pacientes transplantados renais em 2012, no MunicÃpio de Fortaleza, que possui serviÃos de transplante renal consolidados. Fez-se um estudo transversal onde foram analisadas as fichas ambulatoriais, prontuÃrios e fichas de notificaÃÃo e investigaÃÃo da CCIH de pacientes que realizaram transplante renal em 2012, no HUWC e HGF, instituiÃÃes com recordes sucessivos neste tipo de procedimento. Um total de 237 participantes, sendo, 101 (mÃdias de idade: 43,2 anos) pertencentes ao HUWC e 136 (mÃdias de idade: 45,4 anos) ao HGF, foi incluÃdo no estudo. Em ambas as instituiÃÃes, a maioria das pessoas era do sexo masculino, casada e residia na Capital do CearÃ. Grande parte delas tambÃm tinha o IMC normal, era hipertensa, tinha como principais causas de IRC: inderterminada, HAS e nefrites. A proporÃÃo de procedimentos invasivos realizados foi: biopsia do enxerto (HUWC: 45,54%; HGF: 26,47%), punÃÃo de cateter venoso central (HUWC: 98,01%; HGF: 97,06%), FAV (HUWC: 66,33%; HGF: 94,11%), e passagem de cateter duplo J (HUWC: 39,6%; HGF: 22,06%). A estimativa de prevalÃncia de IRAS nos 101 pacientes transplantados renais no HUWC foi de 50 (49,05%), e no HGF, 31 (22,79%). As IRAS mais comuns, tanto no HUWC, como no HGF, foram infecÃÃes do trato urinÃrio, e os principais agentes etiolÃgicos isolados, Klebsiella pneumoniae e Escherichia coli. No HUWC, os fatores sociodemogrÃficos, clÃnicos e epidemiolÃgicos que apresentaram associaÃÃo estatisticamente significante com o acometimento por IRAS foram: a classificaÃÃo do IMC (p<0,03), o tempo em diÃlise antes do transplante (p<0,05), o tempo de internaÃÃo total (p<0,0001), o tempo de cirurgia (p<0,001), o tempo de isquemia fria (p<0,01), a passagem de cateter duplo J (p<0,003), o tempo de uso do TOT (p<0,03) e o tempo de uso da SVD (p<0,04) no HUWC; no HGF, a classificaÃÃo do IMC (p<0,04), o LES como causa de IRC (p<0,01), a transfusÃo sanguÃnea antes do transplante (p<0,02), o tempo de internaÃÃo total (p<0,001) e o tempo de uso do CVC (p<0,04). Portanto, durante todo o perÃodo perioperatÃrio, hà necessidade de desenvolvimento de aÃÃes cautelosas por toda a equipe de saÃde, de forma a prevenir infecÃÃes e gastos desnecessÃrios do governo com internamentos e tratamentos prolongados, sustentando o crescimento da tÃcnica de transplantaÃÃo renal no Estado nos Ãltimos anos. / The healthcare-related infections are among the major complications in patients who undergo kidney transplant, by virtue not only of immunosuppression schemes to which they are subjected, as the care carried out by health teams. The aim of this study was to analyze healthcare-related infections in renal transplant recipients in 2012, in the city of Fortaleza, which has consolidated renal transplant services. A cross-sectional study where outpatient records were analyzed, charts and tokens for notification and investigation of patients who performed CCIH kidney transplant in 2012, in HUWC and HGF, institutions with successive records in this type of procedure. A total of 237 attendees, being, 101 (average age: 43.2 years) belonging to the HUWC and 136 (average age: 45.4 years) to the HGF, was included in the study. In both institutions, most people were male, married and resided in the Capital of CearÃ. Most of them also had the normal BMI was hypertensive, had as main causes of IRC: inderterminada, SAH and lupus nephritis. The proportion of invasive procedures performed were: graft biopsy (HUWC: 45.54%; HGF: 26.47%), central venous catheter puncture (HUWC: 98.01%; HGF: 97.06%), FAV (HUWC: 66.33%; HGF: 94.11%), and passage of double-J catheter (HUWC: 39.6%; HGF: 22.06%). The estimated prevalence of IRAS in 101 renal transplant recipients at HUWC was 50 (49.05%), and HGF, 31 (22.79%). The most common IRAS, both in HUWC, as in HGF, were urinary tract infections, and the main etiological agents isolated Klebsiella pneumoniae and Escherichia coli. In HUWC, the socio-demographic factors, clinicians and epidemiologists who presented statistically significant association with involvement by IRAS were: the classification of BMI (p<0.03) time on dialysis before transplantation (p<0.05), the total length of stay (p<0.0001), the time of surgery (p<0.001), cold ischemia time (p<0.01), the passage of double-J catheter (p<0.003), the speaking time of TOT (p<0.03) and time of use of the SVD (p<0.04) in HUWC; on HGF, classification of BMI (p<0.04), LES as a cause of IRC (p<0.01), blood transfusion before transplantation (p<0.02), the total length of stay (p<0.001) and time of use of the CVC (p<0.04). Therefore, throughout the perioperative period, there is a need for development of cautious actions throughout the health team, in order to prevent infections and unnecessary government spending with hospitalizations and prolonged treatments, supporting the growth of renal transplantation technique in the State in recent years.

