La pneumonie est la première cause de mortalité chez l'enfant dans le monde. Elle peut être provoquée par un certain nombre d'agents pathogènes connus mais 15 à 35% des pneumonies de l'enfant restent encore non renseignées d'un point de vue étiologique. L'utilisation d'un test moléculaire de découverte de nouveaux pathogènes nous a permis de découvrir de nouvelles espèces de Torque Teno Mini Virus (TTMV, Anelloviridae), nommées TTMV-LY, dans trois épanchements pleuraux provenant d'enfants hospitalisés avec une pleuro-pneumopathie, dont l'étiologie demeurait inconnue. Les TTMV sont des virus ubiquitaires dont l'implication dans une pathologie reste à déterminer. Les voies respiratoires ayant précédemment été décrites pour être un site d'infection des anellovirus, nous avons entrepris de caractériser ces nouveaux virus, ainsi que d'étudier leur potentiel rôle dans la pathogénèse.Les génomes complets de TTMV-LY ont été isolés, caractérisés puis répliqués in vitro. La réponse des cellules épithéliales alvéolaires, ainsi que des cellules présentatrices d'antigènes (CPA), impliquées dans l'inflammation, a été étudiée après infection par les virions néo-synthétisés.Ces travaux ont démontré que : i) les TTMV-LY peuvent coloniser les poumons en profondeur, ii) les cellules pulmonaires sont permissives aux TTMV-LY et permettent une réplication virale efficace, iii) l'infection virale module les réponses cellulaires et immunitaires des cellules pulmonaires en induisant des dérégulations de l'expression génique et la production de médiateurs inflammatoires, iv) les TTMV-LY seraient capables d'interagir avec les CPA et de réguler ainsi différentiellement le processus inflammatoire.L'ensemble de ces résultats ont permis de mettre en évidence une implication potentielle des TTMV-LY dans la pathogénèse des pneumopathies, et souligné la complexité des mécanismes biologiques mis en jeu lors de l'infection par les virus de cette famille.

En démontrant sa capacité d’identifier les pneumothorax, de différencier les différentes causes d’insuffisance respiratoire chez les patients dyspnéiques et de confirmer la position d’un tube endotrachéal lors d’une intubation endotrachéale, l’échographie pulmonaire a pris une place prépondérante dans la prise en charge des patients de soins critiques. La majorité des études, notamment celles sur l’intubation endotrachéale, ont évalué la performance de cliniciens possédant une expérience considérable en échographie pulmonaire et souvent dans un cadre idéal permettant des examens d’une durée prolongée. Considérant la disponibilité grandissante de l’échographie ciblée lors des situations de stabilisation et de réanimation des patients de soins critiques, nous voulions évaluer la capacité d’un groupe de clinicien hétérogène en termes de formation échographique à identifier la présence ou l’absence de glissement pleural sur de courtes séquences (comparable à la durée probable d’un examen lors de condition de réanimation) d’échographie pulmonaire enregistrées chez des patients intubés. Un total de 280 courtes séquences (entre 4 et 7 secondes) d’échographie pulmonaire démontrant la présence ou l’absence de glissement pleural chez des patients intubés en salle d’opération ont été enregistrées puis présentées de façon aléatoire à deux groupes de cliniciens en médecine d’urgence. Le deuxième groupe avait la possibilité de s’abstenir advenant une incertitude de leur réponse. Nous avons comparé la performance selon le niveau de formation académique et échographique. Le taux moyen d’identification adéquate de la présence ou l’absence du glissement pleural par participant était de 67,5% (IC 95% : 65,7-69,4) dans le premier groupe et 73,1% (IC 95% : 70,7-75,5) dans le second (p<0,001). Le taux médian de réponse adéquate pour chacune des 280 séquences était de 74,0% (EIQ : 48,0-90,0) dans le premier groupe et 83,7% (EIQ : 53,3-96,2) dans le deuxième (p=0,006). Le taux d’identification adéquate de la présence ou absence d’un glissement pleural par les participants des deux groupes était nettement supérieur pour les séquences de l’hémithorax droit par rapport à celles de l’hémithorax gauche (p=0,001). Lorsque des médecins de formation académique et échographique variable utilisent de courtes séquences d’échographie pulmonaire (plus représentatives de l’utilisation