Thesis (M. Phil.)--University of Hong Kong, 1989.

published_or_final_version / Microbiology / Master / Master of Philosophy

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [85]-91).

Includes bibliographical references.

Justificativa â A pneumonia hospitalar (PH) à causa de morbidade e mortalidade elevadas em pacientes hospitalizados. A terapia antimicrobiana empÃrica adequada e precoce pode salvar a vida de mais da metade dos pacientes com PH e deve ser baseada em padrÃes locais de sensibilidade a antimicrobianos. Praticamente todo tratamento de PH Ã, inicialmente, empÃrico. O objetivo deste trabalho à contribuir com o conhecimento do padrÃo regional de resistÃncia de microrganismos nesse contexto. Metodologia â Foram estudados 588 resultados de culturas de lavado bronco-alveolar (LBA) de pacientes internados em Fortaleza, processados na rotina de um laboratÃrio privado, no perÃodo de janeiro de 1996 a dezembro de 2001. Como resultado de pesquisa aos prontuÃrios mÃdicos desses pacientes, dois grupos foram criados: Grupo 1, com n=147, composto por pacientes com pneumonia hospitalar (PH) notificada segundo os critÃrios do Center for Disease Control and Prevention (CDC); Grupo 2, com n=382, pacientes com pneumonia nÃo-hospitalar (PNH). Utilizou-se a tÃcnica quantitativa de cultivo descrita nos trabalhos de Kahn e Jones (1987), Salata et al. (1987) e Carvalho (1997). IdentificaÃÃo e antibiogramas foram realizados no equipamento VITEK BioMerrieux, exceto para Streptococcus pneumoniae e Stenotrophomonas maltophilia cujos antibiogramas foram realizados pelo mÃtodo Kirby-Bauer e E-test respectivamente. Resultados â No Grupo 1, os cinco microrganismos mais freqÃentes foram Pseudomonas aeruginosa [56 casos (38,1%)], Staphylococcus aureus [24 casos (16,3%)], Klebsiella pneumoniae [12 casos (8,2%)], Acinetobacter spp [12 casos (8,2%)] e Serratia marcescens [10 casos (6,8%)]. No Grupo 2, encontraram-se, mais freqÃentemente, Pseudomonas aeruginosa [113 casos (29,6%)], Staphylococcus aureus [89 casos (23,3%)], Klebsiella pneumoniae [32 casos (8,4%)] e Acinetobacter spp [31 casos (8,1%)]. NÃo foi observada diferenÃa significativa entre os dois grupos para a etiologia. O mesmo ocorreu com o perfil de resistÃncia dos organismos, exceto para o Grupo 1 com S. aureus/oxacilina (p=0,027) e P. aeruginosa/piperacilina/tazobactam (p=0,003). No perfil de resistÃncia do conjunto total de amostras (n=751), destaca-se a de P. aeruginosa ao imipenem, de 40,8%; de Acinetobacter spp ao imipenem, de 10,0%; de Acinetobacter spp a Ampicilina/Sulbactam, de 44,3%; e de S. aureus a oxacilina, de 67,3%. O intervalo de tempo entre a data de internaÃÃo e a realizaÃÃo da cultura foi maior do que 7 dias em 60,18% dos casos. ConclusÃo - no trato respiratÃrio, o problema da multiresistÃncia bacteriana à evidente e preocupante com alta prevalÃncia de bacilos gram-negativos multiresistentes, marcadamente P. aeruginosa e Acinetobacter spp., assim como elevada resistÃncia a oxacilina nas amostras de Staphylococcus aureus. O Grupo 2 nÃo possui caracterÃsticas de pneumonia comunitÃria (PC), provavelmente, porque o tempo entre a internaÃÃo e a realizaÃÃo da cultura foi longo o suficiente para permitir a colonizaÃÃo do trato respiratÃrio superior pela microflora do ambiente hospitalar. à possÃvel que o Grupo 2 seja constituÃdo por pacientes com pneumonia comunitÃria severa refratÃria à antibioticoterapia que necessita internaÃÃo, ou que tiveram vÃrias internaÃÃes anteriores, com conseqÃente colonizaÃÃo por microflora hospitalar. InvestigaÃÃes subseqÃentes devem conferir atenÃÃo especial a esse aspecto. Pode ser Ãtil, neste contexto, o emprego de tÃcnicas de Biologia Molecular para melhor caracterizaÃÃo dos microrganismos isolados / Hospital acquired pneumonia (HAP) is associated with high morbidity and mortality in hospitalized patients. Early, appropriate, and adequate empiric antibiotic therapy can save lives of more than half of all HAP patients and must be based on local data. This study will provide local patterns of antibiotic resistance. Practically all primary therapy of HAP is empiric and information from surveillance program of a given hospital is very important. We studied 588 Bronchoalveolar lavage cultures results from hospitalized patients performed in a private lab during a period of 6 years from 1996 to 2001. As a result of searching patientâs records, two groups were assigned: Group 1, n=147, patients with HAP notified by Nosocomial Infection Commission according to Center for Disease Control and Prevention-CDC; Group 2, n=382, patients with No-Nosocomial Pneumonia. Bacteriologic cultures were done quantitatively with a threshold of >= 105 according to Kahn and Jones (1987), Salataet al. (1987) and Carvalho (1997). Identification and susceptibility tests were performed on VITEK BioMerrieux except for Streptococcus pneumoniae and Stenotrophomonas maltophilia. In patients from Group 1, the five most frequent agents were: P. aeruginosa 56 cases (38,1%), S.aureus 24 (16,3%), K. pneumonia 12 (8,2%), Acinetobacter spp 12 (8,2%) and S. marcescens 10 (6,8%). Group 2 shows: P. aeruginosa 113 (29,6%), Staphylococcus aureus 89 (23,3%), Klebsiella pneumoniae 32 (8,4%), Acinetobacter spp 31 (8,1%) and Candida spp 20 (5,2%). There was no significant difference between resistance profile of isolates when distributed in two groups except S. aureus/Oxacilina (p=0,027), P.aeruginosa/Piperacilina/Tazobactam (p=0,003). The resistance profile in total (n=751) was: P. aeruginosa/Imipenem 40,8%, Acinetobacter spp/Imipenem 10,0%, Acinetobacter spp/AmpicilinaSulbactam 44,3% e S. aureus/Oxacilina 67,3%. The time between admission date and culture request was more than 7days in 60,18% in both groups. Conclusion: a) drug-resistance in lower respiratory tract infection(LRTI) is a serious concern mainly with high prevalence of multi-R gram-negative like P. aeruginosa and Acinetobacter with high resistance for Imipenem and other β- IactÃmic and S. aureus with high resistance to Oxacilina. There was no significant difference between the two groups. Group 2 did not show characteristics of Community-Acquired Pneumoniae (CAP) maybe because of large intervals of time between admission and request of culture, or this kind of patient had either severe CAP with no response to prior multiple antimicrobial therapy or previous hospitalizations or even had recent hospitalization and consequent colonization. Forwards molecular studies should be performed on isolates to provide better characterization of lower respiratory tract pathogens.