Nos hospedeiros mamíferos, os parasitas do gênero Leishmania vivem nos macrófagos se evadindo de mecanismos microbicidas dessas células, tais como a produção de óxido nítrico (NO). A produção de NO pela enzima óxido nítrico sintase induzida (iNOS) nos macrófagos requer L-arginina como substrato, o mesmo aminoácido utilizado pela arginase para produzir ornitina e uréia. Logo, a arginase pode atuar na sobrevivência de Leishmania no hospedeiro competindo com a iNOS, reduzindo a produção de NO, além de seu papel na via de poliaminas, essencial para a replicação dessas células. Com isso, o objetivo desse estudo é elucidar o papel da arginase de L. (L.) amazonensis durante o ciclo de vida do parasita, particularmente, sua função no estabelecimento e na manutenção da infecção da célula hospedeira, e como esse papel seria exercido. Nesse sentido, obtivemos soros policlonais anti-arginase, a partir da arginase recombinante de L. (L.) amazonensis purificada, e esses soros foram utilizados na imunomarcação da enzima em preparações com formas promastigotas e macrófagos infectados com amastigotas de L. (L.) amazonensis. Assim, determinamos a compartimentalização da arginase nos glicossomos tanto na forma promastigota do parasita como na forma amastigota, durante a infecção. Além disso, obtivemos diversos mutantes com a expressão de arginase modificada quanto à quantidade e localização que nos permitiram avaliar a importância da compartimentalização dessa enzima nos glicossomos. Entre esses mutantes temos: superexpressores de arginase, com e sem sinal de endereçamento para glicossomo; parasitas com um alelo de arginase nocauteado e o outro substituído pelo cassete contendo o segmento ddFKBP-ARG, que teriam a expressão de arginase regulada pelo domínio ddFKB sendo nocautes funcionais de arginase; e finalmente, também obtivemos parasitas nocaute nulo de arginase. A análise desses mutantes permitiu conclusões importantes para o conhecimento da fisiologia do parasita e sua relação com o macrófago, revelando que o papel da arginase de Leishmania parece ser muito mais complexo do que o inicialmente postulado, participando na regulação de outras vias metabólicas do próprio parasita e da célula hospedeira. Paralelamente, também determinamos que o sistema ddFKBP é funcional em L. (L.) amazonensis, e assim pode ser utilizado no estudo funcional de outras proteínas importantes para esses parasitas. / In the mammal host, Leishmania parasites live inside macrophages escaping from their microbicidal mechanisms, such as the nitric oxide (NO) production. The macrophage NO production by inducible nitric oxide synthase (iNOS) requires L-arginine as substrate, the same amino acid required by arginase to generate ornithine and urea. So, arginase may play a dual role in Leishmania survival reducing the NO by competing with iNOS, and participating in the polyamines pathway, which is essential for the cells replication. Considering this, the aim of this study is to elucidate the role of L. (L.) amazonensis arginase during the parasite life cycle, mainly its function for the establishment and maintenance of the host cell infection, besides to elucidate the way that this enzyme plays its role. With this in mind, we obtained polyclonal anti-arginase sera using purified recombinant L. (L.) amazonensis arginase, these sera were used in immunolabelling assays of L. (L.) amazonensis promastigotes and macrophages infected with L. (L.) amazonensis amastigotes. These experiments determined that arginase is compartmentalized in the glycosomes of both promastigotes and amastigotes, during infection. Besides, we obtained several mutants with altered arginase expression, modified in terms of quantity and location, which permitted us to evaluate the importance of glycosome arginase compartmentalization. Among these mutants are: overexpressors of arginase, with and without glycosomal addressing signal; parasites with one arginase allele knocked out and the other one replaced by a sequence containing the ddFKBP-ARG fusion that would allow us to regulate arginase expression, working like a functional arginase knockout; and finally, we also obtained arginase null knockouts parasites. The mutants analyses lead us to important conclusions for the knowledge of the parasite physiology and its relationship with the host macrophage, revealing that the Leishmania arginase role appears to be more complex than previously thought, playing an important role in the regulation of other metabolic pathways, of the own parasite and of the host cell. In the other hand, we also determined that the ddFKBP system is functional in L. (L.) amazonensis, and then can be used for functional studies of other important parasite´s proteins.