réelle en clinique), le taux d’identification adéquate de la présence ou l’absence de glissement pleural est plus élevé lorsque les participants ont la possibilité de s’abstenir en cas de doute quant à leur réponse. Le taux de bonnes réponses est également plus élevé pour les séquences de l’hémithorax droit, probablement dû à la présence sous-jacente du cœur à gauche, la plus petite taille du poumon gauche et l’effet accru du pouls pulmonaire dans l’hémithorax gauche. Considérant ces trouvailles, la prudence est de mise lors de l’utilisation de l’identification du glissement pleural sur de courtes séquences échographique comme méthode de vérification de la position d’un tube endotrachéal lors d’une intubation endotrachéale, et ce, particulièrement pour l’hémithorax gauche. Aussi, une attention particulière devrait être mise sur la reconnaissance du pouls pulmonaire lors de l’enseignement de l’échographie pulmonaire. / The field of targeted lung ultrasound in critical care is in constant expansion. Its many proven use include pneumothorax diagnosis, differentiation of the different causes of acute dyspnoea and endotracheal intubation confirmation. These studies on endotracheal intubation evaluated sonographers with extensive ultrasound training using sometimes lengthy exam. Hence, with the growing presence of bedside lung ultrasound we devised a study to evaluate the capacity of a heterogeneous group of physicians, with different levels of ultrasound training, to correctly identify lung sliding on random short sequences of recorded thoracic ultrasound. 280 short ultrasound sequences (4 to 7 seconds) of present and absent lung sliding of intubated patients recorded in the operating room were randomly presented to 2 groups of physicians. Descriptive data, mean accuracy of each participant, as well as the rate of correct answers for each of the sequences was measured and compared for different subgroups. Participants in the second group where instructed that they could abstain from answering in uncertain cases. Mean accuracy was 67.5% (95%CI: 65.7-69.4) in the first group and 73.1% (95%CI: 70.7-75.5) in the second (p<0.001). When considering each sequence individually, median accuracy was 74.0% (IQR: 48.0-90.0) in the first group and 83.7% (IQR: 53.3-96.2) in the second (p=0.006). The rate of correct answer was higher for right hemithorax sequences (p=0.001). Accuracy in lung sliding identification is better when participants have the possibility to abstain themselves from answering in uncertain cases. It is also improved in the right hemithorax, probably owing to the presence of the heart and the lung pulse artefact in the left hemithorax. Considering our results, caution should be taken when using short ultrasound sequences for identifying lung sliding as a mean of confirming endotracheal intubation, particularly in the left hemithorax. Emphasis should also be put on knowledge and identification of the Lung pulse artefact when teaching chest ultrasound curriculum.

Interpretation of Common Used Tumor Markers Affected by Systemic and Inflammatory Diseases Introduction: An examination of tumor markers is often made as a basis for the successful diagnosis and follow-up treatment of patients with malignant tumors. However, are tumor markers truly significant by themselves, or are they just a baseline quantitative expression of value that we use to diagnose a patient as better or worse based on it increasing or decreasing value? Objective: This paper attempts to answer the question of what factors can affect serum protein and mucin markers and thus lead to a misinterpretation of their results. Methods: Tumor markers were determined by isotopic and non-isotopic laboratory analysis methods, using operational protocols of the immunoanalytic laboratory. All methods were checked using internal quality control, and four times a year using an external quality control. Additionally, 16 236 samples were analysed using 3180 probands during the period 2008-2014. Results: We discovered that in premenopausal women, the markers AFP, CA 125 and HE 4 rise during ovulation peak periods while other markers changed minimally or not at all. However, in postmenopausal women, we proved the incidence of a false positivity marker. With women in the 1st and 2nd trimester of pregnancy, the...