The synchronization of flight mechanics with respiration and echolocation call emission by bats, while economizing these behaviors, presumably puts compressive loads on the cartilaginous rings that hold open the respiratory tract. Previous work has shown that during postnatal development of Artibeus jamaicensis (Phyllostomidae), the onset of adult echolocation call emission rate coincides with calcification of the larynx, and the development of flight coincides with tracheal ring calcification. In the present study, I assessed the level of reinforcement of the respiratory system in 13 bat species representing six families that use stereotypical modes of echolocation (i.e. duty cycle % and intensity). Using computed tomography, the degree of mineralization or ossification of the tracheal rings, cricoid, thyroid and arytenoid cartilages were determined for non-echolocators, tongue clicking, low-duty cycle low-intensity, low-duty cycle high-intensity, and high-duty cycle high-intensity echolocating bats. While all bats had evidence of cervical tracheal ring mineralization, about half the species had evidence of thoracic tracheal ring calcification. Larger bats (Phyllostomus hastatus and Pterpodidae sp.) exhibited more extensive tracheal ring mineralization, suggesting an underlying cause independent of laryngeal echolocation. Within most of the laryngeally echolocating species, the degree of mineralization or ossification of the larynx was dependent on the mode of echolocation system used. Low-duty cycle low-intensity bats had extensively mineralized cricoids, and zero to very minor mineralization of the thyroids and arytenoids. Low-duty cycle high-intensity bats had extensively mineralized cricoids, and patches of thyroid and arytenoid mineralization. The high-duty cycle high-intensity rhinolophids and hipposiderid had extensively ossified cricoids, large patches of ossification on the thyroids, and heavily ossified arytenoids. The high-duty cycle high-intensity echolocator, Pteronotus parnellii, had mineralization patterns and laryngeal morphology very similar to the other low-duty cycle high-intensity mormoopid species, perhaps suggesting relatively recent evolution of high-duty cycle echolocation in P. parnellii compared with the Old World high-duty cycle echolocators (Rhinolophidae and Hipposideridae). All laryngeal echolocators exhibited mineralized or ossified lateral expansions of the cricoid for articulation with the inferior horn of the thyroid, these were most prominent in the high-duty cycle high-intensity rhinolophids and hipposiderid, and least prominent in the low-duty cycle low-intensity echolocators. The non-laryngeal echolocators had extensively ossified cricoid and thyroid cartilages, and no evidence of mineralization/ossification of the arytenoids or lateral expansions of the cricoid. While the non-echolocators had extensive ossification of the larynx, it was inconsistent with that seen in the laryngeal echolocators.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2001. / Typescript. Bibliography: leaves 146-155.