Orientadores: Maria Francisca Collela dos Santos, Jorge Rizzato Paschoal / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:24:09Z (GMT). No. of bitstreams: 1 Borges_LeticiaReis_M.pdf: 2034867 bytes, checksum: c8a8d60173531749240dbdcb7dd4df44 (MD5) Previous issue date: 2012 / Resumo: Introdução: A avaliação do processamento auditivo envolve a detecção e interpretação dos eventos sonoros desde a orelha externa até o córtex auditivo em uma tarefa complexa do sistema auditivo nervoso central. A otite média é a infecção mais comum que acomete as crianças nos primeiros anos de vida. A inflamação na orelha média pode alterar o sistema auditivo periférico e central. Objetivo: Analisar o Processamento Auditivo (Central), PA(C), de crianças com histórico de otite média nos primeiros cinco anos de vida. Os objetivos específicos foram analisar os resultados obtidos nos testes de PA(C) em crianças com e sem histórico de otite média na infância, considerando-se o gênero, as orelhas e a faixa etária; classificar os achados dos testes de PA(C) quanto às habilidades alteradas e comparar o resultado dos testes de PA(C) em crianças submetidas à cirurgia para inserção de tubos de ventilação em estudantes da Rede Pública e da Rede Particular de Ensino. Métodos: Foram avaliadas 109 crianças na faixa etária entre oito e 12 anos, do gênero masculino e feminino. Os indivíduos foram reunidos em três grupos: o grupo controle (GC) foi formado por 40 crianças sem antecedentes de otite média; o grupo experimental I (GEI) foi constituído por 39 estudantes da Rede Pública com histórico de otite média secretora que se submeteram à cirurgia para inserção de tubos de ventilação bilateral nos cinco primeiros anos de vida e o grupo experimental II (GEII) foi composto por 30 estudantes da Rede Particular de Ensino com histórico de otite média secretora que se submeteram à cirurgia para inserção de tubos de ventilação bilateral nos cinco primeiros anos de vida. Todas as crianças foram submetidas à avaliação audiológica completa e avaliação do PA(C) que incluiu os testes dicótico de dígitos, identificação sentenças sintéticas com mensagem competitiva ipsilateral, teste xii dicótico não verbal, padrão de frequência e detecção de intervalo no ruído. Resultados: Na comparação entre as orelhas nos testes de PA(C), considerando-se os grupos, a orelha esquerda apresentou desempenho estatisticamente inferior no teste dicótico de dígitos e no teste de padrão de frequência no GEI. Os escolares dos GEI e GEII apresentaram desempenhos estatisticamente inferiores quando comparado ao GC no teste dicótico de dígitos e teste de detecção de intervalos no ruído. Na análise dos testes de PA(C) entre os GEI e GEII, os sujeitos do GEI tiveram resultados rebaixados estatisticamente significantes no teste dicótico de dígitos na orelha esquerda e no teste de detecção de intervalos no ruído. A habilidade auditiva prejudicada de maior prevalência encontrada no GEI foi de resolução temporal e no GEII de figura-fundo. Conclusão: As crianças com histórico de otite média secretora nos cinco primeiros anos de vida e que se submeteram à cirurgia para inserção de tubo de ventilação bilateral, deste estudo, apresentaram alterações nas habilidades auditivas avaliadas, sendo que os escolares da Rede Pública de Ensino obtiveram respostas inferiores nos testes de PA(C) quando comparados aos escolares da Rede Particular de Ensino / Abstract: Introduction: Auditory processing evaluates the stages involved in detecting and interpreting sound events from the external ear to the auditory cortex in a complex central auditory nervous system. Otitis Media is one of the most common infectious diseases in early childhood. Middle ear inflammation can change the peripheral and central auditory system. Objective: To analyze the results from (Central) Auditory Processing, (C)AP, in children suffering from otitis media in the first five years of age. The specific objectives were to analyze, considering gender, the ears and age, the results obtained in tests of (C)AP in children without otitis media history and children who suffered from otitis media in childhood, to classify central auditory processing test findings regarding the hearing skills evaluated and to compare the results of (C)AP evaluates in children who underwent surgery for bilateral ventilation tubes placement belonging to student from Public and Private Schools. Methods: A total of 109 students between eight and 12 years old, males and females, were divided into three groups. The Control Group (CG) consisted of 40 students from Public School without otitis media history, the Experimental Group I (EGI) consisted of 39 students from Public School suffering from secretory otitis media in their first five years of age and undergoing a surgery for bilateral ventilation tubes placement and the Experimental Group II (EGII) consisted of 30 students from Private School suffering from secretory otitis media in their first five years of age and undergoing a surgery for bilateral ventilation tubes placement. All children underwent complete audiological