En démontrant sa capacité d’identifier les pneumothorax, de différencier les différentes causes d’insuffisance respiratoire chez les patients dyspnéiques et de confirmer la position d’un tube endotrachéal lors d’une intubation endotrachéale, l’échographie pulmonaire a pris une place prépondérante dans la prise en charge des patients de soins critiques. La majorité des études, notamment celles sur l’intubation endotrachéale, ont évalué la performance de cliniciens possédant une expérience considérable en échographie pulmonaire et souvent dans un cadre idéal permettant des examens d’une durée prolongée. Considérant la disponibilité grandissante de l’échographie ciblée lors des situations de stabilisation et de réanimation des patients de soins critiques, nous voulions évaluer la capacité d’un groupe de clinicien hétérogène en termes de formation échographique à identifier la présence ou l’absence de glissement pleural sur de courtes séquences (comparable à la durée probable d’un examen lors de condition de réanimation) d’échographie pulmonaire enregistrées chez des patients intubés. Un total de 280 courtes séquences (entre 4 et 7 secondes) d’échographie pulmonaire démontrant la présence ou l’absence de glissement pleural chez des patients intubés en salle d’opération ont été enregistrées puis présentées de façon aléatoire à deux groupes de cliniciens en médecine d’urgence. Le deuxième groupe avait la possibilité de s’abstenir advenant une incertitude de leur réponse. Nous avons comparé la performance selon le niveau de formation académique et échographique. Le taux moyen d’identification adéquate de la présence ou l’absence du glissement pleural par participant était de 67,5% (IC 95% : 65,7-69,4) dans le premier groupe et 73,1% (IC 95% : 70,7-75,5) dans le second (p<0,001). Le taux médian de réponse adéquate pour chacune des 280 séquences était de 74,0% (EIQ : 48,0-90,0) dans le premier groupe et 83,7% (EIQ : 53,3-96,2) dans le deuxième (p=0,006). Le taux d’identification adéquate de la présence ou absence d’un glissement pleural par les participants des deux groupes était nettement supérieur pour les séquences de l’hémithorax droit par rapport à celles de l’hémithorax gauche (p=0,001). Lorsque des médecins de formation académique et échographique variable utilisent de courtes séquences d’échographie pulmonaire (plus représentatives de l’utilisation réelle en clinique), le taux d’identification adéquate de la présence ou l’absence de glissement pleural est plus élevé lorsque les participants ont la possibilité de s’abstenir en cas de doute quant à leur réponse. Le taux de bonnes réponses est également plus élevé pour les séquences de l’hémithorax droit, probablement dû à la présence sous-jacente du cœur à gauche, la plus petite taille du poumon gauche et l’effet accru du pouls pulmonaire dans l’hémithorax gauche. Considérant ces trouvailles, la prudence est de mise lors de l’utilisation de l’identification du glissement pleural sur de courtes séquences échographique comme méthode de vérification de la position d’un tube endotrachéal lors d’une intubation endotrachéale, et ce, particulièrement pour l’hémithorax gauche. Aussi, une attention particulière devrait être mise sur la reconnaissance du pouls pulmonaire lors de l’enseignement de l’échographie pulmonaire. / The field of targeted lung ultrasound in critical care is in constant expansion. Its many proven use include pneumothorax diagnosis, differentiation of the different causes of acute dyspnoea and endotracheal intubation confirmation. These studies on endotracheal intubation evaluated sonographers with extensive ultrasound training using sometimes lengthy exam. Hence, with the growing presence of bedside lung ultrasound we devised a study to evaluate the capacity of a heterogeneous group of physicians, with different levels of ultrasound training, to correctly identify lung sliding on random short sequences of recorded thoracic ultrasound. 280 short ultrasound sequences (4 to 7 seconds) of present and absent lung sliding of intubated patients recorded in the operating room were randomly presented to 2 groups of physicians. Descriptive data, mean accuracy of each participant, as well as the rate of correct answers for each of the sequences was measured and compared for different subgroups. Participants in the second group where instructed that they could abstain from answering in uncertain cases. Mean accuracy was 67.5% (95%CI: 65.7-69.4) in the first group and 73.1% (95%CI: 70.7-75.5) in the second (p<0.001). When considering each sequence individually, median accuracy was 74.0% (IQR: 48.0-90.0) in the first group and 83.7% (IQR: 53.3-96.2) in the second (p=0.006). The rate of correct answer was higher for right hemithorax sequences (p=0.001). Accuracy in lung sliding identification is better when participants have the possibility to abstain themselves from answering in uncertain cases. It is also improved in the right hemithorax, probably owing to the presence of the heart and the lung pulse artefact in the left hemithorax. Considering our results, caution should be taken when using short ultrasound sequences for identifying lung sliding as a mean of confirming endotracheal intubation, particularly in the left hemithorax. Emphasis should also be put on knowledge and identification of the Lung pulse artefact when teaching chest ultrasound curriculum.