evaluation and assessment of (C)AP which included the following tests: the dichotic digits, the pediatric speech intelligibility/synthetic sentence identification with ipsilateral competing message, the dichotic nonverbal, the pitch pattern sequence and the gaps-in-noise. Results: xiv Comparing the ears in the (C)AP tests, considering the groups, statistically the left ear showed significant lower performance in the dichotic digits test and the pitch pattern sequence test. The students from EGI and EGII showed lower performance whether compared to CG not only in the dichotic digits test but also in the gaps-in-noise test. Analyzing the results of (C)AP between the Experimental Groups, EGI children had significant lower results in the dichotic digits test, considering the left ear, and gaps-innoise test. The hearing skills were mostly found altered in the temporal found resolution for EGI and figure-ground for EGII. Conclusion: Children suffering from secretory otitis media in their first five years of age and undergoing a surgery for bilateral ventilation tubes placement showed lower performance in auditory abilities, and children from public school had lower responses in (C)AP test when compared with students from private school / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Orientadores: Célia Regina Garlipp, Carlos Emilio Levy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:20:39Z (GMT). No. of bitstreams: 1 Martinez_MayaraHidalgoMagri_M.pdf: 2010266 bytes, checksum: 23bb4f89ea7b258a0fd5fe0e20f6cc1f (MD5) Previous issue date: 2012 / Resumo: Infecção do trato urinário (ITU) é muito comum na prática clínica, acometendo pessoas de ambos os sexos em todas as faixas etárias. Para seu diagnóstico é importante definir rapidamente a presença de bacteriúria e piúria bem como a etiologia da doença através da urocultura. A urocultura é o teste microbiológico mais comum na prática laboratorial, embora seja um procedimento demorado e de custo relativamente elevado. Nosso objetivo foi avaliar a aplicação de um sistema automatizado de análise da urina (LabUMat/UriSed) como método de triagem para a investigação de ITU através da comparação de seus resultados com os das uroculturas. Analisamos amostras de urina de pacientes adultos e crianças de ambos os sexos provenientes de ambulatórios e enfermarias do Hospital de Clínicas da UNICAMP encaminhados às Seções de Líquidos Biológicos e Microbiologia da Divisão de Patologia Clínica para análise físicoquímica, sedimento e urocultura. Foram estabelecidos valores de cortes baseados na comparação dos resultados das uroculturas com os parâmetros urinários: leucócito-esterase, nitrito, leucócitos, bactérias e leveduras, sendo que a positividade de pelo menos um destes parâmetros classificava a amostra para uma triagem positiva para ITU. O estudo foi conduzido em três etapas: Na primeira etapa, a análise de 2126 amostras de urinas permitiu adotar um primeiro valor de corte para os parâmetros analisados: contagem de bactérias >11/campo; contagem de leucócitos >5/campo, presença de leveduras além de nitrito e leucócito-esterase positivos. Esses valores foram comparados com os resultados da urocultura em meio CLED e testados na rotina laboratorial. Em uma segunda etapa, com a finalidade de aprimorar o valor de corte dos parâmetros e aumentar o valor preditivo positivo sem comprometer o valor preditivo negativo, estabeleceu-se um novo valor de corte. Para tanto, foram analisadas 2075 amostras de urinas e com os seguintes valores de corte estabelecidos: contagem de bactérias 'maior ou igual'12,5/campo; contagem de leucócitos >5/campo, presença de leveduras e nitrito bem como leucócito-esterase positivo 'maior ou igual'2+. Esses valores foram comparados com os resultados das uroculturas em meio CLED e testados na rotina laboratorial. A fim de refinar e validar o teste de triagem para urocultura foram analisados, em uma terceira etapa, 1379 amostras de urina. Nesta etapa os valores de corte dos parâmetros foram: contagem de bactérias >12,5/campo, contagem de leucócitos >5/campo, presença de leveduras e leucócito - esterase positivos 'maior ou igual'2+. Nesta etapa as amostras cujos parâmetros urinários avaliados estavam abaixo do valor de corte, foram consideradas negativas para ITU e semeadas em meio CLED. As amostras em que pelo menos um dos parâmetros estudados estava acima do valor de corte, foram consideradas positivas, sendo semeadas em meio Chromagar a fim de se identificar presuntivamente os patógenos. O teste mostrou sensibilidade de 97%, valor preditivo negativo de 99%, valor preditivo positivo de 27%, especificidade de 59% e acurácia de 64%. Em todas as etapas observou-se uma potencial redução de 50% nas semeaduras de uroculturas. Os dados sugerem que o sistema automatizado LabUMat / UriSed é uma boa ferramenta para a triagem de ITU, especialmente se considerarmos os dados clínicos dos pacientes / Abstract: Urinary tract infection (UTI) is very common in clinical practice, affecting people of both genders in all age groups. For the laboratory diagnosis of UTI is of great importance the definition of significant bacteriuria and pyuria and a bacterial culture of a urine sample to establish the etiology of the disease. The quantitative urine culture is the commonest microbiology test in Clinical Pathology Laboratory practice, although it is a very time-consuming and expensive procedure. Our aim was to evaluate the performance of the LabUMat with UriSed System as a screening method for the investigation of UTI comparing its results with the outcome of urine culture. We studied urine samples from children and adults of both genders from outpatients and hospitalized patients from Clinical Hospital / UNICAMP referred to Body Fluids and Microbiology Laboratories at Division of Clinical Pathology for physicochemical analysis, sediment observation and urine culture. We established cut-off values based on the comparison of the outcome of urine cultures with urinary parameters: leukocyte esterase, nitrite and quantitative determination of bacteriuria, leukocyturia and presence of yeasts. A positivity of at least one parameter classified the sample as a positive screening of UTI. This study was conducted in three stages: In the first stage, the analysis of 2,126 urine samples allowed to adopt the first cut-off value for the parameters analyzed: quantification of bacteriuria (>11 elements/hpf), quantification of leukocyturia (>5 cells/hpf), presence of yeasts besides nitrite and leukocyte esterase positive. These values were compared with the outcome of uroculture in CLED agar medium culture and tested in the laboratory routine. In the second stage, in order to improve cut-off values of urinary parameters and increase the positive predictive value without compromising the negative predictive value, it was established a new cut-off value. We analyzed 2,075 urine samples with the following established cut-off values: quantification of bacteriuria (> or = 12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts, nitrite and leukocyte esterase positive (> or = 2+). These values were compared with the outcome of uroculture and tested in the laboratory routine. In order to refine and validate the screening test for uroculture were analyzed, in a third stage, 1,379 urine samples. In this stage the cutoff values of the parameters were: quantification of bacteriuria (>12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts and leukocyte esterase positive (> or = 2+). In this stage the urinary samples whose evaluated parameters were below the cut-off value were considered negative for UTI and were plated in CLED agar medium culture. Samples which at least one of the parameters evaluated was above the cut-off value, were considered positive, and were plated in Chromagar commercial medium, in order to presumptively identify pathogens. The test showed sensitivity of 97%, negative predictive value of 99%, positive predictive value of 27%, specificity of 59% and accuracy of 64%. In all stages we observed a potential 50% reduction in sowing urocultures. The data suggest that the LabUMat with UriSed System is a good tool for screening for UTI, especially if we consider patients' clinical data / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Orientador: Maria Silvia Viccari Gatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-03T22:33:53Z (GMT). No. of bitstreams: 1 Rodrigues_DanieleMasselli_M.pdf: 1852380 bytes, checksum: f83cb847eec2bcf31bf414b3bbf154ba (MD5) Previous issue date: 2004 / Resumo: O vírus da encefalomielite murina de Theiler (TMEV) é um patógeno entérico de camundongos, pertencente ao gênero Cardiovirus da família Picornaviridae. O TMEV é um vírus não envelopado, icosaédrico, com 20 - 30 nm e genoma constituído de RNA fita simples com polaridade positiva. Os TMEV têm sido classificados em dois subgrupos, de acordo com sua atividade biológica após inoculação intracerebral. Cepas neurovirulentas (GDVII e FA) induzem uma encefalite aguda e fatal, enquanto aquelas de baixa virulência (TO, WW, DA e BeAn) persistem no sistema nervoso central, induzindo doença crônica, caracterizada por desmielinização. A infecção natural por TMEV tem sido demonstrada em colônias onvencionais de camundongos e, em sua maioria, a infecção é assintomática. Embora o TMEV seja descrito como um patógeno de camundongos, anticorpos para TMEV-GDVII têm sido detectados em soros de ratos provenientes de biotérios que mantêm colônias convencionais. A prevalência da infecção por TMEV-GDVII nestas colônias de ratos é alta, em torno de 54,6%. Assim, este trabalho teve por finalidade demonstrar, por métodos sorológicos e molecular, a infecção natural por TMEV em colônias de ratos. Soros destes animais foram analisados pela reação de imunofluorescência indireta e a presença de anticorpos anti-TMEV-GDVII foi detectada em 86,3% deles. Ao mesmo tempo, pelo teste de soroneutralização, 77,2% destes soros demonstraram anticorpos neutralizantes para TMEV-GDVII. Com o objetivo de isolar o vírus de ratos, sistemas ¿in vitro¿ e ¿in vivo¿ foram utilizados. Nove passagens sucessivas de amostras de suspensão intestinal foram feitas em