Interpretation of Common Used Tumor Markers Affected by Systemic and Inflammatory Diseases Introduction: An examination of tumor markers is often made as a basis for the successful diagnosis and follow-up treatment of patients with malignant tumors. However, are tumor markers truly significant by themselves, or are they just a baseline quantitative expression of value that we use to diagnose a patient as better or worse based on it increasing or decreasing value? Objective: This paper attempts to answer the question of what factors can affect serum protein and mucin markers and thus lead to a misinterpretation of their results. Methods: Tumor markers were determined by isotopic and non-isotopic laboratory analysis methods, using operational protocols of the immunoanalytic laboratory. All methods were checked using internal quality control, and four times a year using an external quality control. Additionally, 16 236 samples were analysed using 3180 probands during the period 2008-2014. Results: We discovered that in premenopausal women, the markers AFP, CA 125 and HE 4 rise during ovulation peak periods while other markers changed minimally or not at all. However, in postmenopausal women, we proved the incidence of a false positivity marker. With women in the 1st and 2nd trimester of pregnancy, the...

L'association entre le tabac et le cancer du poumon ou entre l'exposition professionnelle à l'amiante et le mésothéliome pleural ont largement été étudiées. Cependant, comme pour de nombreuses autres relations expositions prolongées-cancer, le rôle de l'intensité d'exposition tout au long de la vie a été peu étudié. La prise en compte de la variation de l'intensité au cours de la vie et de son effet dépendant du temps dans les analyses statistiques des données cas-témoins pose en effet quelques défis méthodologiques. Les objectifs de la thèse étaient 1) d'étudier l'effet dépendant du temps de l'intensité d'exposition au cours de la vie sur le risque de cancer et 2) d'identifier les profils de trajectoires d'intensité d'exposition sur la vie entière et comparer les risques de cancer associés. Pour répondre à ces deux objectifs, nous avons utilisé un indice cumulé d'exposition pondéré flexible déjà existant et nous avons développé un nouveau modèle conjoint à classes latentes, pour analyser les données de deux études cas-témoins françaises sur le mésothéliome pleural et le cancer du poumon. Les résultats montrent la contribution importante de l'intensité de la consommation de tabac récente pour le cancer du poumon et des expositions professionnelles anciennes à l'amiante pour les deux cancers. Ils confirment l'importance de considérer l'aspect temporel des expositions pour évaluer l'association avec le risque de cancer et illustrent l'intérêt des approches statistiques considérées. / The association between smoking and lung cancer or between occupational exposure to asbestos and pleural mesothelioma have been extensively investigated. Nevertheless, as for many protracted exposures-cancer relationships, the role of exposure intensity over lifetime has been rarely addressed. Accounting for individual variation of intensity over lifetime and investigating time-dependent effect in the statistical analysis of case-control data indeed raise several methodological issues. The thesis objectives were 1) to study the time-dependent effect of exposure intensity over lifetime on the risk of cancer and 2) to identify lifetime profiles of exposure intensities and to compare their associated risks of cancer. To address these objectives, we used an existing flexible weighted cumulative index of exposure and we developed a new joint latent class mixed model, to analyze the data from two French case-control studies on lung cancer and pleural mesothelioma. The results show the important contribution of recent smoking intensity for lung cancer and distant intensity of exposure to asbestos for both cancers. They confirm the importance of the timing of exposure in the association with the risk of cancer and illustrate the relevance of the proposed statistical approaches.