células BHK-21 e não foi possível demonstrar efeito citopático. Sinais clínicos da infecção por TMEV em camundongos, ou seja, paralisia das patas posteriores e tremores, foram demonstrados em camundongos e ratos neonatos inoculados com suspensão intestinal de ratos soropositivos e com a cepa padrão de TMEV-GDVII. Os resultados da RT-PCR demonstraram a presença de RNA viral em amostras de cérebro de ratos inoculados com a suspensão intestinal, com TMEV-GDVII e nas amostras de fezes de ratos provenientes de diferentes biotérios convencionais. Os resultados demonstram que ratos se infectam naturalmente por TMEV e, embora hajam poucas descrições na literatura da interferência deste vírus em pesquisas biomédicas, a monitoração sanitária para TMEV em biotérios que mantêm colônias de ratos deve ser incluída / Abstract: Theiler¿s murine encephalomyelitis virus (TMEV) is an enteric pathogen of mice and belongs to the Cardiovirus genus in the family Picornaviridae. TMEV is a non-enveloped, icosaedric virus with 20 ¿ 30 nm size and it has an RNAss positive sense genome. TMEV has been divided in two subgroups on the basis of their biological activities after intracerebral inoculation. Neurovirulent strains (GDVII and FA) causes an acute and fatal encephalitis in mice and in contrast, low neurovirulent strains (DA, BeAn 8386, WW and TO) causes a persistent infection in the central nervous system and produce a chronic disease characterized by demyelination. TMEV infection with low neurovirulent strains has been used as an experimental model to help the studies on demyelination process induced by virus infection and to study diseases as Multiple Sclerosis. The natural infection by TMEV has been related in conventional colonies of mice and it¿s frequently asymptomatic. Although TMEV has been described as a pathogen of mice, antibodies against TMEV-GDVII has been detected in serum of rats reared in non-barrier colonies. Facing this, the purpose of the present study was to demonstrate the natural infection of TMEV in rat colonies through serological and molecular methods (RT-PCR). The rat serum were analysed by indirect immunofluorescence assay and antibodies against TMEV-GDVII were detected in 86,3% of the serum analysed. In the neutralization assay, 77,2% of the same serum showed neutralizing antibodies anti TMEVGDVII. To further isolate this rat virus, ¿in vitro¿ and ¿in vivo¿ systems were used. Nine blinded passages of the intestinal suspension were realized in BHK-21 cells, but no citopathic effect was identified. Clinical signs of TMEV infection in mice were characterized by flaccid paralisis of hind legs and tremor when newborn rats and mice were inoculated with intestinal suspension of seropositive rats and with the prototype strain of TMEV-GDVII. The RT-PCR results showed the RNA genome in the brain samples of rats and mice inoculated both with the intestinal suspension and the prototype strain. In the fecal samples, the RNA genome was also detected. In summary, rats can be naturally infected by TMEV and although there are a few examples in the literature of TMEV infection interference with biomedical researches, a health monitoring program for TMEV should be included in the rat colonies / Mestrado / Microbiologia / Genetica e Biologia Molecular

Class of 2012 Abstract / Specific Aims: 1• Determine the results of urine culture and susceptibility testing for patients with uncomplicated UTI at an emergency department 2• Determine empiric antibacterial agents prescribed for treatment of uncomplicated UTI in the emergency department 3• Compare pathogen susceptibility pattern specific for patients with uncomplicated UTI compared to the overall institution antibiogram Examine the use of cephalexin for uncomplicated UTI in emergency department patients Methods: A retrospective electronic medical records of adult female patients admitted to University Medical Center in Tucson, Arizona, emergency department with a diagnosis of uncomplicated urinary tract infection (UTI) between June 1, 2010 and May 31, 2011 were collected. Different aspects of uncomplicated urinary tract infection (UTI) were characterized, and prescriptions for empiric antibiotic treatment were recorded. Culture results and susceptibility reports as well as antibacterial treatment decisions were studied to evaluate types of pathogens and resistance patterns along with therapy prescribed. The data was managed and analyzed by using SAS. All data was tabulated and described using summary statistics. Main Results: The dominant isolate of the study population was E.coli (88%). Cephalexin was prescribed 76% of the time, nitrofurantoin 8.4%, ciprofloxacin 7.6%, and TMP/SMX 5% of the time. The susceptibility rate of ampicillin was 50%, cefazolin 91%, ciprofloxacin 98%, nitrofurantoin 92%, and TMP/SMX 76%. Conclusions: Our study revealed that the resistant rate of TMP/SMX exceeded 20%; however, ciprofloxacin and nitrofurntoin susceptibility remains high. Cephalexin was the most commonly prescribed treatment, but not included in the antimicrobial susceptibility test (AST) panel.