La pneumonie est la première cause de mortalité chez l’enfant dans le monde. Elle peut être provoquée par un certain nombre d’agents pathogènes connus mais 15 à 35% des pneumonies de l’enfant restent encore non renseignées d’un point de vue étiologique. L’utilisation d’un test moléculaire de découverte de nouveaux pathogènes nous a permis de découvrir de nouvelles espèces de Torque Teno Mini Virus (TTMV, Anelloviridae), nommées TTMV-LY, dans trois épanchements pleuraux provenant d’enfants hospitalisés avec une pleuro-pneumopathie, dont l’étiologie demeurait inconnue. Les TTMV sont des virus ubiquitaires dont l’implication dans une pathologie reste à déterminer. Les voies respiratoires ayant précédemment été décrites pour être un site d'infection des anellovirus, nous avons entrepris de caractériser ces nouveaux virus, ainsi que d’étudier leur potentiel rôle dans la pathogénèse.Les génomes complets de TTMV-LY ont été isolés, caractérisés puis répliqués in vitro. La réponse des cellules épithéliales alvéolaires, ainsi que des cellules présentatrices d’antigènes (CPA), impliquées dans l’inflammation, a été étudiée après infection par les virions néo-synthétisés.Ces travaux ont démontré que : i) les TTMV-LY peuvent coloniser les poumons en profondeur, ii) les cellules pulmonaires sont permissives aux TTMV-LY et permettent une réplication virale efficace, iii) l’infection virale module les réponses cellulaires et immunitaires des cellules pulmonaires en induisant des dérégulations de l’expression génique et la production de médiateurs inflammatoires, iv) les TTMV-LY seraient capables d’interagir avec les CPA et de réguler ainsi différentiellement le processus inflammatoire.L’ensemble de ces résultats ont permis de mettre en évidence une implication potentielle des TTMV-LY dans la pathogénèse des pneumopathies, et souligné la complexité des mécanismes biologiques mis en jeu lors de l’infection par les virus de cette famille. / Pneumonia is the leading cause of death in children worldwide. It can be caused by a number of known pathogens, but 15-35% of childhood pneumonia are still not associated with an etiologic agent. A pathogen discovery assay allowed us to identify new species of Torque Teno Mini Virus (TTMV, Anelloviridae), named TTMV-LY, in three undiagnosed pleural effusions from children hospitalized with parapneumonic empyema. TTMV are ubiquitous orphan viruses, and their involvement in pathogenesis remains unknown. The respiratory tract was previously described to be a site of anellovirus detection. We investigated the role of these new species in the pathogenesis of severe pneumonia.Full-length TTMV-LY genomes were isolated and in vitro replicated. The response of alveolar epithelial cells, and antigen presenting cells (APC), both involved in the inflammation process, was studied after infection with neo-synthesized virions.This study showed for the first time that: i) TTMV-LY can deeply colonize lungs, ii) alveolar epithelial cells are permissive to the TTMV-LY and allow an efficient replication, iii) viral infection modulates cellular and innate immune responses of alveolar epithelial cells, by inducing gene expression deregulations and inflammatory mediators production, iv) TTMV-LY are able to interact with APC and thereby regulate differentially their inflammatory process.All these results allowed to highlight a potential involvement of TTMV-LY in the pathogenesis of severe pneumonia and brought out the complexity of the biological mechanisms taking place during infection by viruses of this family.

Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2013-05-22T19:22:37Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_EstudoClinicoMorfologico.pdf: 2306884 bytes, checksum: 3364fe4e2c0a741056dfa4ce9d06de23 (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2013-05-27T13:57:37Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_EstudoClinicoMorfologico.pdf: 2306884 bytes, checksum: 3364fe4e2c0a741056dfa4ce9d06de23 (MD5) / Made available in DSpace on 2013-05-27T13:57:37Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_EstudoClinicoMorfologico.pdf: 2306884 bytes, checksum: 3364fe4e2c0a741056dfa4ce9d06de23 (MD5) Previous issue date: 2011 / A dificuldade no diagnóstico definitivo da tuberculose extrapulmonar persiste principalmente devido a baixa resolutividade dos métodos convencionais disponíveis para a detecção do Mycobacterium tuberculosis. Esse estudo teve como objetivos avaliar a contribuição da técnica imuno-histoquímica (IHQ) para a detecção de Mycobacterium spp. em casos de tuberculose pleural e ganglionar com histoquímica negativa, assim como, investigar alguns aspectos clínicos, laboratoriais e morfológicos da doença. Para obtenção desta amostra fez-se a busca dos casos no Núcleo de Vigilância Epidemiológica (NVE) e Divisão de Arquivo Médico e Estatística (DAME) do Hospital Universitário João de Barros Barreto (HUJBB) e no Departamento de Anatomia Patológica da Universidade Federal do Pará (UFPA), selecionando-se aqueles que haviam realizado exame histopatológico para esclarecimento diagnóstico do caso. Foram incluídos 50 pacientes, sendo 25 com diagnóstico presuntivo de tuberculose pleural e 25 de tuberculose ganglionar. Para obtenção dos dados clínicos e laboratoriais os respectivos prontuários foram revisados, e para confirmação dos aspectos morfológicos foi realizada a revisão de todas as lâminas selecionadas. Posteriormente, cada amostra foi submetida à técnica IHQ com anticorpo polyclonal Mycobacterium bovis BCG. Encontrou-se no grupo investigado, maior frequência do sexo masculino, cuja média de idade foi de 33,8 anos (desvio padrão: 14,1) sendo a maioria procedente da cidade de Belém-Pará e com nível de escolaridade de sete ou menos anos de estudo. Os sintomas constitucionais mais frequentes em todo o grupo foram a febre e perda ponderal. Nos pacientes com tuberculose pleural, os sintomas específicos mais encontrados foram tosse, dor torácica e dispneia, e naqueles com a forma ganglionar da doença, o envolvimento da cadeia cervical isolada foi mais frequente. Infecção pelo vírus da imunodeficiência humana (HIV) ou Síndrome da Imunodeficiência Adquirida (Sida) e etilismo foram as condições de risco mais frequentemente associadas. Na tuberculose pleural, 20% dos casos cursaram com derrame pleural associado à lesão parenquimatosa, e em 60% o líquido pleural foi do tipo exsudativo. Enquanto, na forma ganglionar, em 50% dos casos evidenciou-se lesão parenquimatosa à radiografia do tórax. Neste estudo, foi inexpressiva a quantidade de participantes nos quais foi realizada a pesquisa direta e cultura para bacilo álcool - ácido resistente (BAAR) nos diversos espécimes clínicos analisados (líquido pleural, tecido pleural e ganglionar, escarro e lavado broncoalveolar) O padrão morfológico predominante em ambas as formas da doença foi o granuloma tipo tuberculoide com necrose caseosa, independente do status sorológico para o HIV. A técnica IHQ contribuiu para o diagnóstico de tuberculose pleural em 21% (4/19) das amostras de tecido pleural e em 37,5% (9/24) de tecido ganglionar. Um resultado imuno-histoquímico positivo define o diagnóstico de micobacteriose, e quando associado aos achados clínicos, laboratoriais e morfológicos torna-se uma ferramenta de grande utilidade para melhorar o diagnóstico da tuberculose extrapulmonar. / The difficulty in definitive diagnosis of extra-pulmonary tuberculosis persists, mainly due to poor solutions available from conventional methods for detection of Mycobacterium tuberculosis. This study aimed to evaluate the contribution of immunohistochemical (IHC) for detection of Mycobacterium spp, in cases of pleural and lymph node tuberculosis with negative staining, as well