Abstract The purpose of the present study was to compare the procalcitonin (PCT), neopterin, interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12) levels with those of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in cancer patients with (56) and without infection (36) and to evaluate their ability to differentiate infections from neoplastic fever (n = 10). The infection group had statistically higher levels of CRP (91 vs. 19 mg/l, p &lt; 0.001), PCT (0.28 vs.0.12 ng/ml, p &lt; 0.001), neopterin (12.8 pg/mL vs. 4.0 pg/mL, p &lt; 0.001), IL-8 (27.7 vs. 16.9 pg/ml, p = 0.032), IL-10 (3.8 pg/mL vs. 1.8 pg/mL, p = 0.005) and ratios of neopterin to IL-12 (1.74 vs. 0.11, p &lt; 0.001), and IL-10 to IL-12 (0.4 vs. 0.05, p &lt; 0.001) than the non-infection group. After a subdivision of the study population into patients with local or advanced disease, the differences between the study groups remained statistically significant for CRP and neopterin both in local (p &lt; 0.05 and p &lt; 0.001) and advanced diasease (p &lt; 0.01 and p &lt; 0.001) and in advanced disease for PCT (p &lt; 0.001), IL-10 (p &lt; 0.05), IL-12 (p &lt; 0.05), neopterin to IL-12 ratio (p &lt; 0.01) and IL-10 to IL-12 ratio (p &lt; 0.01). The ESR levels did not differ between the study group (50 vs. 42 p = 0.16), while the IL-12 values were lower in the infection group (10.6 pg/mL vs. 71.6 pg/mL, p = 0.007). The tumor load did not influence any of the studied infection markers within the study groups. For identifying bacteremia by area under the operating characteristics curves (AUC), the highest values were obtained for PCT (0.92) and neopterin (0.90), and slightly lower values were recorded for the ratios neopterin to IL-12 (0.79) and IL-10 to IL-12 (0.75). None of the markers or ratios were good for differentiating non-bacteremic infections from neoplastic fever, the AUC values rangin from 0.27 for ESR to 0.61 for IL-10 to IL-12 ratio. The simultaneous use of the ratio of neopterin to IL-12 with its high sensitivity (82%) and that of IL-10 to IL-12 with its high specificity (90%) should be further studied.

Salmonella enterica species are intracellular bacteria causative agents of gastroenteritis and typhoid fever in humans. Pregnancy poses an increased risk of severe Salmonellosis in many mammalian species contributing to miscarriage and/or maternal illness. Previous studies indicated that Salmonella infection in pregnant mice caused rapid fetal and maternal death due to massive bacterial proliferation in the placenta. However, the susceptibility of human primary trophoblast cells (cTBCs) to Salmonella infection was not known. We hypothesized that human placental trophoblast cells are productively infected and provide a unique intracellular niche that permits uncontrolled Salmonella replication due to an ineffective maternal innate immune response to the virulent bacteria resulting in placental death. Firstly, we observed that S.Tm strains defective in the Salmonella pathogenicity island (SPI)-1 type III secretion system (TTSS) (S.Tm-ΔinvA) were unable to enter epithelial cells, but efficiently infected placental choriocarcinoma cell lines through scavenger receptor-mediated endocytosis. Next, we observed that S.Tm failed to grow vigorously in macrophages, but replicated rapidly within epithelial and placental trophoblast cells. Further examination of intracellular localization of S.Tm indicated that bacteria were arrested in early Rab5 expressing phagosomal vesicles within trophoblast cells, whereas phagosomal maturation progressed steadily in macrophages (with expression of lysosomal-associated membrane protein-1 (LAMP-1) and cathepsin D). Moreover, human primary cTBCs harboring S.Tm underwent rapid death of the cells. Infected cTBCs expressed phosphorylated-receptor-interacting serine/threonine-protein kinase (RIPK)-1 protein and phosphorylated-mixed lineage kinase domain-like (MLKL), suggesting induction of the necroptosis pathway of cell death. Furthermore, specific inhibition of necroptosis rescued S.Tm-induced death of cTBCs. Finally, S.Tm infected trophoblast cells produced interleukin (IL)-10, and signal transducer and activator of transcription (STAT)-3 signalling. This correlated to delayed phagosomal maturation which consequently facilitated intracellular pathogen proliferation. Overall, human trophoblast cells may act as reservoirs for S.Tm survival and may aid dissemination in the pregnant host.

La primo-infection est un moment critique de l’établissement du réservoir justifiant de l’initiation d’un traitement précoce. Nous avons initié un essai randomisé évaluant l’impact de deux ans d’un traitement antirétroviral intense (essai ANRS147 OPTIPRIM, trithérapie versus pentathérapie) sur le réservoir et avons initié des études physiopathologiques au cours de cet essai. Nous montrons ainsi la faible diversité génétique des virus en primo-infection dans les compartiments sanguins et rectaux. Le réservoir s’établit dès le premier mois de l’infection par diffusion d’un cluster viral homogène au sein des lymphocytaires T CD4 naïfs (TN) et mémoires centrales (TCM), transitionnelles (TTM), effectrices (TEM) quiescents. Il en résulte une perturbation de l’homéostasie lymphocytaire associée à une faible contribution au réservoir des cellules peu différenciées à longue demi-vie, TN et TCM. Par ailleurs nous montrons que la majorité des patients au moment de leur primo-infection n’ont pas la capacité de développer des réponses T CD8 à même de supprimer la réplication virale comme chez les patients HIV Controllers. Après deux ans de traitement, nous observons que la diversité virale n’a pas évolué, par contre la taille du réservoir est fortement réduite. Les anomalies de l’homéostasie lymphocytaire T CD4 persistent, par contre le traitement très précoce a permis de protéger les TN et TCM. Il n’y a pas de bénéfice additionnel d’une pentathérapie mais nous avons validé le concept qu’un traitement précoce permet d’induire un contrôle virologique au long cours après arrêt de traitement. Nos résultats indiquent qu’un traitement plus long que deux ans permettrait de renforcer la diminution du réservoir. Ces résultats seront à prendre en compte pour l’élaboration de futurs essais en primo-infection visant à réduire le réservoir pour une rémission au long cours. / HIV primary infection is a critical period in the establishment of the reservoirs that justifies the initiation of an early treatment. We started a randomised trial to assess the impact of a two-year intense HAART (ANRS147 OPTIPRIM trial: five-drug therapy versus. three-drug therapy) on the blood reservoir; within this this trial, we included some pathophysiological studies. Thus, we show that during the primary infection, viruses have a low genetic diversity in blood and rectal compartments. The reservoir establishes itself as early as the first month of the infection by spreading a homogeneous viral cluster in CD4 T cells subsets, naive T cells (TN), central memories (TCM), transitional memories (TTM), effector memories (TEM), and resting T cells. This results in a disruption of the lymphocyte homeostasis, linked to the low contribution to the reservoir of TN and TCM, which are little differentiated cells with long half-lives. Moreover, we show that, at the time of the primary infection, the majority of patients do not have the ability to develop CD8 T cells responses that could suppress the viral replication, as HIV Controllers patients do. After two years of treatment, we observe that there is no evolution of the viral diversity, but the size of the reservoir is significantly reduced. The abnormalities of the CD4 T cells lymphocyte homeostasis remain, but the very early treatment was able to protect the TN and TCM. The five-drug therapy does not have any additional benefit, but we confirm the idea that early treatment can induce long-term virological control after the discontinuation of the treatment. Our results show that a treatment lasting more than two years would be able to reinforce the reduction of the reservoir. These results should be taken into account in the development of future trials aiming to reduce the reservoir in patients treated at the time of primary infection for a sustainable remission.