as investigate some clinical, laboratory and morphological aspects of the disease. To obtain this sample was made in the pursuit of cases through surveillance (NVE) and Division of Medical Archives and Statistics (DAME), University Hospital João de Barros Barreto (HUJBB) and the Department of Pathology, University of Pará (UFPA), selecting those who had performed the histopathological examination for diagnosis of the case. Fifty patients were included, twenty-five with presumptive diagnosis of pleural tuberculosis and twenty-five of lymph node tuberculosis. To obtain the clinical and laboratory data were reviewed their medical records, and to confirm the morphological aspects review was performed of all selected slides. Thereafter, each sample was subjected to IHC with polyclonal Mycobacterium bovis BCG. It was found in the investigated group, more often male, whose average age was 33.8 years (SD: 14.1) with the majority coming from the city of Belem, Pará and education level of seven or fewer years of schooling. Constitutional symptoms more frequent in the whole group were fever and weight loss. In patients with pleural tuberculosis, the most frequent specific symptoms were cough, chest pain and dyspnea, and in those with lymph node involvement of the cervical alone was more frequent. Infection with human immunodeficiency virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) and alcohol consumption were the risk conditions most frequently associated. In pleural tuberculosis, 20% of cases presenting with pleural effusion associated with parenchymal injury, and 60% of the pleural fluid was exudate type. While in the lymph nodes in 50% of the cases revealed a parenchymal lesion on chest. This study was marginal participants in the amount of which has been held to direct research and culture for bacillus acid – resistant (AFB) in various clinical specimens analyzed (pleural fluid, pleural tissue and lymph node, sputum, and broncho-alveolar lavage). The predominant morphological pattern in both forms of the disease was tuberculous granulomas with caseous necrosis, regardless of serologic status for HIV. The IHC technique contributed to the diagnosis of pleural tuberculosis in 21% (4/19) samples of pleural tissue and 37.5% (9/24) of lymph node tissue. A positive immunohistochemical result defines the diagnosis of mycobacterial disease, and when associated with clinical, laboratory and morphological finds become a valuable tool to improve the diagnosis of extra-pulmonary tuberculosis.

Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2013-05-27T22:30:52Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_DerramePleuralParapneumonico.pdf: 1292379 bytes, checksum: 8a3f8707228342fb38225abdd021a07b (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2013-05-29T17:00:59Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_DerramePleuralParapneumonico.pdf: 1292379 bytes, checksum: 8a3f8707228342fb38225abdd021a07b (MD5) / Made available in DSpace on 2013-05-29T17:00:59Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_DerramePleuralParapneumonico.pdf: 1292379 bytes, checksum: 8a3f8707228342fb38225abdd021a07b (MD5) Previous issue date: 2012 / Introdução: A pneumonia é uma das infecções mais comuns em crianças, sendo o derrame pleural uma complicação potencial, principalmente nos países em desenvolvimento, onde existem sérias limitações de recursos diagnóstico-terapêuticos. Objetivos: Conhecer o perfil das crianças portadoras de derrame pleural parapneumônico, analisando sua evolução a partir da terapêutica clínica e cirúrgica que são submetidas. Método: Estudo descritivo, transversal, de coleta prospectiva, no qual foram estudadas todas as crianças internadas em um hospital de referência de doenças infecciosas na Região Norte-Brasil com diagnóstico de derrame pleural parapneumônico, submetidas a procedimento cirúrgico para abordagem do mesmo, no período de outubro de 2010 a outubro de 2011. Resultados: A amostra foi composta por 46 crianças, com distribuição igual entre os sexos, predominância de menores de 3 anos (74%) e procedentes do interior do estado (54,3%). Parcela considerável (28%) possuía algum grau de inadequação do estado nutricional. A média de tempo de doença até à admissão na referida instituição foi de 16,9 dias, e todos os indivíduos eram provenientes de outro hospital. A duração média da internação hospitalar foi de 26,0 dias, e a do estado febril, de 9,8 dias. Foram utilizados 2,2 esquemas antimicrobianos, em média, por paciente e o Ceftriaxone foi o antibiótico mais comum. Diagnóstico etiológico só foi alcançado em um único caso. Em 22 crianças, (47,8%), havia empiema pleural, e elas apresentaram maior tempo de drenagem. Foi encontrada associação entre crianças com nanismo e cirurgias múltiplas (Teste G = 8,40; p= 0,040). A grande maioria das criança foi operada uma única vez (80,4%), e a drenagem torácica fechada foi a cirurgia mais realizada. A drenagem torácica aberta foi instalada em 24,0% dos pacientes. A toracotomia com descorticação foi realizada em 2 pacientes (4,0%). Todas as crianças da amostra obtiveram recuperação clínica e radiológica em até quatro meses após a alta hospitalar, e não houve óbito na amostra. Conclusão: A população estudada possui doença em estágio avançado e distúrbios nutricionais prevalentes, que podem influenciar na evolução. É necessária padronização da antibioticoterapia, e reconsiderar a drenagem torácica aberta no empiema pleural, a partir de novos estudos sobre o tema, principalmente na indisponibilidade da videotoracoscopia. / Introduction: Pneumonia is one of the most common diseases in children, and pleural effusion is a potential complication, especially in developing countries, where there are limitations in diagnostic and therapeutic resources. Objectives: The aim of this study is to know the profile of the children presenting pleural effusions complicating pneumonia analyzing their evolution regarding the clinical and surgical treatment instituted. Methods: A descriptive, transversal, prospective survey, which studied all children admitted in a Brazilian hospital which is reference in infectious diseases with diagnosis of parapneumonic effusion, submitted to surgery because of this complication, in the period between October of 2010 and October of 2011. Results: The sample was composed by 46 children, mostly younger than 3 years old (74%). A significant part of the sample (28%) had some nutritional inadequacy. The mean of disease duration until the ingress was 16,9 days, the whole sample came from other hospitals. The means of duration of hospital length and febrile state were, 26,0 and 9,8 days, respectively. It was used a media of 2,2 antibiotic schemes, and Ceftriaxone was the most drug most used. Etiological diagnosis was achieved in one single case. In 22 patients, (47,8%), it was observed empyema pleural, and they had a longer drainage duration. It was attested association between stunting and multiple surgeries (G Test = 8,40; p = 0,040). The majority of the children (80,4%) was submitted to surgery just once. The closed thoracic drainage was the most common surgery (85%). The open thoracocentesis was used in 24,0% of the children. The thoracotomy was performed in 2 patients (4,0%). All patients were clinical and radiological reestablished within 4 months after the hospital discharge, and there were not deceases in this sample. Conclusion: the sample studied has advanced disease and common nutritional disturbs, which may influence in surgical evolution. It is necessary antibiotic therapy standardization. Pleurostomy is still a valid option, and new studies are demanded in order to reconsider it, mainly in centers where videothoracoscopy is unavailable.

Philosophiae Doctor - PhD / Tuberculosis (TB) is an infectious disease that, despite all efforts devoted towards its eradication, remains a threat to many countries including South Africa. Current diagnostic assays do offer better performance than the conventional sputum smear microscopy and tuberculin skin tests. However, these assays have been proven to be affected by various factors including the condition of an individual's immune system and vaccination history. By far, electrochemical biosensors are amongst the currently investigated techniques to address the shortcomings associated with these diagnostics. / 2020-08-31